The inspection visit took place on 16 May 2017 and was unannounced.

Redannick provides residential care for up to 41 older people most living with dementia. At the time of the inspection there were 41 people living at the service. The home is situated within a residential area of central Truro, the town centre and transport network. Car parking is available at the front of the home on a private forecourt. This is a single storey service so accommodation is all on one level. There are external garden areas suitable for people to use.

At the last inspection in June 2015 the service was rated ‘Good’ overall and Outstanding in the domain Responsive. At this inspection we found the service remained ‘Good’ and Outstanding in Responsive.

People and relatives all spoke positively about the service. Relatives told us that people were safe living at the service and that staff were kind, friendly and treated people well. They told us that the registered manager was always available and approachable.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Accident and Incidents were logged, investigated and action taken to keep people safe. Risk assessments were in place which were individualised for the person. This was to minimise potential risk of harm to people during the delivery of their care and support. Risk assessment were regularly updated and changes made as necessary so staff were responding to current risk levels.

The premises were safely managed. Recent improvements had been made to the environment to make it more pleasant and homely. Further refurbishment work was taking place when rooms became vacant. All areas were clean and hygienic and a safe place for people to live. Equipment had been serviced and maintained as required.

We found the way medicines were managed was safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with safe arrangements for storage.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were enough staff available to ensure people received prompt and attentive care. Staff had time to chat with people as well as meeting their care and support needs. Recruitment procedures were safe to help ensure staff were of suitable character to work with vulnerable people.

People and relatives told us staff were competent and well trained. Staff had been provided with a range of training relevant to their role and the registered manager had installed a culture where staff sought out new knowledge and shared their knowledge with their peers.

People and relatives spoke positively about the food provided by the home. There was sufficient choice and people received appropriate support where required. We observed regular snacks and drinks throughout the day were provided between meals to make sure people received adequate nutrition and hydration. Comments from people who lived at the home were all positive about the quality of meals provided. One person said, “It’s perfectly OK, I’ve got no complaints about it.”

We found people had access to healthcare professionals and their healthcare needs were met.

There was an extensive range of meaningful activities available to people including regular access to community events. Families were extremely satisfied with the activities available to their relatives and told us the service went, ‘over and above’ what they would expect to be available. Comments included, “Loads of tri

Redannick is a care home which provides care and support for up to 40 older people. On the day of this inspection there were 37 people living at the service.

There was a registered manager in post who was responsible for the day-to-day running of the home. 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.

We carried out this unannounced inspection on 8 June 2015. We last inspected this service in July 2014. At that inspection we found the service was meeting the requirements of the regulations.

The atmosphere at the service was welcoming, calm and friendly. The service provided accommodation and communal areas for people on ground floor level. The doors to people’s rooms, bathrooms and toilets were identified by pictures that aided recognition and provided orientation for people living with dementia.

People were well cared for. Staff were kind and respectful when supporting people. One family told us; “I have no concerns about anything at the home.” Staff told us; “Everyone is safe, there is no danger, nothing that can harm them.” Staff were aware of the different types of abuse and were clear on how they would raise any concerns they had with the management of the service, and with outside agencies if appropriate. One staff member told us’ “I can raise a safeguarding if I have any concerns.”

There were sufficient numbers of care staff to support the needs of the people living at the service. The service had robust recruitment processes in place to ensure new staff were safe to work with older people. Families told us; “I do not have any unfavourable comments to make, they (staff) are always very helpful and never dismissive of my enquiries, even when I ring at their busy times,” “I am quite happy, no issues” and “Excellent they (staff) look after (the person) well.”

People received their prescribed medicines in a safe and timely manner. However the cold storage of medicines was of concern. This was due to high temperatures having been recorded in the medicine fridge and the safe storage of medicines could not be ensured. This was considered to be due to a faulty thermometer that was not able to be re-set each day and was reading the maximum temperature ever reached. The registered manager purchased a new thermometer for the medicine fridge after the inspection and we were told this was reading between 2 and 8 degrees centigrade each day. This helped ensure medicines were safely stored in the fridge.

Staff working at the home understood the needs of people they supported. Staff received training and support which enabled them to be effective in their care and support of people in the home. The care plans at the service contained information to direct and inform staff regarding the needs of each person, and how they wished their care to be provided. Staff were aware of people’s preferences and choices. People were treated with kindness and their privacy and dignity were mostly respected at all times. However, one member of staff did speak to us about a person’s medical condition in a corridor outside their open room. This did not respect their privacy.

People were supported to have a varied diet. People told us they enjoyed the food. The service had commenced a project to increase the amount of fresh fruit and fluids taken by people. Fruit smoothies and milk shakes were offered to everyone in the afternoons and were proving popular with people.

People received care that was individualised and responsive to their needs. The registered manager had made improvements to the service as a response to people, families, healthcare professionals and staff comments. The service had raised money to obtain their own minibus which opened up opportunities for people who lived at the service to access the local community regularly. A staff room had been created to provide a space for staff to relax during breaks. New communication processes between visiting healthcare professionals and the service staff had been implemented.

Volunteers visited people at the service to support them with activities as well as fund raising and organising and running events such as Easter, Christmas and birthday parties. The service provided the opportunity for a person with a learning disability to visit the service to enable people to have their nails painted. There was a varied programme of relevant and meaningful activities at the service.

The registered manager rewarded staff who ‘went the extra mile’ spontaneously rewarded staff in the form of chocolates or bottles of wine. Staff told us; “The manager is nice and always friendly” and “The manager is a brilliant manager.”

The service had good relationships with other external healthcare professionals who ensured effective care delivery for people whenever they needed or wanted it. Families and staff felt they could raise any concerns or issues they may have with the manager who was approachable. People felt their views and experiences were listened to.

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

At the time of the inspection people were safe. Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Redannick alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service.

Redannick had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people’s needs were met.

Is the service effective?

At the time of the inspection we found the service to be effective. People, or their representatives, were involved in writing or reviewing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs and care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

Is the service caring?

At the time of the inspection we found the service to be caring. Feedback from a visiting relative was positive, for example, “it’s all fine”. We saw humour in some of the interactions between people and staff. For example, when asked “How are you this morning?” one person responded with a smile and “I don’t know yet”.

Redannick had regular support from the GPs from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

At the time of the inspection we found the service to be responsive to changing care needs and wishes, for example, recent minutes of a resident’s meeting showed “X would like a beer with lunch” and this had been provided and plans had been made for a suggested ‘sherry and cake afternoon’. Many people who lived at Redannick had complex health needs and were either not able, or chose not to join in group activities. There was evidence to show that people were routinely offered one-to-one time or group activities. We saw one such activity taking place at the time of the inspection and the people taking part appeared to genuinely enjoy the event.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

At the time of the inspection we found the service to be well-led. Redannick had a registered manager. The deputy manager was available on the day of the inspection.

We saw minutes of meetings held with the staff and people who lived at Redannick. This showed the management had consulted with staff and others to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs. We spoke to two people who told us that they were pleased to live at Redannick, and we spoke with two relatives who were both happy with the care their loved ones’ received.

We saw people’s privacy and dignity was respected and staff were helpful. We saw people engaged in activities, and we saw people chatted with each other and with staff. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights, and people were protected by the home’s robust recruitment procedures.

There were enough qualified, skilled and experienced staff to meet people’s needs, and we found staff received appropriate professional development.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

Records were legible, up to date and stored securely.

Some of the people who used the service were not able to comment in detail about the service they receive due to their healthcare needs. We spoke to two people who told us that they were pleased to live at Redannick. One person was very happy that they had been joined by their dog. People confirmed that they had choices, such as at meals.

We used our SOFI (Short Observational Framework for Inspection) tool for approximately one and a half hours in the dining area. The SOFI tool allowed us to spend time watching what was going on and helped us record how people spent their time, the type of support they got and whether they had positive experiences. We saw people’s privacy and dignity was respected and staff were helpful. We saw people engaged in activities and we saw people chatted with each other and with staff.

During our inspection, we found people’s privacy, dignity and independence were respected and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights, and people were protected against the risks associated with medicines, because the staff had appropriate arrangements in place to manage medicines.

We found staff received appropriate professional development and supervision.

We reviewed all the information we hold about this provider, carried out a visit on 4 February 2012, observed how people were being cared for, used an short observational tool (SOFI), talked with staff, and checked records.

Most of the people using the service were not able to comment in detail about the service they received. We were able to observe people who used the service and staff throughout the inspection. We saw people’s privacy and dignity being respected and staff being helpful. There were no issues raised by people who used the service or staff. People who used the service were moving freely around the home. We did see people speaking with staff, and approaching staff without hesitation. We saw and heard staff talking with people in an adult to adult, respectful way. The atmosphere at the home was relaxed and pleasant throughout the inspection.

Staff told us that training was provided, that they enjoyed working at Redannick, and that they felt they could approach the manager and senior staff if they needed to. Staff told us they would not hesitate to report any perceived abuse. They also told us that supervision had lapsed over recent months.