Needham Court

We found the following examples of good practice.

• Systems were in place to help prevent people, staff and visitors from catching or spreading infection.

• The environment was clean. Additional cleaning was taking place, including of frequently touched surfaces.

• Staff wore appropriate PPE and there were sufficient supplies. The registered manager carried out weekly checks to ensure the service always had enough PPE for staff to access. PPE stations were in situ around the home for ease of access to staff.

• Staff had undertaken training in putting on and taking off PPE and other COVID-19 related training.

• People and their relatives were supported to keep in contact using a range of technology as well as visits to the home.

• People and staff participated in a regular testing programme, in line with government guidance.

• Appropriate vaccination status checks were in place.

People’s experience of using this service: People, their relatives and visiting professionals told us the people living at Needham Court received a good level of care. They told us staff knew and fully understood people’s needs.

People told us they felt safe. The provider had safeguarding policies in place and records confirmed this process was followed. People told us there were enough staff to look after them. Recruitment of staff remained good. Care plans included individual risk assessments, which were regularly reviewed to keep people safe. Medicines continue to be managed safely. Regular premises safety checks were carried out.

The provider worked closely with various healthcare professionals. People also had access to healthcare services such as GPs, dieticians and dentists.

Staff received support from the manager and deputy manager via supervision meetings. Staff also had access to training which supported them in their role.

People were supported to maintain a healthy diet and people told us they enjoyed their meals. The home was very clean and well furnished. People’s rooms were well decorated and had been personalised with people’s own belongings. The first floor had been designed to support people living with dementia.

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

People and their relatives were involved in the creation of care plans. Care plans were reviewed on a monthly basis or sooner if people’s needs changed. Care plans were updated to reflect changes made.

People were encouraged to provide feedback of their experience. Regular meetings were held with people and their relatives to discuss ideas for improving the home. People were encouraged to participate in a range of activities both internal and external to the home.

People, staff, relatives and healthcare professionals spoke in positive terms about the manager and deputy manager. Staff told us the manager was both supportive and approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published October 2016).

Why we inspected: This was a planned inspection based on the rating at the previous inspection.

Follow up: We will return to re-inspect this service within the published timeframe for services rated as good.

Needham Court is a purpose-built three storey care home that provides personal care and support for up to a maximum of 57 people, some of who are living with dementia. At the time of our inspection there were 55 people using the service.

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, relatives and staff spoke very highly of the registered manager and felt they managed the running of the home extremely well. Staff were very enthusiastic about how approachable both the registered manager and deputy manager were and how they felt supported in their roles as management had a vast amount of knowledge, skills and expertise. The registered manager was very committed and passionate about providing an excellent service and had implemented systems to monitor and drive improvement and excellence.

People told us staff were skilled and experienced to meet their needs. The registered provider had its own academy where staff attended a wide range of training courses. Staff received regular training in core subjects as well as additional training specific to meet people's needs such as dementia awareness. Staff had opportunities to go on advanced courses when they expressed a wish to excel in particular subjects suitable to their role as well as to further their career. Staff told us they felt enabled and empowered to attend new courses and specialise in particular areas. They were able to explain how they implemented new found knowledge from training into their working roles. Staff felt valued and supported to attend training at the registered provider's dedicated academy and transport was provided for those who required it.

Staff told us they felt supported and received regular supervision, observations and competency checks. They also received annual appraisals which they used to express specific goals and plan future development. Staff told us they found supervisions and appraisals useful as they could discuss career aspirations and long term goals as well as short term development opportunities and successes. Staffing levels were monitored by the registered manager to ensure they met people's individual needs. Staff provided input into staffing levels which the registered manager considered and increased staffing levels as a result. Staff were recruited safely with all necessary checks carried out to ensure they were fit to support people.

We received excellent feedback from people who used the service regarding the quality of food at Needham Court as well as the level and variety of choice. We saw menus were varied and consisted of two options each meal time, with additional options being readily available also. Staff were very knowledgeable about people’s nutritional and hydration needs and were passionate about ensuring those needs were met. The registered provider had successfully introduced a new method of preparing and serving pureed food so that people with a specialised diet such as dysphasia could benefit from a more pleasurable dining experience. It had also proven successful in increasing people's appetite, restoring their weight to a safe level and maintaining their dignity when dining as their food was moulded to resemble the meal they had chosen and they were able to eat it with a knife and fork. We found people’s dietary needs and preferences were extremely well catered for and they were highly supported to maintain a healthy weight. The home had also recently introduced a new twilight dining experience which included dimmed lighting, imitation candles and a restaurant service. This created a more relaxing environment and a peaceful dining experience which the registered manager and staff told us had a positive impact. People’s nutritional and dietary requirements were met, with referrals being made to dieticians, speech and language therapists and other health care professionals where needed and their recommendations were acted upon.

We found the design of the building to be tailored to the needs of people who used the service, including people who lived with dementia. There were a number of themed areas in the home including a beach as well as smaller areas with meaningful objects to stimulate people's memory such as old laundry equipment and a workbench. The home had been decorated with the consideration of people who lived in Needham Court which included themed pictures and pictorial formatted signs.

The registered manager, deputy manager and staff had a very good understanding of safeguarding and were confident in their role in safeguarding people. Any safeguarding concerns were investigated with the outcomes fed back and practices changed if necessary in order to prevent reoccurrences.

Medicines were managed effectively with safe storage and appropriate administration. All records were complete and up to date with regular medicine audits being carried out.

People had risk assessments in place and associated care plans were clearly linked and updated in line with risk assessment reviews.

A robust system was in place for the application and authorisation of Deprivation of Liberty Safeguards (DoLS) in line with the Mental Capacity Act 2005 (MCA). Best interest decisions were recorded in people’s care records and staff were aware of what this meant in relation to people’s care. Where required, people were deprived of their liberty in the least restrictive way. For example, those vulnerable to leave the home unsupervised were accompanied by staff or family members when away from the home.

People were treated with dignity, respect and compassion. Staff spoke with people in a friendly, gentle, polite manner and were warm and caring in their approach. People told us staff were "lovely" and they were happy and content living in the service. There was a wide range of activities provided in the home and in the community. The home had two activity co-ordinators who designed activity programmes tailored to people's individual interests. People were also involved in running activities such as a knitting club.

People had a range of care plans in place that were personalised and specific to their individual needs. Care plans contained relevant detail to guide staff how to support people appropriately and in line with their wishes. Care plans were reviewed regularly, were up to date and relevant to each person.

The registered provider had a clear complaints procedure in place. All complaints received were recorded, fully investigated and appropriately acted upon. Complainants received feedback from the registered manager on the outcome of any complaint made. People knew how to make a complaint and felt comfortable in doing so, although they told us they had never needed to complain about the service.

The registered provider conducted a staff awards scheme every two years which included individual members of staff being nominated by colleagues, people who use the service and relatives. People were involved in the awards ceremonies and the awards were to acknowledge exceptional contribution and performance of staff members.

Staff were very enthusiastic about the service and told us the registered manager was very approachable and supportive and that the home was very well managed. They told us they felt fully supported, appreciated and valued in their roles at Needham Court due to the wide range of staff incentives that were available. These included tickets to local football clubs, trips to a chalet at Kielder Trust and numerous discounts and vouchers on offer.

The registered provider and manager had robust audit systems in place to monitor the quality of service delivery and to drive improvement. The registered manager sent out surveys to people, relatives, staff and external professionals to gain their views of the service. Records showed feedback from all was positive.

Staff members were seen to interact well with people and knew them by their first name. There was a choice in what people wanted to do and we observed care interventions being carried out. Staff spoke to people in a pleasant and respectful manner.

People had been individually assessed to see if they could make their own decisions. Care records had enough information so staff would be able to know how to support each person in the right way.

We spoke with three people about their medicines. One person said 'I sometimes need painkillers and I get them quickly when I ask for them'. Another person told us 'they look after my medicines well and I get them regularly'.

One person had chosen to manage some of their medicines and said 'the staff always make sure I never run out of my medicines and arrange for more when I need them'.

Overall, we found that medicines were not always safely handled and improvements are needed.

People we did speak with told us they were happy with the care they received and liked living at Needham Court. A visitor we spoke with confirmed they were satisfied with the care their relative received and had no concerns. One person who lived at Needham Court told us, 'its okay here. They're all very friendly. A relative we spoke with said he was very happy with the home and he found he was always made to feel very welcome when he visited.

People were engaged in activities during our inspection and staff had conversations with people during the day.

We asked one person what they thought about the staff at Needham Court and they told us "they always help and I never have to ask twice".

We spoke with relatives during our inspection and they told us "we're so much happier no mum is here, we don't worry when the phone rings we know she's safe".