The inspection took place on 22 February 2018 and was unannounced.

Alderwood 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. Alderwood Care Home is registered to provide accommodation and personal care with nursing for up to 65 older people who may also have dementia. Care is provided on three floors, residential, people living with dementia and people who have nursing needs. At the time of our inspection 65 people were living in the service.

At the last inspection in 2016, the service was rated Good. At this inspection, we found the service had continued to develop and was therefore rated outstanding.

The service had 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.

We found the service was very well managed. The service had a full complement of nurses with the necessary skills to meet the needs of the people using the service. This meant people received continuity of care from highly skilled staff. There was an established management team who regularly supported and audited the service to ensure it provided high quality care.

Staff were extremely motivated in their role and valued their focus was on the people that used the service. The manager was enthusiastic and motivated. They were visible and actively involved in supporting people and staff. Staff morale was extremely high and they felt listened to and that their views were valued.

The provider worked extremely hard with the management team to ensure all staff felt valued and appreciated.

Staff had excellent relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times. S

People were encouraged to follow their interests and hobbies and to engage in meaningful person centred activities. People were kept stimulated and engaged and the providers helped ensure that people continued to live a full a life as possible and to have their wishes fulfilled. They were supported to keep in contact with their family and friends. The service worked extremely hard with relatives and friends to ensure everyone was supported at all times. People’s care plans were individual and contained information about people’s needs, likes and dislikes and their ability to make decisions.

The service was brightly decorated and stimulating for the people living there. The communal areas were decorated to a high standard were clean and furnished giving an overall homely feel. The outside area had accessible gardens with benches and easy access for people with limited mobility.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. Medicines were managed safely by staff that had been trained and assessed as competent to administer medicines and there were sufficient numbers of care staff with the correct skills and knowledge to safely meet people’s needs.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and are required to report on what we find. The MCA sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The DoLS are a code of practice to supplement the main MCA code of practice. Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act.

People

The inspection took place on 29 June 2016 and was unannounced.

Alderwood Care Home provides accommodation and personal care with nursing for up to 65 older people who may also have dementia. Care is provided on three floors, people living with dementia and people who have nursing needs live on separate floors.

The service had 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.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and are required to report on what we find. The MCA sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The DoLS are a code of practice to supplement the main MCA code of practice. Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act.

Staff had excellent relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times.

People had sufficient amounts to eat and drink to ensure their dietary nutritional needs were met. The service worked well with other professionals to ensure that people’s health needs were met. People’s care records showed that, where appropriate, support and guidance was sought from healthcare professionals.

People were encouraged to follow their interests and hobbies and to engage in meaningful activities. The service went above and beyond to support people in a person centred way with activities. They were supported to keep in contact with their family and friends. People’s care plans were individual and contained information about people’s needs, likes and dislikes and their ability to make decisions.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were appropriate arrangements in place for medication to be stored and administered safely, and there were sufficient numbers of care staff with the correct skills and knowledge to safely meet people’s needs.

People received support that was personalised and tailored to their needs. They were aware of how to complain and there were a number of opportunities available for people to give their feedback about the service.

Staff were motivated in their role and felt valued their focus was on the people that used the service. The manager was visible and actively involved in supporting people and staff. Staff morale was high and they felt that their views were valued.

The management team had systems in place to monitor the quality and safety of the service provided, and to drive improvements where this was required.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The last inspection took place in February 2014 and the service was found to be meeting the requirements. This inspection took place on 15 August 2014 and was unannounced, which meant the provider and staff did not know we were coming.

Alderwood Care Centre provides nursing and residential care for up to 65 older people, including people living with dementia. On the day of our inspection there were 64 people using the service. The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. A registered manager was in post at the time of the inspection.

The procedures to manage risks associated with the administration of medicines were not always followed by staff working at the service.

We found the staff knew what to do if they had any concerns about people’s welfare. Staff had received training on safeguarding adults, the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). They also knew how to manage risks to promote people’s safety, balanced with their right to take risks.

People were supported by appropriately recruited and trained staff that had the skills needed to carry out their duties. The staff knew the needs of the people they supported. They worked in a way so as to promote people’s independence. People had access to health and social care professionals as and when they needed them. Prompt action was taken in response to illness or changes in people’s physical and mental health.

People told us that they were pleased and happy with the care and support they received at the service. They told us their likes, dislikes and preferences were central to how their care was provided. The staff respected their choices about all aspects of their lives.

The registered manager and designated staff consistently monitored and reviewed the quality of care people received at the service. Management audits were carried out on all aspects of the service, such as people’s care records, staff recruitment records, the environment, building upkeep and equipment.

The service encouraged feedback from people using the service and their representatives, to identify, plan and make improvements to the service.

The service is split into three floors which provided specific services to people. The ground floor supported people with residential needs and included people with early onset Dementia. The first floor was a specialised dementia service and the second floor was a nursing service for people and also those people living with dementia. We spoke with nine people who used the service, five members of staff and the manager. Overall people were happy with the care they received at Alderwood Care Home.

We examined the care records of nine people who used the service. We saw evidence that care provided to people met their individual needs, their care plans were well formulated and were person centred and specific to the individual. This meant that people were provided with safe and effective care at the service.

We found that people were mostly treated with respect. We observed some positive and supportive interactions between staff and people who used the service. Where some negative interactions were noted the manager had a clear plan in place to improve dignity in care.

We found there were insufficient staff on duty at the time of our inspection to support the needs of people using the service. We viewed the staff roster, spoke with five members of staff and undertook observations as part of our judgement.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noting how they interacted with other people living in the home and with staff.

During our inspection we spoke with people who told us they liked living at Alderwood. We saw that people appeared relaxed and comfortable with staff and others living in the home.

Relatives were complimentary about the standard of care provided at Alderwood. One relative told us that they were, “Happy with the way staff provide care.”

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.