About the service: Needham Court is a residential care home that provides care for up to 57 older people and people living with a dementia. On the date of this inspection there were 57 people using the service.

People’s experience of using this service: People, their relatives and visiting professionals told us the people living at Needham Court received a good level of care. They told us staff knew and fully understood people’s needs.

People told us they felt safe. The provider had safeguarding policies in place and records confirmed this process was followed. People told us there were enough staff to look after them. Recruitment of staff remained good. Care plans included individual risk assessments, which were regularly reviewed to keep people safe. Medicines continue to be managed safely. Regular premises safety checks were carried out.

The provider worked closely with various healthcare professionals. People also had access to healthcare services such as GPs, dieticians and dentists.

Staff received support from the manager and deputy manager via supervision meetings. Staff also had access to training which supported them in their role.

People were supported to maintain a healthy diet and people told us they enjoyed their meals. The home was very clean and well furnished. People’s rooms were well decorated and had been personalised with people’s own belongings. The first floor had been designed to support people living with dementia.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, policies and systems in the service supported this practice.

People and their relatives were involved in the creation of care plans. Care plans were reviewed on a monthly basis or sooner if people’s needs changed. Care plans were updated to reflect changes made.

People were encouraged to provide feedback of their experience. Regular meetings were held with people and their relatives to discuss ideas for improving the home. People were encouraged to participate in a range of activities both internal and external to the home.

People, staff, relatives and healthcare professionals spoke in positive terms about the manager and deputy manager. Staff told us the manager was both supportive and approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published October 2016).

Why we inspected: This was a planned inspection based on the rating at the previous inspection.

Follow up: We will return to re-inspect this service within the published timeframe for services rated as good.

The inspection took place on 17 May 2016 and was unannounced. We previously inspected the service on 30 September 2013 and found the service met the regulations we inspected against at that time.

Needham Court is a purpose-built three storey care home that provides personal care and support for up to a maximum of 57 people, some of who are living with dementia. At the time of our inspection there were 55 people using the service.

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. People, relatives and staff spoke very highly of the registered manager and felt they managed the running of the home extremely well. Staff were very enthusiastic about how approachable both the registered manager and deputy manager were and how they felt supported in their roles as management had a vast amount of knowledge, skills and expertise. The registered manager was very committed and passionate about providing an excellent service and had implemented systems to monitor and drive improvement and excellence.

People told us staff were skilled and experienced to meet their needs. The registered provider had its own academy where staff attended a wide range of training courses. Staff received regular training in core subjects as well as additional training specific to meet people's needs such as dementia awareness. Staff had opportunities to go on advanced courses when they expressed a wish to excel in particular subjects suitable to their role as well as to further their career. Staff told us they felt enabled and empowered to attend new courses and specialise in particular areas. They were able to explain how they implemented new found knowledge from training into their working roles. Staff felt valued and supported to attend training at the registered provider's dedicated academy and transport was provided for those who required it.

Staff told us they felt supported and received regular supervision, observations and competency checks. They also received annual appraisals which they used to express specific goals and plan future development. Staff told us they found supervisions and appraisals useful as they could discuss career aspirations and long term goals as well as short term development opportunities and successes. Staffing levels were monitored by the registered manager to ensure they met people's individual needs. Staff provided input into staffing levels which the registered manager considered and increased staffing levels as a result. Staff were recruited safely with all necessary checks carried out to ensure they were fit to support people.

We received excellent feedback from people who used the service regarding the quality of food at Needham Court as well as the level and variety of choice. We saw menus were varied and consisted of two options each meal time, with additional options being readily available also. Staff were very knowledgeable about people’s nutritional and hydration needs and were passionate about ensuring those needs were met. The registered provider had successfully introduced a new method of preparing and serving pureed food so that people with a specialised diet such as dysphasia could benefit from a more pleasurable dining experience. It had also proven successful in increasing people's appetite, restoring their weight to a safe level and maintaining their dignity when dining as their food was moulded to resemble the meal they had chosen and they were able to eat it with a knife and fork. We found people’s dietary needs and preferences were extremely well catered for and they were highly supported to maintain a healthy weight. The home had also recently introduced a new twilight dining e

This review was carried out to check improvements made to the service's procedures about medicines management and record keeping. We did not speak directly with users of the service on this occasion. At both of our previous visits on 16 April and 29 May 2013 we spoke to staff and people who use the service. We spoke with two relatives and a visiting general practitioner during this visit. They told us "Things are alright here and it is the staff what makes this home, they are lovely and really pleasant and supportive". One person said, “The staff are very good they are all very caring in looking after people.”

Staff members were seen to interact well with people and knew them by their first name. There was a choice in what people wanted to do and we observed care interventions being carried out. Staff spoke to people in a pleasant and respectful manner.

People had been individually assessed to see if they could make their own decisions. Care records had enough information so staff would be able to know how to support each person in the right way.

We watched one carer giving people their medicines. People were treated respectfully and safe practice was followed.

We spoke with three people about their medicines. One person said “I sometimes need painkillers and I get them quickly when I ask for them”. Another person told us “they look after my medicines well and I get them regularly”.

One person had chosen to manage some of their medicines and said “the staff always make sure I never run out of my medicines and arrange for more when I need them”.

Overall, we found that medicines were not always safely handled and improvements are needed.

Because some of the people we saw living at Needham Court care home could not give their verbal opinions on the services they received we decided to undertake a Short Observational Framework for Inspection (SOFI) during the lunchtime serving of meals. SOFI is designed to be used when inspecting services for people who have some difficulty in communicating their opinions on the services they receive.

People we did speak with told us they were happy with the care they received and liked living at Needham Court. A visitor we spoke with confirmed they were satisfied with the care their relative received and had no concerns. One person who lived at Needham Court told us, “its okay here. They’re all very friendly. A relative we spoke with said he was very happy with the home and he found he was always made to feel very welcome when he visited.

People we spoke with were positive about the service they received from staff at Needham Court. One person told us "the food is really good and there's always choice. If I don't like what is on the menu they will cook me something else".

People were engaged in activities during our inspection and staff had conversations with people during the day.

We asked one person what they thought about the staff at Needham Court and they told us "they always help and I never have to ask twice".

We spoke with relatives during our inspection and they told us "we're so much happier no mum is here, we don't worry when the phone rings we know she's safe".

One person using the service told us “it’s home” and that the staff “are like one big happy family”.

Relatives of people who use the service told us “we see on the board that there’s a lot going on”. “Mums a picky eater but the cook comes and has a chat with her if she loses weight”.

Other people told us “we’re always involved in her reviews, we try and let mum do the talking though” and “it’s head and shoulders above the rest”.