Ryecourt provides nursing care and support for a maximum of 35 people who live with dementia and/or a physical disability. At the time of our inspection there were 34 people living at the home. Ryecourt is situated in a residential area of Blackpool close to the promenade. Communal areas located on the ground floor consist of four lounges and two dining areas. A passenger lift is provided for ease of access throughout the building.

Ryecourt is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both of which we looked at during this inspection.

A registered manager was in place. 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.

At the last inspection on 23 September 2015, the service was rated good. At this inspection, we found the service had improved to outstanding.

During this inspection, we found multiple examples to demonstrate the staff and management team were passionate about providing an innovative, excellent service. A relative told us, “It’s outstanding here, there is no other word to describe it.” Our observations confirmed staff were highly skilled communicators and able to engage with profound empathy and respect.

The home’s ethos was strongly focused on providing highly personalised care. We found very high staffing levels and excellent communication at Ryecourt meant care was delivered efficiently and with a timely approach. All interactions we observed demonstrated a service consistently focused upon the person’s dignity.

Staff had in-depth training in equality and we observed they demonstrated their understanding in practice by continuously promoting a highly inclusive environment. It was very clear they respected each person’s rights and treated them as individuals. We observed a strong, family-orientated service where staff were not afraid to display their love towards people.

The registered manager went to great lengths to ensure people and relatives had access to different information. This enabled families to gain a greater awareness of their care, which they said was an example of the registered manager going above and beyond.

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. Various evidence-based tools and best practice procedures were completed by staff to maintain high levels of effective mental health treatment.

All personnel had a very structured and supportive start to their employment, underpinned with shadow shifts and regular supervision. Staff development at Ryecourt was exceptional because the registered manager used every opportunity as a training session. This included tools to ensure learning was put in practice, such as reflective work, meetings, competency tests and learning logs.

The skilled workforce had a massive impact on people because we saw evidence this reduced unnecessary hospitalisation. Systems to effectively monitor and treat pain, anxiety symptoms and depression levels resulted in significantly reduced incidents. For instance, the rate of falls, health infections and pressure ulcers over the last year were cut to minimal or zero levels.

The provider ensured the chef was able to provide individual soft and pureed diets that resembled the original food. People and visitors were highly complementary about meals, choice and staff support. A relative said, “The food is wonderful.” Staff deployed prescribed treatment and adapted care planning to protect the most vulnerable individuals from the ris

The inspection visit at Ryecourt Nursing Home was undertaken on 23 September 2015 and was unannounced.

Ryecourt provides care and support for a maximum of 35 people who live with dementia and/or a physical disability. At the time of our inspection, the home was full. The home is situated in a residential area of Blackpool close to the promenade. There are ensuite facilities and lift access to all floors. A number of lounges and dining rooms are available so people can choose where to relax and to eat or drink.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 15 November 2013, we asked the provider to take action to make improvements to how potential employees were recruited. At the follow-up inspection on 16 January 2014, we observed improvements had been completed and the service was meeting the requirements of the regulations.

During this inspection, we observed outstanding approaches to care were in place at Ryecourt. The ethos of the home was to provide excellence in care. This was modelled by the leadership and employees, who continuously strived to sustain their person-centred model of care. People and their representatives told us they experienced an extremely caring approach from staff who had an exceptionally compassionate attitude.

We found, without exception, staff were sensitive and respectful towards people and engaged with individuals in an affectionate, loving manner. A staff member told us, “The best part of the job is the residents.” Staff put people first and consistently tailored care to people’s needs rather than working in a task-orientated way. We observed staff interacted with people in ways that demonstrated they mattered to them and helped them to live meaningful lives. All staff were extremely driven, with a continuous approach, to maintain and improve upon people’s care, dignity and living experiences.

The registered manager had guided staff to provide high standards of care for the benefit of people who lived at Ryecourt. Additionally, a variety of audits was completed regularly in order to monitor and sustain outstanding levels of personalised care approaches. These processes checked people’s health, care requirements and current stability levels. The provider worked with external agencies to provide excellence in end of life care. It was evident staff really enjoyed their work and performed their duties incredibly hard for the individual’s benefit. All the staff we spoke with said the registered manager was ‘loved’ by people, staff and visitors.

People who lived at the home and their representatives told us they felt safe. We observed staff had a good understanding of how to protect individuals from harm, injury and abuse. Risk assessments were in place to protect people from the potential risks of receiving care and support.

Staff worked with individuals to ensure they received appropriate support and followed their agreed care plans. They demonstrated an in-depth understanding of people and how best to assist them within their preferred methods of support. The registered manager had ensured care was responsive to the person’s ongoing needs. This was because care records were reviewed daily and personalised to the individual’s requirements. Staff effectively monitored people’s health and worked with other providers to ensure their continuity of care.

We found Ryecourt was well resourced because staffing levels and skill mixes were very high. We observed staff supporting individuals in a timely and unhurried manner, using a caring and patient approach. The registered manager had safeguarded people against unsuitable staff by completing thorough recruitment processes and checks prior to their employment.

The provider had protected people from unsafe medicines management by ensuring staff were adequately trained. We observed safe approaches were followed when staff administered medication.

We noted staff demonstrated an effective understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS documentation informed all care records, including the individual’s associated best interest documents, care plans and risk assessments. Systems were in place to protect people’s human rights and we observed staff followed their recorded preferences and diverse needs.

We found there was a welcoming and friendly atmosphere in the home. Staff we spoke with said the service was well organised and the leadership inspired them to meet high standards in place. Staff, people and their representatives were supported to express their views about the quality of the service. The management team carried out frequent audits to protect the welfare and health and safety of staff, visitors and people who lived at Ryecourt.

At our previous visit in November 2013 we found shortfalls in the recruitment procedures at the home. This was because it was not always clear whether people were cared for, or supported by, suitably qualified and experienced staff.

At our visit on the 16th January 2014 we reviewed staff files, spoke with the quality manager and with a member of staff who had recently been recruited.

We found new systems and paperwork had been introduced to ensure recruitment procedures were more robust.

We saw staff sought confirmation routinely that what they were doing was ok. We heard staff say, “That is a drink of tea, for you to drink, is that ok?” We heard people who lived in the home respond positively to this sort of interaction.

We did not speak to anyone on the day of the inspection about the support they received. We could see through staff interaction and the records kept, consideration had been given to ensure people were supported appropriately.

Staff were dedicated in meeting people’s complex and changing needs. One staff member said, “I know that if at an end of a shift, everyone is kept safe and their needs are met that I’ve done my job.”

Contracts had been redrawn this year and issued to staff with changes to terms and conditions. The provider had not confirmed the start date for these contracts with the start date for employment.

The home had an effective quality monitoring and quality assurance procedure in place.

We were only able to speak with one person living at the home. Conversation with other people was difficult because of the effects of their dementia. The person spoken with told us, “I cannot fault it, that is my opinion. The meals are alright but I have to ask what the meal is they don’t tell you. If I don’t like something they usually find an alternative. I only have one course, I don’t like puddings”. This same person spoke positively of the staff team and explained that he was free to make choices for himself.

In addition to using SOFI, we spent periods of time observing staff and residents in a communal area of the home. We saw that people were consistently treated with dignity and respect. For example, we saw staff offer assistance with personal care needs in a discreet and dignified manner and called the person by the name they preferred.

Care plans were in place however the information would have been strengthened if more detailed information had been included such as people’s personal preferences, wants and wishes.

Staff spoken with confirmed that training was provided and supervision arrangements in place.

We spoke with two relatives who were visiting. Both of these people visited very regularly. One person told us that staff were, “Worth their weight in gold and are all so patient, very, very nice staff”. When we asked what the service did well, we were told, “Attention of the staff, there is always somebody with them defusing situations”.

“All the staff are excellent, if you have a question or need to ask anything you can. As a family we are very involved in his care and are encouraged to be. We take him for hospital appointments even though staff are offered”.

A person described staff as ‘friendly people, they always have a smile on their face and help you when you need it’.

A family member said they did not have any concerns about the care of their relative and found the staff to be attentive to the care of people. The relative said, “If I had any concerns I would talk to the provider. She is very good at communicating, keeps in touch and gives the family information”.

Comments about the main meal served where “I enjoyed that and am not just eating for eating sake”. Another person described himself as a “meat and two veg man, I’m not fussy about food”. The person said of the meal that it was “acceptable, not spectacular but wholesome and I enjoyed it”. Another person said “I’m not over keen on the main course so will have a pudding as well”.

One visitor told us that her relative had put on weight. “I have had to buy him larger trousers”.