This inspection took place on the 19, 20 June and 5 July 2017 and was unannounced on the first day.

Rose Court Nursing and Residential Home is situated in a residential area of Radcliffe near Bury Greater Manchester. The home is purpose built and provides care and accommodation for up to 109 people. People are cared for with a wide range of needs, from residential care to nursing. The home is set on three levels. There are lounges, dining areas and bedrooms on all three floors. All bedrooms are single accommodation. There were 86 people living at the home at the time of our inspection.

At the last inspection in June 2015 the service was rated Good. At this inspection we found the service remained Good, with an outstanding rating in the Well-Led section of the report.

Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

We found staff had been recruited safely and the service had sufficient staffing levels in place to provide the support people required. We saw staff could undertake tasks supporting people without feeling rushed.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked around the building and found it had been maintained to a good standard, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required. We saw care workers assisting people with mobility problems. They were kind and patient and assisted people safely.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required to administer medicines to people safely. Medicines were safely kept with appropriate arrangements for storing in place.

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

Staff we spoke with and records seen confirmed training had been provided to enable them to safely support people who lived at the home. We found staff were knowledgeable about the support needs of people in their care.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

People had access to healthcare professionals and their healthcare needs were being met.

People who lived at the home told us they were happy with their care being provided and liked the staff who looked after them. We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards the people in their care.

We saw people who lived at the home were clean and well dressed. They looked relaxed and comfortable in the care of staff supporting them.

Systems were in place to help ensure people received the care they wanted when they were nearing the end of their life.

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received.

People who lived at the home and their visitors told us they enjoyed a wide variety of activities which were organised for their entertainment and to promote their wellbeing.

The service had a complaints procedure which was displayed in the entrance hall. Records of all complaints, concerns and compliments made were kept at the service.

There was a strong commitment to continually strive to improve the service. The registered manager w

People were provided with a choice of suitable and nutritious food and drink. People who we had lunch with told us they liked the food and if they did not like the choices on offer then they could ask for an alternative. They said the food was “very good” and “delightful”.

All the staff we spoke with regardless of their role told us that they had received safeguarding training and that they would have no hesitation speaking to the manager if they had any concerns about the treatment of people living at the home. They also said they could challenge each other’s practice regardless of role.

We saw copies of four recent relatives feedback questionnaires from Clarence and Windsor units. Relatives thought the home was clean and tidy and the laundry service was good.

At the time of our visit the home’s overall appearance was "tired". However we were told that a major refurbishment of all the floors of the building was due to start at the end of September 2013.

People we spoke with said that the staff team were “very nice,” “I get on well with all the staff. I help them where I can as they work very hard” “I am happy with all they are doing for me” and “staff are very kind”.

We spoke with three people using the service and with three relatives. People using the service told us they were involved in making decisions about their care and treatment. They also told us that they had a choice in how they spent their day. Comments made were; “It is very easy going, I do my own thing”. “I spend quite a bit of time in my room; as you can see I have lots to occupy myself with”. Relatives told us; “I have no complaints; the staff are nice and they look after her very well”. “I trust them, they do a good job”. “Very professional staff and they keep us informed”.

People's care records contained detailed information to show how they were to be supported and cared for. People told us they were well looked after. They told us; “The staff are wonderful and they look after us very well”. “They are all great and know what they are doing”.

The medication system was safe and people told us they received their medicines when they needed them.

Regular monitoring of the services and facilities provided was in place to help protect people against the risks of inappropriate or unsafe care.

This was an unannounced inspection which took place on 24 and 25 June 2015. We had previously carried out an inspection on 12 September 2013 when we found the service had complied with all the regulations we reviewed.

Rose Court provides accommodation for up to eighty seven people who have nursing and personal support needs. Rose Court is a purpose built home that has recently been extensively refurbished with the aim of becoming a centre of Excellence for Dementia Care. The home is on three floors. Clarence Unit on the ground floor is a residential unit, Windsor Unit provides both nursing care and personal support to people while Wilton Unit on the 2nd floor provides nursing care and support to people living with dementia. However there are people who use the service on all units who may have a diagnosis of dementia.

The service had a manager who was registered with us. 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 and associated Regulations about how the service is run.

People told us they felt safe at Rose Court, “Yes I feel very safe here. Better than where I was before. Staff are like good friends. Make sure I am safe and keep an eye on me. Take me the shop for my cigarettes”, “I feel very safe with all the staff. You can talk to any of them and they will listen” and “No trouble at all with feeling safe. The staff are all very nice. If I was worried I would tell my son and he would speak to them about it.”

Staff had received training in safeguarding adults and whistleblowing. They were able to tell us of the correct action to take should they have any concerns about people who used the service.

People who were able to mobilise safely and independently were free to walk about and go out into the securely fenced garden areas where there are marked paths, rails and ample seating areas with protection from the weather. One relative said, “[My relative] has been in three homes and this best by far as she can walk about and go outside. Staff will go and find her when we come if she is not about.”

There were systems for managing medicines, infection control, risks and health and safety.

The home had recently been fully refurbished and had fully taken into account the needs of people who live with dementia in the design.

People who used the service and their relatives thought that staff had the necessary knowledge and skills to provide the care that was needed and that there was sufficient staff to meet people’s needs. We spoke with two new members of care staff who had previous experience of working in other homes. They said, “I love it here. The training is amazing. They throw it at you and I will take it. It’s properly run” and “It’s a fantastic team. All good.”

Staff understood their responsibility to support people to make their own decisions wherever possible and always asked for consent before carrying care tasks.

People told us that they enjoyed the food provided by the home. We saw that drinks and snacks were always available to people who used the service

A person who used the service said, “No messing if I am not well they call the GP straight away here.” Relatives told us that if the person who used the service needs changed or there were any concerns and that they were good at seeking professional health care advice.

People who used the service told us that staff were kind and caring. This was confirmed by our observations during the inspection. The atmosphere was calm and relaxed.

Systems were in place to help ensure people received the care they wanted at the end of their life.

People told us that they are given choices about everyday things and that staff respect their choices. This included when to get up, go to bed, what to wear, what to eat, how and where to spend their time. People told us, “Lots of choices. I can come and go to my room as I like.” “Go out in the garden for a smoke. Staff look after cigarettes but only have to ask. Choose whether I have shower or bath and when I want to have it.”

There was a wide range of activities for people to get involved in they wanted to which included people living with the advanced stages of dementia.

People we spoke with told us they thought the home was well-led and that unit managers and seniors as well as the registered manager were readily available and approachable at all times. The registered manager promoted a whole team approach to the running of the home.

Systems were in place to monitor the day to day running of the home and review the quality of the service provided.