We carried out an unannounced inspection of Courtlands on 20 August 2018. Courtlands is a care home which provides care and support for up to 35 predominantly older people. At the time of this inspection there were 31 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is on two floors with access to the upper floor via stairs or a passenger lift. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas included two lounges, an open plan dining room with an adjoining conservatory. The service is situated in its own grounds with a large side garden area. However, as most people were living with dementia, they required support to access this due to its proximity to a main road. There was a separate administration building at the rear of the service.

The service is required to have a registered manager and at the time of our inspection a registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they were happy with the care they received and believed it was a safe environment. The atmosphere was calm and relaxed. People moved around the building choosing where to spend their time and who with. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner.

People’s risks were being managed effectively to ensure they were safe. Records showed where changes in people’s level of risk were. Care plans had been updated so staff knew how to manage those risks.

People received their medicines as prescribed. Systems and processes relating to the administration and storage of medicines helped ensure medicines were managed safely.

Care plans contained information about the person and what their individual needs were and how they would be met. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff responsible for people’s care.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse. Formal systems for supporting care staff were in place.

The premises were arranged to meet people’s needs. People had access to quiet areas or could socialize with others in a sun lounge or the other two lounges.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

There was a variety of home cooked meals on offer and people told us they enjoyed their meals. When necessary food and fluid records were kept to help ensure people received enough to eat and drink.

Management and staff had a good understanding of the underlying principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

The provider had systems in place to monitor the quality and safety of the service.

Courtlands Care Home is a care home which provides accommodation for up to 35 older people who require personal care. At the time of the inspection 33 people were using the service. Some of the people who lived at Courtlands Care Home needed care and support due to dementia, mental health needs sensory and /or physical disabilities.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

We inspected Courtlands Care Home on 23 and 24 February 2016. The inspection was unannounced. The service was last inspected in May 2014 when it was found to be meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. People told us, “It is very good, a very high standard,” and “I am very fond of the place…I like it here” A health professional told us “It is very good, I come here regularly, it is probably the best home we go to. A member of staff told us “I am very proud to work here.”

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to a good standard, and staff received updates about important skills such as moving and handling at regular intervals. Staff also received training about the needs of people with dementia.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included two written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals.

There were enough staff on duty and people said they received timely support from staff when it was needed. People said call bells were answered promptly and we observed staff being attentive to people’s needs.

The service had a programme of organised activities. These activities included musicians, group activities such as flower arranging, gentle ‘sports’ activities and arts and crafts. Some external entertainers such as musicians and singers visited. The service had two small vehicles to enable people to go out on occasions. The service had introduced an additional afternoon / evening shift, each day, to enable more individual activities with people.

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with the Mental Capacity Act 2005 legislation and guidance.

People were happy with their meals. Everyone said they always had enough to eat and drink. Comments received about the meals included, ”There is lots of choice. I never feel hungry”and “Food is good .” People said they received enough support when they needed help with eating or drinking.

People said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint. A relative told us, “They are very proactive in managing any difficulties as they arise through discussion and appropriate action if required.”

People felt the service was well managed. We were told “(The service) is improving with the new management.

This inspection was carried by one inspector over two days. During the inspection, the inspector worked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, we judged the service was safe.

People told us they felt safe and secure. The people we spoke with were positive about the staff who worked with them. People told us staff were caring and supportive. For example, one person said “The staff are very kind and considerate…I think it is wonderful how they look after us.”

The staff that we spoke with said they had confidence in colleagues’ practices. Staff told us if they had any concerns about how people who used the service were cared for the registered persons would take their concerns seriously. For example, we were told “Everyone in the team is a good carer. The management would take it very seriously if any of us raised a concern about any of the team.”

We saw that the home was well designed and maintained. Decorations and furnishings were well maintained and comfortable. Equipment was well maintained and regularly serviced.

On the days of the inspection the home was very clean and there were no unpleasant odours. The people who used the service all said they were happy with the standard of cleanliness. People said the laundry service was satisfactory.

We inspected the staff rotas, which showed that there were sufficient staff on duty to meet people’s needs throughout the day and night. People said call bells were promptly answered and staff were unrushed and patient with them.

Is the service effective?

Yes we judged the service was effective.

People all had an individual care plan, which set out their care needs. Care plans contained satisfactory information and were accessible to staff. People said staff met their needs and responded promptly when they needed assistance. People had access to doctors, district nurses, chiropodists and opticians, although some improvement was required regarding documenting the support received from some external medical professionals. People were generally positive about the meals provided although we did receive some comments that the vegetarian menu could be more varied and nutritious.

Is the service caring?

Yes we judged the service was caring.

People who used the service said they were supported by kind and professional staff. We were positive about the care practices we observed. Comments from people who lived at Courtlands included “I love it here…all the staff are very kind…I have no grumbles” and “I am very happy…the staff are very good. I have no complaints at all about how I am looked after.” A relative told us the care provided was “individualised” and “they treat every resident as different and adapt routines accordingly.”

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were taken into account and respected.

Is the service responsive?

Yes we judged the service was responsive.

The people we spoke with all said the staff treated them with respect and dignity. The care practice we observed was professional and supportive. For example a person who lived in the home told us “the staff are very good. I cannot fault them” and a relative told us “It is great…they have been so supportive…it is excellent, first class. I am very happy. Nothing is too much trouble.”

People who used the service told us there was a range of activities available. If people did not want to get involved with organised activities this was respected. One person told us they enjoyed the baking and the armchair exercises which regularly occurred.

People were positive about the care they received. People we spoke with said their care was unrushed and received in a way they wanted staff to provide it. From reviewing records we judged care plans as including suitable information to assist the staff who worked at the home. Records showed care plans were regularly reviewed and updated.

Is the service well-led?

Yes we judged the service was well led.

Staff, people who used the service and their relatives were all positive about the management of the home. People told us the management had high standards, would listen, and the new owner of the home was making lots of improvements.

The home had a system to check people were happy with the service. This had included employing an external consultant to assist the service to develop.

The home had well established links with external professionals such as the district nurse service and the local general practitioners. We spoke to visiting professionals who were very positive about the staff and management of the home.

People’s personal care records, and other records kept in the home, were accurate and complete. For example there was a system to monitor accidents and incidents.