This unannounced inspection took place on 10 December 2018. We last inspected Boarbank Hall in July 2016. At our last inspection we rated the service as good.

At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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Boarbank Hall Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is owned and run by the Augustinian Canonesses of the Mercy of Jesus, a religious order dedicated to caring for others. The service provides long term and respite care for up to 27 people including palliative and end of life care and convalescent/post-operative nursing care. Boarbank Hall is in the village of Allithwaite overlooking Humphrey Head and Morecambe Bay. On the day of the inspection there were 26 people living there.

At this inspection we found the service remained good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. At this inspection we found that the service was continuing to improve and demonstrated characteristics of 'outstanding'. For example, the service was particularly skilled at caring for and supporting people and their families at the end of life, responding to changing needs, providing meaningful activities and working with other professionals. Professionals who visited the service said that it was well managed, professional and person centred in the care provided.

At the time of the inspection there was not a registered manager in post. However, this had been quickly addressed to ensure continuity and the new manager was already well on with the registration process. 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. The new manager was experienced and had the skills required to effectively manage and knew the home well having previously held the registered manager’s post.

The service was currently undergoing accreditation for The Gold Standards Framework (GSF).) for end of life care in care homes. This accredited programme focused upon systems for using and developing high levels of holistic care at the end of a person’s life. Relatives and professional feedback was very positive and appreciative about this aspect of the service.

People who lived at Boarbank Hall told us they felt they were well cared for, were happy and felt safe and secure living at the home. People who lived at the home, relatives and visiting professionals expressed great confidence in the staff skills and knowledge and the management to keep people safe and happy and provide a high standard of nursing care. People told us staff were “very kind” and “really caring.”

We looked at the recruitment files for new staff members and each included required security checks, proof of identity and a minimum of two references. We discussed with the manager that where a person has previously worked with vulnerable people their reason for leaving their previous employment needed to be always clear. The new manager confirmed this would be formally included on all application forms in future.

Staffing levels were monitored and kept at a consistently high staff to person ratio with individual’s dependency kept under review so the service could be flexible to meet changing needs.

Medicines management systems were safe and staff had undertaken appropriate training in medicines administration. Staff were

This unannounced inspection took place on 28June 2016. We last inspected Boarbank Hall in June 2014. At that inspection we found the service was meeting all the regulations that we assessed.

Boarbank Hall Nursing home is owned and run by the Augustinian Canonesses of the Mercy of Jesus, a religious order dedicated to caring for others. They provide long term and respite care for up to 27 people including palliative and end of life care and convalescent/post-operative nursing care. Boarbank Hall is located in the village of Allithwaite overlooking Humphrey Head and Morecambe Bay. On the day of the inspection there were 24 people living there.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 living at Boarbank Hall and their relatives spoke highly about the support and care that was provided for them and the “kindness” and “understanding staff showed to them. We were told how the staff “Always do the very best for you” and “I am really well taken care of, very good carers and nurses”.

There was a relaxed atmosphere in the home and we saw how frequently staff interacted with the people living there and in a very calm, friendly and respectful manner. We found that people living there were regularly asked for their views of their home and their comments were acted on to make any changes they wanted.

We saw that people were supported to maintain their independence and control over their lives as much as possible. People living there were able to see their friends and families as they wanted, participate in planned activities in the home and go out into the community with support. There were no restrictions on when people could visit the home. People had a choice of meals and drinks, which they told us were good and that they enjoyed.

We looked at people’s care and health plans and these were detailed, person centred and clearly described the care, treatment and support people needed and preferred. People had their needs and risks assessed using recognised tools and plans were in place to manage risk. We saw nursing staff giving people their medicines. They followed safe practices and treated people respectfully.

The service followed the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

The staff we spoke with were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home.

The service had worked well with health care professionals and external agencies. This included social services, speech and language therapists and mental health services to provide appropriate care to meet people’s different physical, psychological and emotional needs. We saw that there was regular involvement with the Care Home Education and Support Service [CHESS] in Cumbria.

Staffing levels in the home were monitored to make sure they reflected people’s care needs and were adjusted in line with them. There were thorough quality monitoring systems in operation to assess and review the quality of the services provided.

Effective systems were in place for the recruitment of staff and for their induction and on going training and development. Staff said they had regular supervision and were well supported to access the training they needed and to develop their skills.

Staff supported people towards the end of their life and made sure their dignity was maintained and they received the speci

We considered our inspection findings to answer the questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service told us they felt “safe” and “It’s always good to know there is always someone around if you want them”.

We saw that risk assessments had been carried out to help make sure that the people who lived there received safe and appropriate care and treatment. This included the important areas of nutrition, personal care, skin care and wound management, mobility and moving and handling and the risk of falls.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had appropriate policies and procedures regarding The Mental Capacity Act 2005. The manager of the home was knowledgeable about the Mental Capacity Act 2005 and the Mental Capacity Act Codes of Practice. This meant people could have confidence that their rights would be protected.

Staff had received training on safeguarding vulnerable adults. Staff we spoke with were clear about the procedures to use in reporting any concerns. We found that staff had received a range of training to maintain and develop their skills and was suited to their roles and responsibilities.

We saw that the premises and grounds were being well maintained and were accessible to the people living there. Appropriate measures were in place to ensure the security of the premises to keep people safe. The service had systems in place to manage and monitor the prevention and control of infection and a clean environment.

Is the service effective?

We found that people’s health and care needs had been assessed with them and they were involved in deciding the care, treatment and life styles they wanted. We saw records that showed staff had undertaken appropriate and accredited training to give them the skills and knowledge to look after people properly.

Care plans in place showed the aids and equipment needed to support people and how they wanted this support to be provided. The care plans included the things that people could do themselves as well as the support they needed from the staff in the home. This helped to make sure people retained their independence, as far as they were able.

Is the service caring?

The information we looked at about the people using the service was written in a holistic and positive way that included people's emotional and spiritual needs as well as physical needs. People using the service told us that staff were "cheerful and friendly" and "very caring".

In some of the care plans we looked at we saw information about individuals that provided personalised information about their preferences, likes and dislikes. We saw that where necessary people had been referred to other services to make sure they received appropriate treatment and support.

We saw many positive interactions between the staff on duty and people who used this service. These positive interactions supported individuals' wellbeing.

Is the service responsive?

People were able to take part in activities they wanted to inside and outside the home and to decide for themselves how they spent their time. We saw that people were treated with respect and given choices about their daily lives. The staff we spoke with showed that they knew people’s preferences about their lives and how they wanted to be supported.

People we spoke with knew how to make a complaint if they were not happy with the service provided. There had not been any complaints made and people spoke with said they had not needed to make any.

We saw from the sample of care plans we looked at that the management plans of care, treatments and support were subject to evaluation, review and alteration in response to changes in people’s needs and preferences.

We could see that the manager and staff monitored people’s conditions and made timely referrals to others to access the care people needed.

Is the service well led?

The home had a comprehensive and verifiable quality assurance and monitoring system in place. This helped to identify any areas that had problems or needed to change. There were policies and procedures in place and subject to regular review to guide staff practices.

Staff we spoke with were clear about what their responsibilities were and told us that the management was supportive and approachable. Staff told us the provider was “Good to work for” and that training and development was well supported so staff could carry out their roles.

The manager and staff in the home showed they were committed to providing people with a good quality of service which met their needs.

People living at Boarbank Hall Nursing Home told us, "I'm very happy thank you, they look after me properly" and that "Staff are just fine, very helpful, very caring." We did not receive any negative comments about the nursing or personal care received, the food served, the cleanliness of the home or the staff approaches and support. People were complimentary about the food and told us the meals were "Very good" and "There is always a choice."

People told us they had not needed to make a complaint and they had confidence in the manager to support and help them. One person told us, "There is nothing here I don't like and if there ever was I would just say so to the nurses."

From our observations and conversations with people there we found they got the support they needed and were given choices about their care and their social activities. We were told "I need a lot of help and they do it at my pace." We saw that staff encouraged people to maintain their independence and control over their lives and one person said, "Its always up to me what I do." We saw that people were comfortable and confident with the staff on duty.

Staff working there had received appropriate training to support individual needs and to understand different conditions. The provider had effective recruitment procedures in place and had carried out relevant checks on the staff they employed. This helped to make sure that staff were suitable for working with the people living there.

We carried out this desk top based review on this service 28 November 2012 using information gathered to assess if the service had achieved full compliance. We did not visit the service. The evidence we had gathered from different sources indicated that the service was now compliant in the three outcomes that had been non compliant.

Our inspection of 23 May 2012 found that the needs of people living at Boarbank Hall were not being assessed before admission to the home or care plans regularly reviewed. The provider did not have an effective system to assess and monitor the quality of services received and did not have suitable arrangements to make sure staff were supported in relation to training, induction and supervision. As a result of these we found that there was a reasonably foreseeable risk that peoples’ needs may not be fully met.

The provider wrote to us in July 2012 with an action plan of how they would achieve compliance.

Evidence received indicated there are now systems in place for gathering, recording and evaluating information about the quality and safety of the service. This included using audits and satisfaction surveys for people living there, relatives and staff. We had evidence of a structured induction for staff to complete and an annual training and development plan. A training monitoring matrix was in place for monitoring training provision. The provider had reviewed and re-written care plans involving the individuals in this process.

People who talked to us told us they were happy with the support they received with their medicines.

Most people living at Boarbank Hall, who talked with us during our visit told us that they liked living there and were happy with the services and support they received.

We spent a lot of time talking to people living there and observing daily life in the home and received many positive comments about the standard of personal care and the

individual attention people received.

People told us about the high quality of the the food on offer to them and the cleanliness of the home. People living there told us, "The food is very good" and also, "The food is super, there is plenty of variety and they will provide whatever I fancy". People told us they were always asked about what they wanted to eat and that they got alternatives if they wanted something different.

People we talked with confirmed that they got up and had their meals when and where it suited them and also went to bed when they wanted.

People also told us that the laundry services were "very good" and that their clothes were being well laundered and returned to them promptly. Other people chose to have their laundry done for them outside the home and this was supported according to individual wishes.

Most people told us how clean and well kept they felt their home was and we could see that was the case as we walked around the home. People also told us that they could decide how they spent their time, saying, "I just tell them what I want". They told us that there were organised social activities if they wanted to join in but they felt they did not have to join in any activity or outing if they did not want to.

We spoke with four people about their medicines and the care they received. Nobody raised any concerns about their medicines.