We carried out an inspection on 4 and 13 July 2017. Rush Court is a care home registered to provide personal and nursing care for up to 50 people. At the time of our inspection there were 49 people using the service.

At our inspection in June 2015 we found that medicines were not always managed safely. At this inspection we found improvements had been made and people received their medicines safely.

There was a strong caring culture that created a family feel to the service. The registered manager promoted a person-centred culture that ensured everything the service did benefited the people who lived there. People and relatives were complimentary about the responsiveness and approachability of the registered manager. Staff were passionate about their work and were supported by the management team within the service.

Without exception people and their relatives were extremely positive about the quality of care people received and described many examples of staff going the extra mile when supporting people. People received compassionate care that put them at the centre of everything the service did. People developed relationships with staff based on mutual respect and kindness. There were many caring interactions where staff showed they knew people well and valued people as individuals.

People had the opportunity to engage in activities that took into account their individual interests. People were encouraged to continue to enjoy past interests and to re-establish skills they had not used for sometime. People had close links with the community and enjoyed regular outings to local places of interests. When people's needs changed the service took immediate action to ensure their needs were met.

The service supported people at the end of their life and did so with empathy, ensuring people experienced a dignified, pain free death. Staff supported bereaved families with compassion and carried out acts of kindness to reduce their distress.

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 support this practice.

There were effective systems in place that ensured the registered manager had an overview of the quality of the service and enabled continuous improvement.

The registered manager looked for innovative ways to improve the service. The service benefitted from membership of nationally recognised schemes that promoted high quality care and respected people as individuals. People were involved in the development of the service. The registered manager ensured learning from complaints and feedback from people was used to improve the service.

The registered manager ensured they kept their skills and knowledge up to date and looked for ways to share learning throughout the organisation.

We inspected Rush Court on 9 June 2015. Rush Court provides residential and nursing care for people with a range of conditions. The home offers a service for up to 50 people. At the time of our visit 47 people were using the service. This was an unannounced inspection.

At our previous inspection in August 2013, the provider was meeting all the standards inspected.

People's medicines were not always managed safely. Medicine records were not always accurate and systems in place to monitor medicines coming into the home were not effective. This put people at risk of not receiving medicines as prescribed.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

People received caring and compassionate support. People were extremely complimentary about the care they received and about the care staff. There was a caring culture throughout the home, shared by all staff. People's needs were at the centre of all activity and people valued their relationships with staff. Care staff provided personalised care and knew people's needs, likes and dislikes. Care staff were committed to providing personalised care and found innovative ways to engage with people.  

People had access to a wide range of activities to meet their individual needs. People were involved in deciding activities they would like organised and those they would like to attend. The social engagement leads used innovative ideas to ensure people had access to activities that interested them.

People and their relatives were complimentary about the approachability of the registered manager. A scheme called 'Ladder to the moon' had been introduced which promoted the participation of everyone involved in the home to ensure the whole service was about the people living in the home. People and their relatives were encouraged to give feedback on the service and their views were valued.   

Staff felt well supported and had access to development opportunities to improve their skills and knowledge. Staff received regular supervision and were encouraged to have input into improving the quality of service.

The provider was adhering to the principles of the Mental Capacity Act 2005 Code of Practice. The Mental Capacity Act 2005 ensures that where people lack the capacity to make decisions, any decisions made on the person's behalf are made in their best interest.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We saw evidence in individual care plans and notes of group meetings the provider was respecting and involving people. We observed people being treated with respect and their views being sought. We were told by a family member that "people are treated with dignity and respect at Rush Court".

We were told by one person that "we do lots of lovely things" and we saw the provider made a variety of activities available for people. We found the provider was providing personalised care, treatment and support and that peoples individual needs were

assessed with appropriate plans being drawn up and implemented.

There was guidance in the home on safeguarding people from abuse. Staff members spoken to knew how to report any concerns regarding abuse. People we spoke told told us they would be able to speak up if they were unhappy with the way they were cared for. We found the provider was protecting people from the risk of abuse.

We found by looking at staff rotas and training records and speaking with the provider that there was sufficient qualified, skilled and experienced staff to provide care and support for people.

There was an improvement plan in place and we saw the provider was seeking the views of family representatives and making changes as a result. We found the provider was investigating comments and complaints and accidents and incidents and was learning from these in order to improve the care, treatment and support provided to people.

The people we spoke with were happy they were consulted about and involved in their care. We saw that care plans included references to people’s wishes and preferences although documented consents were not always in place. People’s privacy and dignity were supported by staff.

People had access to a range of social activities, events, outings, and their spiritual needs were also provided for.

Appropriate arrangements were in place to manage people’s medication and people who were able, could choose to manage this for themselves.

Appropriate recruitment checks were carried out before new staff began work at the home, although induction records could be better documented.

The home had an appropriate complaints procedure and all complaints were investigated. Not all complaints in the previous 12 months had been resolved to people’s satisfaction and some aspects of complaints recording were not sufficiently detailed. We saw that people had a range of other opportunities to discuss their opinions about the home and the care provided.

People told us that care was given in a dignified manner in the privacy of their own room. People told us they liked the food and the variety. People were asked what they wanted to eat on a daily basis. There was always a choice. Relatives and friends were made welcome and there were no set visiting times. People told us they had access to health services and could either go to the surgery or see the doctor in the home. People told us there was plenty to keep them occupied. Activities were available both within the home and outside. The home had a minibus to take people on regular outings.