The inspection took place on 14 December 2016 and was unannounced. This was a comprehensive inspection.

Redcot Residential Care Home is a residential home providing support to older people, some of whom are living with dementia. The home is registered to provide care for up to 32 people. At the time of our inspection there were 23 people living at the home.

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 were kept safe from abuse as staff understood their role in safeguarding people. Risks to people were assessed and plans were in place to minimise risks to people. Where incident had occurred, measures were taken to prevent a reoccurrence.

There were enough staff present to meet everybody’s needs. We did receive feedback that at weekends staff were sometimes stretched. We have recommended that the provider reviews their deployment of staff. Staff had undergone checks to ensure that they were appropriate for their roles.

People were supported by staff who knew them well. Staff provided support in a way that promoted people’s independence, privacy and dignity. Care plans were person centred and people’s needs were reviewed regularly to identify any changes.

People lived in an inclusive atmosphere in which they were consulted on issues that may affect them. People were encouraged to make their own choices and decisions. Where people were not able to make decisions, their rights were protected as staff worked in accordance with the Mental Capacity Act 2005.

People had access to a wide range of activities. People were provided with a choice of food that matched their dietary requirements.

People’s medicines were administered safely by trained staff. Staff worked alongside healthcare professionals to ensure that people’s healthcare needs were met.

The provider asked for people’s feedback in order to identify improvements that they could make. There were a number of audits in place to improve the quality of the care that people received. People had a good relationship with management and were aware of how to raise a complaint.

Staff had input into the running of the home and told us that they felt supported by management. Staff received regular supervision and appraisals and told us that they had access to the training that they needed in order to ensure that they were effective in their roles.

Systems were in place to reduce the risk of fire and to ensure people’s health and safety. A plan was in place to ensure that people’s needs would continue to be met in the event of an emergency.

A single inspector completed this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you wish to see the testament that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Domestic staff worked daily and used guidance in the form of checklists which ensured all areas within the service were cleaned regularly. Equipment used to care for people had been serviced within the last twelve months and there were sufficient quantities available to meet the needs of people. The deputy manager told us about a person who had been diagnosed with an infective illness and we saw they were in the process of "deep cleaning" their room during our visit. They told us they had been promoting their infection control policies with staff by providing extra training and were "pleased" that no other resident had complained of any symptoms.

We reviewed the staffing rota and saw that there were enough staff on duty to meet the needs of people. The manager identified challenges within the size of the building which impacted on the care they provided for people and told us about their intention to improve the call bell system and increase minimum staffing levels. This meant people could have access to staff more often. Staff told us they worked as "doubles and singles" during the day which ensured people who required two care staff to support their needs did not wait long periods for care to commence.

We spoke with four members of staff who told us they had received mandatory training within the last year in line with the providers training policy. The manager told us fifty per cent of staff had received their mandatory training within the last year. They told us they had recently started using a new format to deliver training which meant not all the staff were up to date. A plan had been put in place which meant staff would receive the training over the coming months.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted, proper policies and procedures were in place to protect people against unlawful restraint.

Is the service effective?

People told us they were happy with the care they received and felt their needs were met. People told us the staff were "extremely kind" and "wonderful". They told us they felt staff enabled them to remain "independent" and "don't get impatient" with them

We observed the staff caring for people and saw that they were knowledgeable about people's treatment. We observed a member of staff who had a discussion with a person about their health needs. They encouraged them to rest as they had been advised by the local GP and demonstrated good knowledge of their prescribed medication. People's on-going health needs were documented in the care plan and staff ensured treatment had been given according to the direction of external professionals.

Is the service caring?

Staff who supported people were kind and caring. We observed staff caring for people and saw they spoke to them kindly and respectfully. People were offered choices about their care and staff told us they "knew people well". People we spoke with confirmed this and told us "it feels like home". The building had an area for people of religious faiths to gather and people from external organisations were encouraged to visit. People told us the staff were "very attentive" and they were given choices about their daily routines. They told us they could change aspects of their care if they wanted to and the staff supported them well.

Is the service responsive?

People's needs were assessed before they moved into the service. We reviewed the care plans for three people and saw a wide variety of assessments were completed which identified people's needs. Care plans were individualised and consideration had been given to people's wishes. Care had been reviewed regularly which ensured people were given choices about their on-going care.

People had access to a variety of activities and told us they felt it enabled them to stay "independent". They told us they were supported to access activities out of the home if they wanted to and family and friends were encouraged to visit. People's records confirmed people's interests and preferences

Is the service well-led?

The acting manager told us they had been in post for two weeks but had transferred from another service owned by the provider. Staff we spoke to had a good understanding of the ethos of the service and quality assurance processes were in place. People were able to provide feedback and used a variety of methods including: comments books, resident survey's and meetings. We could see changes had happened as a result of feedback from people as a "date board" had been displayed in the main lobby and changes had been made to the menu. Comments books were visibly available for people and staff wrote comments alongside which detailed actions that had happened as a result of feedback.

Staff we spoke with were clear about their roles and responsibilities and were able to tell us about how they escalated concerns and learnt about changes to the service. There was a clear management structure within the service and staff were supported by senior care staff everyday. They told us training was provided which ensured they could care for people's needs and "team building exercises" were offered which they felt had been a good way of "getting to know" their colleagues. Staff meetings were held regularly and staff told us they felt the management team "listened" to their ideas and "changes happened" as a result of these meetings.

We spoke with eight people during our visit. They told us that they were very happy with the home. One said, “It’s jolly good”. Another told us, “They’re all very nice and kind”. We saw that everyone who had responded to a recent residents’ survey had said they would recommend the home to others.

We spoke with three relatives. They also expressed their satisfaction with the home and the care provided.

We spoke with four members of staff, including the deputy manager. They told us that they had a good and stable team and that they enjoyed working at the home. One carer said, “I really like the work here. We get so much support from our seniors and we are taught whatever we want to know”. Another told us, “Everyone is pleasant and willing to learn more”.

We found that the home was spacious and bright and that people looked well cared for. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered. Staff were welcoming and we saw that they supported people with kindness and respect. People told us that they could approach staff or the manager if they were unhappy or had ideas to discuss.

We spoke with people and their relatives who told us that they were treated as individuals and that they were given information and choices in relation to their care. One person said that "the staff are really nice, one in particular is wonderful, they will do anything, nothing is too much trouble’’. People told us that their dignity, independence and privacy was respected. This was confirmed by our review of people's records as well as our observations.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided before doing so. We saw that activities were altered to suit individual needs.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs. Any equipment or adaptations needed were provided.

People who used the service told us they were involved in the planning of their care; that their named care worker discussed their support options and treatments with them and their family. People said they were provided with the service user guide and a contract of residency, outlining costs and services which either they or their relatives signed.

People who used the service told us that they visited and spent time at the service before making an informed decision that the service could meet their needs. They told us prior to admission an assessment was undertaken at their home, and another fuller assessment with them and their relatives were again completed when they came into the service. They told us their plan of care needs was based on their individuality, such as religion, likes and dislikes,social and day time activities and to maintain relationships with their families.

People who used the service told us they were able to make choices in their meals. They told us they could have a cooked breakfast if they wanted, and this was served either in the dining room or in their bedrooms. Some people tend mostly to have a light breakfast which they provided for themselves in the kitchenettes attached to each unit on each floor. They told us a strict eye is kept on their weight as they are weighed often. One person said they have a choice of two hot meals at lunch time or the chef will make something for us if we do not feel for what is on the menu even if it is at the last minute. People said the food was mainly good and the servings were ok. However, during the lunch period one person who used the service complained to us that the braised beef was too tough to cut. We tried cutting the beef and did not find it tough. Another person said the pastry on the Quiche was too dry but refused to have a different meal, saying they liked it. Most of the people spoken to during the luch time said they were enjoying their meal.