Ryecourt Nursing Home

Ryecourt 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, both of which we looked at during this inspection.

A registered manager was 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.

At the last inspection on 23 September 2015, the service was rated good. At this inspection, we found the service had improved to outstanding.

During this inspection, we found multiple examples to demonstrate the staff and management team were passionate about providing an innovative, excellent service. A relative told us, "It's outstanding here, there is no other word to describe it." Our observations confirmed staff were highly skilled communicators and able to engage with profound empathy and respect.

The home's ethos was strongly focused on providing highly personalised care. We found very high staffing levels and excellent communication at Ryecourt meant care was delivered efficiently and with a timely approach. All interactions we observed demonstrated a service consistently focused upon the person's dignity.

Staff had in-depth training in equality and we observed they demonstrated their understanding in practice by continuously promoting a highly inclusive environment. It was very clear they respected each person's rights and treated them as individuals. We observed a strong, family-orientated service where staff were not afraid to display their love towards people.

The registered manager went to great lengths to ensure people and relatives had access to different information. This enabled families to gain a greater awareness of their care, which they said was an example of the registered manager going above and beyond.

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 supported this practice. Various

evidence-based tools and best practice procedures were completed by staff to maintain high levels of effective mental health treatment.

All personnel had a very structured and supportive start to their employment, underpinned with shadow shifts and regular supervision. Staff development at Ryecourt was exceptional because the registered manager used every opportunity as a training session. This included tools to ensure learning was put in practice, such as reflective work, meetings, competency tests and learning logs.

The skilled workforce had a massive impact on people because we saw evidence this reduced unnecessary hospitalisation. Systems to effectively monitor and treat pain, anxiety symptoms and depression levels resulted in significantly reduced incidents. For instance, the rate of falls, health infections and pressure ulcers over the last year were cut to minimal or zero levels.

The provider ensured the chef was able to provide individual soft and pureed diets that resembled the original food. People and visitors were highly complementary about meals, choice and staff support. A relative said, "The food is wonderful." Staff deployed prescribed treatment and adapted care planning to protect the most vulnerable individuals from the risks of malnutrition.

We found the continuously fluid method of treatment provided at Ryecourt maximised positive outcomes to people's care. This was because it assisted staff to be more adaptive to their everchanging needs. The registered manager further excelled at providing multiple systems to maximise staff awareness of each person who lived at the home.

The service provided a personalised, caring and excellent end of life care. The sensitive management team approach meant they could obtain a wealth of information to guide staff about each person's end of life preferences. We saw staff showed genuine sensitivity, compassion and love.

Care records contained detailed information to give staff an exceptional understanding of activities people enjoyed and to improve their social engagement. A relative said, "Sometimes they will spend a long time just chatting and being with [my family member] and other times they will play games or read with her. They do more here than I ever could at home."

The registered manager had a variety of surveys and systems to obtain the best possible feedback about the quality of care. One relative stated, "Even though Ryecourt is outstanding, in my opinion, they never stop looking at how they can tweak things. That's a sign of how excellent [the registered manager] is as a manager."

The management team had incredible oversight by scrutinising all areas before issues occurred, which showed they had strong control measures in place. Staff confirmed the management team were keen to listen to their ideas and encouraged them to raise any concerns.

We found staff files contained required documents and checks to protect people from the employment of unsuitable staff.

Information contained in people's bedrooms gave staff immediate access to guidance in an urgent situation. Care records held risk assessments and control measures intended to manage potential risks and maintain people's safety. Staff had a good awareness about how to identify and report any concerns to the local authority and CQC.

Medicines records were completed accurately. Associated risk assessments for each person who lived at Ryecourt were detailed and frequently reviewed to ensure they continued to maintain people's safety.

The five questions we ask about services and what we found