This inspection took place on 28 November and 4 December 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Picktree Court Care Home 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.

Picktree Court Care Home accommodates up to 88 people in a purpose built, five storey building. Accommodation is provided across three separate floors. During our inspection there were 80 people using the service. Some of the people had nursing care needs and some people were living with a dementia type illness.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 last inspected the service in March 2015 and rated the service as ‘Good.’ At this inspection we found the service had improved to ‘Outstanding’ and met all the fundamental standards we inspected against.

The service was exceptional at supporting people with their dietary needs. A healthcare professional described the service as “outstanding” and “highly proactive in managing swallowing difficulties.”

The Provider had a holistic approach to assessing, planning and delivering care and support. They were instrumental in the development of a monthly multi-disciplinary team meeting between the home, the GP practice and the local mental health team. This was established to support people at the home with the most complex needs, such as dementia.

There was a strong, visible, person-centred culture at the home. Without exception, people who used the service and family members told us staff were very caring. Staff treated people with dignity and respect, and enabled people to maintain and regain their independence. Thank you cards sent to the home provided evidence of the kind and caring nature of staff.

Positive comments about the service had been posted on the NHS choices website feedback page. These included, “I can give nothing but five stars, more if I could to this wonderful care home”, “I will always feel and know that I made the right decision in choosing Picktree Court for my mum to be cared for”, “If you are looking for a Care Home for a loved one, look no further than Picktree Court. You won't be disappointed” and “Picktree Court Care Home is a fabulous example of what a care home should offer.”

Staffing rotas were specifically formulated to ensure people’s needs were met and staffing levels varied depending on the needs of the people who used the service. Records showed that staffing levels consistently exceeded the number of staff required as per the provider’s dependency tool and we saw there were sufficient numbers of staff on duty during our inspection visit to keep people safe and engage in activities.

The registered manager and staff understood their responsibilities with regard to safeguarding and staff had been trained in the protection of vulnerable adults. The service has implemented the use of the ‘Herbert Protocol’. The Herbert Protocol is a national scheme which encourages carers to compile useful information that can be used in the event of a vulnerable person going missing.

Systems were in place to create a safer environment for people who used the service, visitors and staff, and helped to determine how improvements could be made following incidents.

Medicines were safely stored and administered. The administration and recording of medicines was carried out using an electronic, hand held device that used a barcode scanning system. This reduced the risk of medicines errors.

The home was very cle

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person said “The staff do ask my permission (before providing care or treatment).”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us they were happy with the care and support they received. One person told us "I like it here very much, all of my needs are met” and another person said “I think it’s lovely here and the food is excellent.” Other comments included “It’s like a home from home”, “All the staff are kind, you’ve only got to ask and they do it” and “It’s absolutely fantastic, the way we are looked after, there couldn't be a better place.”

People told us their rooms were kept clean and they were happy with the standard of cleanliness throughout the home. Three visitors told us “The care here is excellent. One visitor said “It’s always spotless, I can find no fault at all with the environment and the care my Mother receives."

There were sufficient staff employed to meet the care, treatment and support needs of people who used the service. We also saw the professional registrations of nurses were checked to ensure they were up to date.

People were protected from the risks of unsafe or inappropriate care and treatment. This was because people’s personal records, including medical records, were accurate and fit for purpose.

All the people we spoke with said they were happy at Picktree Court. One person said "It's like a home from home" and another told us "We're happy here, we've always got each other." People said they had been given the opportunity to look around the home before deciding to live there.

People told us they were happy with the care and treatment they were receiving. One person said "We're getting well looked after here" and another person said "The attention we get is marvellous."

People said they were happy with the staff and the care they provided. One person said "They (the staff) are very good to me here" and another person said "They all know our names" and "The staff's really good - they are there if you did need help." People said they felt safe with the care staff employed by the service.

People said they were aware of the complaints system. One person told us "I can't complain about anything", another said "He's (the manager) really good, he sorts things out" and another added "I've got no complaints, everything's here that I want." All of the people we spoke with said they hadn't had any reason to complain.

We inspected this service over two days on 2 and 3 March 2015 and the inspection was unannounced.

Picktree Court Care Home is registered to provide accommodation, nursing and personal care for up to 88 people. The service is set over three floors and is situated in its own grounds in Chester le Street on the outskirts of County Durham. At the time of our inspection there was a registered manager in place.

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 who used the service, their relatives and friends told us they were happy and safe in the home. One of the people who used the service said, “Safe, why should I not feel safe. My room is warm and lovely and the staff are so nice” and the relative of another told us, “This is a good home. We had a good look around before [relative] came here and we were impressed with all aspects of the place”.

There was clear guidance for staff on how to identify signs of abuse and how staff could report concerns. In addition we saw information regarding safeguarding on display in staff offices and were told by the registered manager that safeguarding was discussed during all staff supervisions and appraisals.

The registered manager showed the service was pro-active in terms of safeguarding and not only made appropriate notifications in relation to concerns within the service but also provided evidence of safeguarding concerns in relation to people who had received care from others.

The provider had policies and procedures in place for the storage and administration of medicines. We saw policies included instructions for staff regarding prescribed medicines, when required medicines and homely medicines, and gave staff clear guidance on the handling and storage of these. Medicines were stored in locked trolleys inside staff offices throughout the home with controlled drugs kept in locked cupboards.

We spent time looking around the service and found the service was a modern purpose built home with a high standard of decoration. All corridors were wide and free of clutter allowing people who used the service to move around freely. The entire service including, individual rooms, en-suite bathrooms and communal and public areas were clean and tidy. Specialist equipment was found to be clean and stored in appropriate areas.

All staff in the service had received training in infection prevention and control and an infection control champion was in place. Personal protective equipment was provided to staff and we saw staff used and disposed of this correctly throughout the day.

We found there were two maintenance people employed by the service and they were responsible for ensuring all repairs were carried out within seven days of them being reported. During our inspection we saw work being carried out to repair a blocked pipe which had affected one of the serveries. Although work was being carried out we found protective sheeting was used to ensure dust and dirt were kept to a minimum and people who used the service were not affected.

People who used the service, their families and staff working in the service told us they were well trained. One person told us, “You can’t fault the staff” and a family member of another told us, “The staff are skilled at what they do”.

The service was pro-active with training and this was provided internally by management, external training specialists, tutors and colleges. The registered manager provided us with the training matrix which detailed all the training staff had undertaken in the previous year as well as the planned training for the next twelve months. Training included mandatory areas like moving and handling, infection control and safeguarding, with additional training in more specialised areas like sensory awareness, preventing falls and fractures, oral health training and verification of death. Staff were also offered the opportunity to complete a National Vocational Qualification (NVQ) in Health and Social Care.

Some of the people who used the service had a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) in place. This was a decision made by the individual or their representative in conjunction with a medical professional, to let people know that they did not wish to be revived if they stopped breathing. Where a DNACPR had been completed we saw documents were kept in the person’s care file. The registered manager told us the service has a sticker system in place which meant anybody who had a DNACPR in place had a sticker placed on their file which made it easy for staff to identify. We saw there was a diary system in place which was used to ensure updates of DNACPRs were carried out in good time and therefore meant they were renewed before the old ones expired.

We saw some people who used the service had medical conditions which meant they were unable to eat certain foods. Where this was the case we saw details were recorded in care plans. We also saw information relating to people’s dietary needs was recorded in the kitchen and all recipes used included details of ingredients used and any potential allergens. This complied with Food Information Regulations which came into force in December 2014.

The service had good links with the local community and we saw representatives from local churches carried out regular services. Local schools held carol services and the service had a volunteer from the local school that provided assistance to the activities team. In addition to this the service had links with local schools and colleges allowing them to offer work placements. We saw people who volunteered in the service were required to have Disclosure and Barring Service (DBS) checks carried out to ensure people who used the service remained safe.

People who used the service and their families told us staff treated them well and they were happy with the care they received. One person told us, “The home is warm and comfortable and I am well cared for, nothing is a trouble”. The relative of one person told us, “They are excellent”, another told us, “The staff are very respectful to [relative]”.

We looked at the care records of eight people who used the service. We saw care plans were written in an individual and person centred way with detailed information about people’s likes, dislikes and preferences. Care records included information about people’s histories and their memories of earlier life. We also saw care records included information about people’s wishes for the future and what they would like to happen in the event of their death.

Staff working in the service had received training in dignity and respect and we saw people who used the service were treated with respect at all times. Staff were observed asking people if they would like assistance with their meals and when help was requested it was given discreetly with staff sitting next to people and talking to them throughout the meal.

People who visited the service told us they felt welcome and did not feel restricted in the time they were allowed to visit. We saw the provider offered food to people’s relatives if they wanted to join their family member for meals and there were a number of areas which people could use, other than their bedrooms, to have private time with their visitors.

Care plans were written and updated with the co-operation of people who used the service, their family or someone else who knew them well. Care plans were comprehensive with individual plans relating to pressure care, bathing, mobility and challenging behaviour, as well as others.

The provider had made arrangements to ensure people with sensory difficulties would be able to communicate with others and would be kept safe in the service. This included induction loops throughout the service, cue cards for people who were not able to communicate verbally and visual and auditory alarms to ensure people were aware if there was an emergency.

The provider had a formal complaints procedure in place and information on how people were able to raise a complaint was in the handbook which was provided to people who used the service and on notice boards around the service.

The provider had clear values and a philosophy of care that was well advertised. People who used the service and their visitors told us the management team were happy to spend time talking with them and was seen walking around the service. One of the people who used the service told us, “I see the manager regularly and he always has a chat”. The relative of another person told us, “When I arrive staff always update me on how my [relative] has been and I know what to expect. I usually have a chat with the manager as well”.

Throughout our inspection we found there was a calm and relaxed atmosphere in the service. Staff worked in a caring and professional manner and people who used the service were treated in a polite and courteous manner at all times.

We spoke with the registered manager about the quality of the service provided and the building. The registered manager told us the service was decorated to the highest standards and he had invested in a number of different areas to ensure the environment was clean, safe and environmentally friendly.

The provider sought the views of people who used the service, their friends and relatives and staff members by asking them to complete surveys. Annual surveys were carried out and the results analysed and fed back to those who had completed the surveys. Results from surveys also triggered action points which were also included in the feedback.

The provider was pro-active in promoting improvement and change in the care sector and this was evident by the participation in various different meetings and associations within the care sector. For example the provider is a member of the Registered Nursing Home Association and the County Durham Care Home Association.

The provider had a quality assurance system in place to ensure the care provided and the surroundings of the home were kept to a high standard. Regular room checks were carried out to ensure carpets were clean, lights were working, there was no damage to furniture, carpets or walls and the room temperature was appropriate. Further checks were carried out around the communal areas to ensure the same standards throughout.