This comprehensive inspection was unannounced and took place on the 20 and 22 November 2018. At our last comprehensive inspection on the 14 March 2017 the service was rated outstanding.

Ryefield Court 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, and both were looked at during this inspection. In the case of Ryefield Court, no nursing care is provided. The home can accommodate up to 60 people in one adapted building over three floors which are run as separate units, each of which have separate adapted facilities. The unit on the second floor specialises in providing care to people living with dementia.

The registered manager who was in post at the last inspection had left and at the time of this inspection, there had been a new registered manager in post for two months. ‘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.’

During the inspection we found some aspects of medicines management were not always carried out safely. The provider introduced plans to address the areas that required improvement when we pointed these out to them.

The provider’s arrangements around the control and spread of infection were not always effective. We identified several issues which fell short of good practice.

People did not always receive person centred care that met their needs. A few people were woken up early in the morning when there were no indications that this met their needs, wishes or preferences.

Care plans were not always person centred and detailed, to address how people’s needs were to be met. For example, the care plans to support people with their elimination care needs did not make clear how these needs would be met.

The provider’s quality assurance systems and governance arrangements were not always effective because they had not identified the shortfalls we identified at this inspection, so they could make the necessary improvements and protect people from the risk of receiving unsafe and inappropriate care. Once we pointed out the shortfalls, the provider started to address these promptly.

Whilst the home provided a warm, clean, well maintained and inviting environment for people, the unit for people with dementia did not always support their orientation and independence because of a lack of signage, the use of colour and features. We have made a recommendation to the provider about this.

The provider had recruitment processes which were not always adhered to robustly. The registered manager stated they would make sure that these were adhered to as required.

The provider had policies and procedures in place to protect people from abuse. Staff we spoke with had received training and knew how to respond to safeguarding concerns.

Staff had up to date training, supervision and annual appraisals to develop the necessary skills to support people using the service.

People's dietary and health needs had been assessed and recorded so any dietary or nutritional needs could be met. People were supported to maintain healthier lives and access healthcare services appropriately.

The provider worked within the principles of the Mental Capacity Act (2005). People were generally supported to have choice and control over their day to day decisions.

Before coming to the service, the provider undertook an assessment to determine if the service could meet the person’s needs.

There was a complaints procedure in place and the provider responded to complaints as per their procedure.

People using the service and staff told us the registered manager was available and listened to them.

We found three

The inspection took place on 14 March 2017 and was unannounced.

This was the first inspection of the service since it was registered in July 2016.

Ryefield Court is a care home for up to 60 older people in the London Borough of Hillingdon. The home caters for some people who may be living with the experience of dementia. At the time of the inspection 24 people were living at the service. Some of these people were there for short stay care. The service is run by Ryefield Court Care Limited, which is part of the Berkley Care Group, a national privately run organisation. The organisation had five care homes at the time of the inspection, with plans to open a sixth home in 2017.

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 and associated Regulations about how the service is run.

The service was exceptionally caring and people were supported to feel special. The leadership of the home and the staff worked in a natural and well-coordinated way to focus their attention on each person. Every interaction we observed showed how the staff treated people as individuals and appeared happy and confident in the way they supported them. In addition, people living at the service and their visitors reported this was always the case. People shared stories with us and the registered manager told us about examples where staff had gone the extra mile to give someone the care and support they needed. In these examples we saw how the staff considered the holistic needs of each person, thinking about their emotional wellbeing as well as their physical needs.

People's needs were met in an exceptionally person centred way. They were supported to plan their own care and to pursue the life they wanted to live. The staff showed empathy and understanding around the challenges people felt when they moved into a care home and tried to support people to ease this. Examples of this were supporting people with hobbies and interests and helping people to feel more confident and able to accept help and support.

The service was closely linked with the local community. Vulnerable and older local community members were invited to the home to take part in activities, share meals and socialise with people. This service was free of charge and people were offered transport to and from the home. This initiative was supported by Age UK and allowed some of the more vulnerable members of the local community to have access to support and services, including hot meals, which they may not otherwise have had. In addition the people living at the service enjoyed this aspect of the service, as local community members volunteered, socialised and spent time with them.

The arrangements for social activities and entertainment were innovative and reflected people's preferences and needs. The provider arranged for regular unique and interesting visiting entertainers. People enjoyed this. People also had access to community activities, including regular trips to places of interest and the theatre. The spa room offered treatments each day and people had unlimited access to the cinema room to watch films or sporting events. The provider had access to satellite films and sporting events and was a member of social media film clubs.

The provider had designed an all-inclusive luxury service. This meant that the environment, furniture and furnishings were all very good quality. The provider had a policy that any damaged items would be immediately replaced. The environment included additional communal features which people were able to use whenever they wanted, free of charge. For example, there was a cinema, which people could use to watch films or sporting events with their friends and families, a spa where people usi