The inspection visit at Rossall was undertaken on 08 and 09 March 2017and was unannounced.

Rossall currently provides nursing care and support for a maximum of 33 people who live with dementia, physical disability, alcohol/drug dependency or mental health conditions. As part of the planned, staged expansion by the provider, an additional 13 bedrooms were registered following our inspection. At the time of our inspection there were 32 people living at the home. Rossall is situated next to the promenade in Fleetwood. Accommodation is provided on the ground floor within separate units. There are multiple lounges, rest spaces, dining areas and themed rooms, including a cinema. Every bedroom is for single occupancy, spacious and contains a wet room, toilet and sink.

Rossall was newly registered on 18 March 2016. Consequently, this was their first inspection.

During this inspection, we found the provider had thoughtfully redesigned the building and deployed cohesive staff teams in an exceptional manner. A member of the commissioning team told us the systems in place were ‘amazing’ and care was ‘exceptional’. A relative said, “I know you give a rating on homes now. We are incredibly happy.”

We corroborated this when we toured the building and talked with people and relatives. Outstanding features included automatic bedroom lights to illuminate the path to the ensuite toilet and discreet bed safety strips to reduce the risk of falls. The provider had funded a member of staff to commence a degree in physiotherapy as an advanced way of supporting people’s mobility. We saw the management team completed an in-depth risk assessment matrix to monitor the efficiency of risk evaluation and related processes. We saw this had consequently reduced falls and serious injuries resulting in reduced hospitalisation.

Staff worked within a highly trained team and had ample time to support individuals in a meaningful way. This was because very high staff numbers and skills mixes were deployed to provide a holistic approach to care and people’s safety. We found excellent, consistent recordkeeping, systems related to the recruitment of suitable staff. A newly recruited staff member told us, “It’s in my best interest because I’m new in care and want to learn as much as possible.”

We found care records contained detailed, personalised and specific medicines management care plans. We observed staff followed these in their exceptionally safe and caring approach to people’s related support. The provider was the only service in the region to train their nurses to deliver intravenous fluids and antibiotics. These safe systems meant staff maintained people’s related care to a very high degree.

Staff recorded best interest meetings and transparently documented mental capacity assessments and decision-making practices. We saw this followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). We observed staff treated people as equals, offering them options whenever they engaged with them. Local commissioners said they found staff were very knowledgeable about the MCA and tried everything to help people make their own decisions.

Food standards were enhanced by a very high level of organisation of the kitchen. The provider utilised inventive processes to support people with their nutritional requirements. When we discussed the quality of meals with people and their relatives, they said food was of a very high quality.

People and their representatives said staff worked collaboratively with them to ensure they received high standards of care. One relative said other services had never involved them in their family member’s care planning. They added, “They involved me right from the start and focused on what my [relative] was like. What did he use to do? What was family life like? His food likes and dislikes. To me, that’s where Rossall goes above and beyond.”

We found Rossall had