This inspection was carried out on 25 and 26 February 2018. The inspection was unannounced on the first day and announced on the second day.

Plessington Court is a 'care home'. 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.

Plessington Court is a purpose built care home that accommodates up to 20 people and is located on the outskirts of the village of Puddington. The home is surrounded by open countryside and is not accessible by public transport. At the time of our inspection 19 people were living at the home.

The home 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 last inspected the service in October 2015 and rated the service as ‘Good.’ At this inspection we found the service had improved to ‘Outstanding’ in one domain and met all the fundamental standards we inspected against.

Without exception everyone we spoke to was positive about the staff and management team. People and their relatives described staff as knowledgeable, kind, caring and patient. Relatives described staff as welcoming and stated the management team were visible within the home.

Staff had developed excellent relationships with the people they supported and were very attentive to each person's needs. People's privacy and dignity was consistently respected. We observed many positive interactions between staff and the people living at the home.

People's care plans were very person centred and reflected their individual wishes, preferences and choices. Their needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. Risks to people's health, safety and well-being were assessed and plans were put in place to mitigate risks and ensure people received an appropriate level of support to meet their individual need.

People participated in a wide range of interesting activities of their choice to reduce the risk of social isolation. People's individual needs were met by a knowledgeable and skilled staff team that knew people really well. People engaged with their local community and were supported to continually expand their horizons. The registered provider had introduced a programme called Namaste which had enhanced a person’s life. There was a creative approach that supported people to positively engage in activity.

People's individual dietary needs were assessed prior to them living at the home and were regularly reviewed. People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records demonstrated people were supported to access external health care professionals.

Recruitment procedures were robust and only staff of suitable character were employed. There were enough staff to meet the needs of the people living at the home. Staff had the skills and knowledge to support people and were offered opportunities for development.

All staff had received safeguarding training, were familiar with the policies and procedures and understood how to report any concerns they had.

People's medicines were ordered, stored and administered in accordance with good practice guidelines. Staff had received training and regularly had their competency assessed. Medication administration records were fully completed.

The registered provider acted in accordance with the principles of the Mental Capacity Act 2005 (MCA). Records showed and people told us consent was always sought in relation to care and treatment.

Accidents and

This was an unannounced inspection, carried out on 7 September 2015.

Plessington court is a purpose built residential care service which provides accommodation and personal care for up to 20 people including people living with dementia. The home is set in its own grounds and is a two storey building. Access to the upper floor is via a passenger lift or stairs. All bedrooms have ensuite facilities and there are gardens to the side and rear of the property. The home provides care staff 24 hours a day. At the time of our inspection there were 19 people living at the service.

The service has a registered manager. 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 last inspected this location in August 2013 and we found that the registered provider met all the regulations we reviewed.

People were safe and staff understood what is meant by abuse and they were aware of the different types of abuse. Staff knew the process for reporting any concerns they had and for ensuring people were protected from abuse. Staff told us they would not hesitate to raise concerns and they felt confident that they would be dealt with appropriately.

People supported told us “I have only been here for a short while and this is the safest I have felt in a long time”, “I know there is always someone lovely to help me and that makes me feel safe here”. Family members told us they had no concerns about their relative’s safety. They commented; “I know that my family member is safe here, it really is their home now and they would always let me know if there are any concerns”.

Staff were caring and they always treated people with kindness and respect. People were happy with the care that they had received. They told us that “staff always know what I need and are very kind and caring when they help me”. Observations showed that staff were mindful of people’s privacy and dignity and encouraged people to maintain their independence. Relatives and visitors told us that they had no concerns about the care that they observed. They said they had always been made to feel welcome and part of a family when visiting. They felt that the service was warm and homely.

People’s needs were assessed and planned for and staff had information about how to meet people’s needs. People’s wishes and preferences and their preferred method of communication were reflected in the care plans. Care plans we reviewed were personalised and completed in full and reviews always promoted the involvement of the person or other important people such as family members. Staff worked well with external health and social care professionals to make sure people received the care and support they needed. People were referred onto the appropriate service when concerns about their health or wellbeing were noted.

Robust recruitment processes were followed and there were sufficient qualified, skilled and experienced staff on duty to meet people’s needs.

Staff received support through supervision, coaching and team meetings which enabled them to discuss any matters, such as their work, training needs or areas of development. There was a programme of planned training which was relevant to the work staff carried out and the needs of the people who used the service.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had a good knowledge and understanding of the Mental Capacity Act 2005 and their role and responsibility linked to this. Staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and were able to show an understanding of the key principles when asked.

People received their medication as prescribed and staff had completed competency training in the administration and management of medication. Medication administration records (MAR) were appropriately signed and coded when medication was given.

The service was well managed by a person described as supportive, helpful and fair. Systems were in place to check on the quality of the service. Records were regularly completed in line with the registered provider’s own timescales. We were notified as required about incidents and events which had occurred at the service.

We looked at four care plans and they all had an assessment of their health and social needs completed. The care plans were up to date and reviewed on a monthly basis.

We spoke with seven people who used the service, two visitors, three staff and two professionals involved in the service. People who used the service said: “The staff are lovely”, “The food is good” and “the staff are very good.”

Relatives commented: “The staff treat my relative very well”, “I am kept informed of any issues regarding my relative” and “The staff are very attentive.” All the people spoken with said they didn’t have any concerns or complaints.

Staff commented: “The staff team are a good mix”, “The training is good” and “The deputy manager is supportive and helpful.” Staff said the best part of their jobs were supporting and communicating with the people who lived at Plessington Court. Other professionals commented “The staff are very professional”, “The home is clean and odour free”, “I think the people who live there are clean and well cared for” and “The staff were friendly and very knowledgeable.” All visiting professionals said that they had no concerns with the service.

We looked at the training and supervision of staff and found that they were well supported.

We observed interactions between the people who used the service and staff and found there was a relaxed and friendly atmosphere between them.

During a tour of the building we found it was clean and odour free.

People told us that they had freedom of movement within the home. One person told us “We can come and go as we please.” and another said “I go to my bedroom whenever I want, I don’t have to tell anyone”. Some people were able to use the lift independently. People were appropriately dressed and looked well groomed, which protected their dignity. The care plans we looked at had plenty of information about people’s likes and dislikes and what they liked to do. People had a choice of what to eat and drink and picture menus were used to help people choose.

The Cheshire West and Chester Local Involvement Network visited the home in 2012 and commented that: “Plessington Court is a Care Home providing an extremely high standard of care where it was obvious to the Link Team that residents are treated with dignity and respect”.

People were patients of three different medical practices and could have a visit from their GP whenever needed as the doctors made regular visits to the home. A full review of each care plan was carried out monthly and written invitations were sent out to families to ask them whether they would like to attend a review of their relative’s care.

We found that all areas of the home were decorated and furnished to a good standard and all parts of the building were clean and free from clutter. An environment risk assessment was in place covering all areas and equipment and this was reviewed every month and updated as required.

We spoke to people who use the service and they said:

“The staff are very nice.”

“I like living here.”

“The food is very good.”

We spoke with relatives of the people who use the service and they commented:

“My relative has been here six months. The staff are wonderful and we have no concerns or complaints. We often eat with our relative and the food is very good. We looked around several homes in the area and decided this would be the best one for our relative.”

“My relative has been here two months. We chose the home for Mum as she was not able to do this for herself. The staff are lovely and Mum is looked after very well. We don’t have any problems or concerns. It would, however, be nice to have another lounge or conservatory”

We spoke with staff and they commented:

“The staff team is good and we work well together. I get good team support.”

“I have been here a couple of years. It is very homely here and there is a good team of staff. The manager is supportive and a good listener. I have completed a wide range of training and it is good.”

“I have worked here a year. I enjoy being here. The manager is very good and the deputy is very helpful. The training is good and I have completed NVQ 3 training.”

During discussions this staff member showed their knowledge and understanding of adult abuse and what they would do if they suspected abuse of a resident. They described the support that different people need within the home and that each person is an individual with needs that are specific to themselves.