The Julie Richardson is a care home for up to 40 people who require nursing or personal care, some of whom are living with dementia. At the time on our inspection there were 39 people living at the home.

We inspected this service on 18 July 2017. This was an unannounced inspection.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good. However, they were outstanding in effective

Why the service is rated good:

People received exceptional care from well trained staff. Staff demonstrated high levels of knowledge and understanding required to be able to positively impact on people’s wellbeing. People received care from staff that understood the needs of people living with dementia. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager), appraisals and team meetings to help them meet the needs of the people they cared for.

The provider sought innovative ways to continuously improve the home and better people’s well- being. The home was involved in several research projects which had resulted in positive changes for people.

The environment had been creatively adapted to help meet people's needs, in particular people living with dementia. It provided clear dementia friendly pictorial signage and points of interest. The layout and design helped to maintain people's independence and to reduce restrictions of their movements.

People experienced positive outcomes regarding their health care as the service had developed excellent working relations with a number of health care professionals. The service had reduced the use of antipsychotic medicines allowing people more independence.

People's dietary needs and preferences were well met. Meal times were sociable and positive experiences. People were given choices and received their meals in timely manner. People were supported with meals in line with their care plans.

People were supported to express their views and were involved in making decisions about their care and were offered day to day choices. Staff sought people's consent for care and treatment and ensured they were supported to make as many decisions as possible. The registered manager and staff had a good understanding of the Mental Capacity Act 2005. Where people were thought to lack capacity, assessments in relation to their capacity had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People supported by the service felt safe. Staff had a clear understanding on how to safeguard people and protect their health and well-being. People received their medicine as prescribed. There were systems in place to manage safe administration and storage of medicines.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people's needs and followed guidance to keep them safe.

The Julie Richardson care home had enough suitably qualified and experienced staff to meet people's needs. People told us they were attended to without unnecessary delay. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The Julie Richardson continued to provide support in a caring way. Staff supported people with kindness and compassion. Staff respected people as individuals and treated them with dignity. People were involved in decisions about their care needs and the support they required to meet those needs.

The home continued to be responsive to people's needs and ensured people were supported in a personalised way. People's changing

On the day of our visit 35 people were using the service. They were supported by a combination of five care workers, two nurses and two activity co-ordinators. We spoke with five people who used the service and six relatives. We also spoke with two nurses, three care workers, an activity co-ordinator, the registered manager and provider. An inspector and an expert by experience carried out this inspection. The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The service was safe. People told us that they felt safe. People were protected from the risk of choking. People’s needs around social stimulation and pressure area care were also maintained.

People’s medicines were administered safely and the service had appropriate systems in place to ensure medicines were securely stored.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. During our visit we noted that the registered manager and staff had awareness of DoLS. We spoke with the manager about the recent high court judgement around DoLS.

Is the service effective?

The service was effective. People told us they enjoyed being at the home and felt well cared for. People we spoke with told us they felt respected.

People’s views and experiences were taken into account in the way the service was provided and delivered. For example, we noted that people and their representatives could suggest changes to the service and these were acted upon.

Staff were supported and trained to carry out their roles. We saw training records for staff at the home and saw that staff were trained to meet the needs of people. Staff felt supported and told us they had access to supervision.

Is the service caring?

The service was caring. People we spoke with were complementary about the home. One relative said, “They have [relative] a named Carer, I have a good relationship with them, I can tell that they are caring for example, I always notice that they are always dressed differently each day.” One person told us, “I’m so very happy here.” A relative told us “I do think the staff are really good here.” Another relative said, “The amount of care they [relative] receive is second to none.”

We saw that staff treated people with dignity and kindness. We conducted a Short Observation Framework for Inspection (SOFI) observation. SOFI is used to capture the experiences of any person who may have cognitive or communication impairments and cannot verbally give their opinions on the services they receive. We observed that people benefitted from positive and caring interactions with staff.

We observed that people were involved in a range of activities and one person was encouraged to play guitar and sing for others. People enjoyed this and became involved.

Is the service responsive?

We noticed that incident and accident records noted that the service took appropriate action to manage the risks associated with incidents and accidents and ensure the health and welfare of people living at Brooklands 1 Limited.

We noticed that the service acted upon complaints and audits to inform the delivery of the service.

Is the service well led?

We found that the service was well led. The service had a registered manager. Staff we spoke with felt they had clear leadership from the registered manager who always had their door open and would listen to any concerns.

Robust systems were in place to monitor the quality and safety of the service. Systems were in place to protect people from the risk of malnutrition and ensure incidents and accidents were learnt from.

On the day of our visit there were 36 people living at Brooklands 1. The majority of people at the home were living with dementia. We saw there were two nurses, six care workers, an activities co-ordinator and kitchen and cleaning staff on duty to support people.

We conducted a Short Observational Framework for Inspection (SOFI) exercise and saw that people were treated with genuine care and respect. Care workers were patient and took time to involve and encourage people to participate in activities and in their care. We also spoke with five relatives of people who used the service. One said "everyone is extremely friendly here. There is lots of stimulation to help them". Another said "I think it is very good here. The care staff talk to them really well".

We spoke with five care workers and asked them about safeguarding vulnerable adults. Care workers we spoke with demonstrated a good knowledge of the risks of abuse and what action to take if they suspected abuse was occurring. This meant people were protected.

The provider had a rigorous and robust selection and recruitment procedure and we noted that care workers and nurses were recruited appropriately. We also saw that the provider conducted audits and managed complaints, accidents and incidents appropriately. This showed us the provider monitored the quality of service it provided and responded to people's comments and needs.

During our inspection residents told us that " staff are always helpful" " they look after us well". Residents we spoke to felt that there were always enough staff available but they were always busy.

People said that staff were good at their jobs and cared for people. In our discussions residents told us that they felt safe with the staff in the home and would talk to the manager or nurses if they had any concerns.

We observed that staff treated people with dignity and respect, addressing people by their preferred name. Staff were polite, cheerful and helpful in caring for people some with very complex health needs.

We spoke with staff who told us that they felt happy in the home and in their roles. Staff told us they were very well trained and that they received supervision every six-eight weeks. In discussions with staff they told us "i love it here" "everyday is different, but I love being here with the residents", " I've only been here a few years and my only regret is that I didn't do this work sooner."

There were arrangements in place for monitoring the safety and welfare of people and systems for managing the quality of services provided.

People told us that they were happy living in the home.

Relatives of people who lived in the home told us that they were very happy with the care that their family members were receiving and felt it was of a very high standard. They told us that they were involved in planning people’s care and were always kept informed of any changes or concerns about people’s well being. Relatives told us that the home was always clean and tidy. Relatives said that they were absolutely confident that people were safe and well looked after.

We visited Julie Richardson Nursing home on 20 and 21 May 2015 It was an unannounced inspection. We previously inspected the service on 7 June 2014. The service was meeting the requirements of the regulations at that time.

The service provides nursing care for people over the age of 65. Some people at the home were living with dementia. The home offers a service for up to 40 people. At the time of our visit 33 people were using the service.

There was a registered manager at the service. 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.

There were enough staff to meet people’s needs. People felt safe and supported by competent staff. Staff felt motivated and supported to improve the quality of care provided to people and benefitted from regular supervision and training in areas such as dementia awareness.

People were cared for in a caring and respectful way. People were supported to maintain their health and were referred for specialist advice as required. People were provided with person-centred care which encouraged choice and independence. Staff knew people well and understood their individual preferences.

People were supported to have their nutritional needs met. People liked the food, regular snacks and drinks were offered and mealtimes were relaxed and sociable. People who had lost weight had a plan in place to manage their weight loss. People were supported with specialist diets and nutritional supplements as prescribed.

Although risks to people’s health were identified and plans were in place to minimise the risks, there was not a system to identify whether pressure relieving mattresses were set correctly. We identified one person with a mattress that was set too high for their weight which may mean they were not protected from developing a pressure ulcer. We discussed this with the registered manager who took immediate action to ensure the mattress was set correctly.

Medicines were stored and administered safely; however, one person had a topical medicine that had expired. This meant it may not be effective. We brought this to the attention of the nurse who removed it immediately and arranged for a further supply to be delivered.

People told us they enjoyed the many and varied activities. People who were living with dementia benefitted from an interesting and stimulating environment.

The provider, registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions or who may be deprived of their liberty for their own safety.

People, relatives and staff were complimentary about the registered manager and the management team. The registered manager sought feedback from people and their relatives and was continually striving to improve the quality of the service. There was an open culture where people and staff were confident they could raise any concerns and these would be dealt with promptly.