We inspected this service on 18 January 2018. Barton Cottage is a short-stay care home for 12 people. The unit is located in a wing of The Barton Health & Community Care Centre. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People were admitted from the local hospital or through the primary care trust instead of receiving treatment in hospital. Nine beds were allocated and funded for rehabilitation, intermediate and palliative care and three beds provided respite care for people with significant long term neurological conditions, such as Parkinson’s disease. The accommodation includes a combined lounge and dining room, a visitor’s room, a games room and enclosed garden. On the day of our inspection visit, ten people were staying at the home.

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.

At the last inspection, the service was rated as Good. At this inspection, we found the service had improved their rating to outstanding in Effective by demonstrating that they worked in partnership with a number of organisations to ensure people’s care and support needs were met holistically. We found the service remained Good overall.

Staff worked closely with other professionals to ensure people’s specific health needs were met and they were supported to regain their independence and return home as soon as possible. Staff looked for new approaches and equipment to improve people’s care offering them maximum independence and choice. Improvements had been made to the premises which encouraged people to engage in activities and provided private space for people to spend time with their families. People enjoyed a wide range of food and drink, and the importance of eating and drinking well was promoted by all staff. Staff received appropriate training to meet the needs of people at the service and they were supported and encouraged by the provider to develop their skills and knowledge. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We saw the policies and systems in the service supported this practice.

People continued to receive safe care. People were protected from the risk of avoidable harm by staff who understood their responsibilities to identify and report any signs of potential abuse. We saw that concerns were taken seriously and investigated thoroughly to ensure lessons were learnt. Risks associated with people’s care and support were managed safely and relatives were confident their family members were safe and well cared for. People received their medicines when needed and there were suitable arrangements in place in relation to the safe administration, recording and storage of medicines. There were sufficient, suitably recruited staff to meet people’s needs.

The care people received remained good. People liked the staff and had formed positive, caring relationships. Staff were kind and caring and supported people to make choices about their care. People’s privacy and dignity were maintained at all times.

The service remained responsive. People’s support plans reflected their views and were reviewed when their needs changed. People were supported at the end of their life to have a comfortable, dignified and pain-free death. People’s diversity was recognised and promoted by the staff and people were supported to follow their religious beliefs and to maintain important family relationships. People were supported

This inspection took place on 21 December 2015. The inspection was unannounced. Our last inspection took place in December 2013 and at that time we found the provider was meeting the regulations we looked at.

Barton Wing provides care for up to 12 older people. Nine beds were allocated and funded for rehabilitation, intermediate and palliative care. People were admitted from the local hospital or through the primary care trust instead of receiving treatment in hospital; three beds provided respite care for people with significant long term neurological conditions, such as multiple sclerosis.

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.

Staff had a good understanding and knowledge of safeguarding people and understood what constituted abuse or poor practice. Where harm or abuse was suspected, the staff knew how to respond to protect people.

There was sufficient staff to provide care and support for people’s assessed needs. People felt safe and their risks were assessed and reviewed to protect them from harm. People were provided with care that met their preferences and were supported to gain the skills they needed so they could move on. Staff and health care professionals were available to support people with their specific needs and people’s medicines were managed and administered safely.

Staff received regular training which ensured they had the knowledge and skills required to meet people’s needs. Staff told us the management team were approachable and that they listened to them and supported them to develop their skills.

People were offered a choice of food and drinks to maintain their health and wellbeing. Specialist diets were catered for and alternative meals could be provided upon request. People received support to remain independent at meal times and where they needed support, this was done in a caring and supportive way.

People made decisions about their care and staff sought people’s consent before they provided care and support. The staff knew people well and treated them with kindness and compassion and their privacy and dignity was respected. People were encouraged to maintain relationships with family and friends and continue to maintain their interests.

People knew how to raise any complaint or concern. Complaints procedures informed people how they could make a complaint and if they had any issues, they felt able to raise them with the staff or management.

People were encouraged to feedback their experiences and these were acted on to improve the quality of care provided.

People told us they were happy with the care they received and staff were responsive to their needs. One person told us, “It’s fabulous here; they can’t do enough for you and they are helping me back on my feet.”

We observed interactions and saw that people were relaxed with staff. Staff had a good understanding of the needs of people using the service and treated people with respect.

The staff had the skills and knowledge to support people using the service.

People using the service had care records which recorded how they wanted to be supported.

People told us they could make choices about their food and drink. People were provided with a choice of food and refreshments. Snacks and drinks were available throughout the day.

We carried out this inspection to check on the care and welfare of people using this service and as part of our schedule of planned inspections. The inspection was unannounced which meant the provider and the staff did not know we were coming. We spoke with three people using the service, two visitors, the registered manager and a visiting health care professional.

People told us they could express their views and were involved in decision making about their care. They said they had been involved in the assessment of their care needs and had agreed with the care to be provided. They said they were treated with respect and dignity. One person told us, “The staff are very respectful and always make sure I keep my dignity.”

We were told by people using the service the staff team provided sensitive and flexible personal care support and they felt well cared for. The people we spoke with said they felt safe and protected from potential harm. They said they were happy with their care and the staff were responsive to their needs. We were told they were consulted about the service being provided and felt their views were listened to.

Staff had a good knowledge of the care needed and what people wanted. People told us, ‘You couldn’t stay anywhere better than here. Everything is top class.”

People told us they were provided with a good choice of food and refreshments and were asked what meal they would like to eat.

We carried out this review to check on the care and welfare of people using this service. Information we hold about the service showed us that we needed to undertake a monitoring visit, in order to update our records, and to establish that people's needs were being met. We concentrated on finding out how the care was provided and looked at the quality of the service.

People told us the staff were friendly and responsive to their needs and they liked the staff, who treated them with respect. People said they were encouraged to do as much for themselves as possible, and people understood they needed to be as independent as possible for when they returned home.

People who used the service were involved in developing their care records, and there was a copy of their care record available in their bedroom. Where changes were made people told us they knew why their care had been reviewed and staff asked people for their agreement. People were confident that should there be any reason to complain or raise a concern this would be dealt with appropriately and staff would listen to their views.

We were informed people were supported to access the community and with staff support could visit the shops, walk, or use their mobility equipment and visit local places. Staff told us it was important that people retained their contacts and routine for when they returned home.

We asked people who used the service if they felt safe and all people we spoke with commented that they felt safe and told us the staff treated them well. People told us they were satisfied with the service and comments included, “They are very patient and understanding” “It’s like a home away from home, everyone makes you feel relaxed and they are all so friendly.” “I wish all places were like this, the staff are excellent.”