The inspection was carried out on 21 September 2016 and was unannounced.

Radbrook Nursing Home is registered to provide accommodation with nursing care for up to a maximum of 43 people. There were 42 people living at the home on the day of our inspection. Some people were living with dementia

There was a registered manager in post. They were not present during the inspection due to being on annual leave. 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 2008 and associated Regulations about how the service is run.

People were protected from harm and abuse by staff who had been trained in how to recognise and report abuse. Staff were aware of the risks associated with people’s needs and how to minimise these. There were enough staff to safely meet people’s needs. People were supported to take their medicines safely and accurate records were maintained. Staff monitored people’s health and arranged health appointments as needed.

People were supported by staff who had the skills and knowledge to meet their individual needs. There was an open and positive working culture where staff felt well supported by the management team and peers. Staff sought people’s consent and respected their wishes. Where people were unable to make decisions for themselves these were made in their best interest by people who knew them well.

People were pleased with the quality and choice of food available to them. People were provided with equipment and support to eat their food independently. People’s nutritional needs were routinely assessed, monitored and reviewed. Where there were concerns about people’s dietary needs specialist advice was sought and followed.

People received care and support that was personalised to their individual needs and preferences. Staff spoke with and about people with warmth and respect. Staff treated people with dignity and promoted their independence. People were able to spend their time as they wished. People were pleased with the range of activities offered.

The registered manager was open and approachable. The provider had a range of checks in place to monitor the health, safety and wellbeing of people living at the home. The registered manager sought the views of people and staff to make improvements to the service.

People felt able to raise concerns with staff or management and were confident that these would be dealt with promptly. The provider had a clear complaints procedure that was followed by staff.

A single inspector carried out this inspection. The focus of the inspection was to answer the 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 people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found.

Is the service safe?

People living in the home told us they felt safe because their rights and dignity were respected. People confirmed that they were involved in making decisions about any risks they may decide to take in their daily lives. One person said, “Radbrook provides a sense of safety and security, especially at night.” Another person said, “It’s the way staff are with me that makes me feel quite safe.”

We spoke with staff who said they knew what to do if concerns about abuse were raised and they were aware of the provider’s policies and procedures. This meant that people were protected from potential abuse.

The registered manager showed us an effective system to manage accidents and incidents and learned from them so they were less likely to happen again.

The staff and the registered manager understood the requirements of the Mental Capacity Act 2005, its main Codes of Practice and Deprivation of Liberty Safeguards and put them into practice to protect people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people living in the home were protected from bullying, harassment, avoidable harm, abuse and breaches of their human rights.

When people were at risk staff followed effective risk management policies and procedures to protect them. This meant that risks to individuals were managed well so that people were protected and their freedom was supported and respected.

Is the service effective?

People living in the home told us that they could express their views about their health and quality of life. They said these were taken into account in the assessment of their needs and the planning of their care and treatment. People told us they had been involved in the assessment of their needs prior to living at the home. The care records we looked at reflected people’s current individual needs, choices and preferences.

Staff we spoke with demonstrated that they had the skills and knowledge to meet people’s assessed needs, preferences and choices at all times. People we spoke with said they felt confident discussing their health needs with staff. They said their health was regularly monitored to identify any changes that may require additional support or intervention such as referral to the GP or physiotherapy. We looked at records that showed referrals were quickly made to health services when people’s needs changed. Records noted that relatives were kept informed. A relative had told us, “I am kept informed of all aspects of mum’s care and that’s what her wishes are”. Another relative said, “I am kept fully informed and updated at all times and I am confident mum is receiving appropriate, dignified and gentle care day and night.”.

Staff told us they received effective support, supervision and training. The registered manager had an ongoing workforce development plan that encouraged staff to develop and promote innovative practice. This meant that people received effective care from staff who had the knowledge and skills necessary to carry out their roles and responsibilities.

Is the service caring?

People living in the home told us that they were treated with kindness and compassion and that their dignity was respected when receiving personal care. We observed as staff went about their work that people were shown kindness and compassion in day to day care. People explained how their individual needs were met, including needs around age, disability, religion and belief. Staff we spoke with knew the people they were caring for well including their preferences and personal histories. This meant that caring positive relationships were developed with people living in the home.

Records were stored in the office so that people were assured that information about them was treated in confidence. Staff we spoke with described how they promoted respectful behaviour and positive attitudes. This meant people’s privacy and dignity was respected and promoted.

People and their relatives were given the opportunity to complete a survey about life in the home. Regular resident meetings and informal groups were encouraged. This meant people and those that mattered to them were encouraged to make their views known about their care and support, and these were respected.

Is the service responsive?

People said that they and their family were encouraged to make their views known about their care and support. One person explained how staff made sure that they had the time they needed to make decisions about their life. Care records detailed how people’s individual needs were regularly assessed and met.

Staff spoke about how they would record any assessment when a person’s capacity was considered under the Mental Capacity Act 2005. If a person did not have capacity, decisions were always made in their best interest. The way staff interacted with people showed that they actively sought and listened to people’s views and decisions. This meant people were supported to express their views and be actively involved in making decisions about their care and support.

People who lived at the home attended meetings so that they could put forward their views for activities that were important and relevant to them and they were protected from social isolation. People were very much enabled to maintain relationships with their friends and relatives. Staff we spoke with recognised the risks of social isolation and loneliness and worked hard to balance the risk against this and how people wanted to live their life. This meant that people received personalised care that was responsive to their needs.

Is the service well-led?

Discussions with the registered manager and staff showed there was an emphasis on fairness, support and transparency and an open culture in the home. The registered manager operated a clear set of values that included involvement, compassion, dignity, respect, equality and independence which were understood by all the staff we spoke with. This meant that the service promoted a positive culture that was person centred, open, inclusive and empowering.

Robust quality assurance and governance systems were in place and used to drive continuous improvement. There were effective arrangements to continually review health and safety, safeguarding concerns, accidents and incidents, medication, care plans and complaints.

The management team had links with external practitioners that acted as sources of best practice. For example, the local medicines management team were conducting a review of medication practice in the home. This meant that the registered manager demonstrated good management and leadership.

Staff we spoke with knew and understood what was expected of them. Effective processes were in place for staff to account for their decisions, actions, behaviours and performance. This ensured that responsibility and accountability was understood at all levels. A staff member told us, “There is a strong focus on training for staff at all levels.” A visitor said , “Managerially the home is very very good.”

We talked with a number of the people who lived in this home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

Most people told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were usually available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “Good staff, good food and a nice room”.

The provider had developed a system whereby they can monitor how well the home was meeting the needs of the people who live there.