This inspection took place on 1, 6 and 16 November 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

Northbourne 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.

Northbourne provides residential care for up to 33 older people across two floors, in one purpose built building. Some of the people using the service were living with dementia. On the day of our inspection there were 33 people using the service.

At the time of our inspection visit, the service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. They had been registered since October 2010.

At our last inspection we rated the service good. At this inspection we found the service had improved to outstanding. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

The service was extremely person-centred. Person-centred means the person was at the centre of any care or support plans and their individual wishes, needs and choices were taken into account. People received exceptionally personalised care that was responsive to their needs. People, family members and visitors were extremely complimentary about the service.

The provider had innovative ways of protecting people from social isolation, and went the extra mile for people they supported and to find out about their past.

The service had extremely effective ways of encouraging discussion and social stimulation, and had developed therapeutic approaches to support people with anxiety and frustration.

People and family members were an integral part of the service and were involved in making decisions about the home.

The registered manager continually strived to develop their knowledge and skills, and shared this learning with staff to ensure continuous improvement across the staff team. Staff were highly motivated and proud to work at the service.

The registered manager worked in partnership with external professionals to develop and improve

outcomes for people who used the service. The service had developed excellent links with the local community.

Governance was well embedded in the service and systems were in place that continuously assessed and monitored the quality of the service. People, family members and visitors were provided with several ways of feeding back on the quality of the service.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

There were enough staff on duty to meet the needs of people. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

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.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

This was an unannounced inspection which took place over two days on 6 and 7 April 2016. The service was last inspected in August 2014 and was meeting the regulations in force at the time.

Northbourne is a care home which provides personal care for up to 33 people. Care is primarily provided for older people, including people who have dementia related conditions. There were 33 people living there at the time of inspection.

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.’

The home was warm, clean and had comfortable communal areas. The home was undergoing refurbishment and had been adapted to meet the needs of people with a dementia related condition. There were sufficient staff, with different skills to meet the needs of the people living there.

People told us they felt safe, being cared for by staff who knew them well. Staff told us they knew how to raise concerns and had confidence action would be taken if they had any issues. Relatives told us they felt their families were safe at Northbourne and the home was welcoming and had a happy atmosphere.

Risks to people, such as for malnutrition and skin integrity, were assessed and care plans were in place to protect people from harm. Where people’s needs changed, referrals were made to health care services and advice from external professionals was integrated quickly into the care plans and acted upon.

Staff were trained so that they could work with different people and were deployed so there was sufficient staffing. Staff were effectively deployed throughout the day to meet the needs of people. For example, ensuring there was support for people at mealtimes.

People’s medicines were managed safely; stock control and ordering were managed by trained staff with checks to ensure that the risk of errors were minimised. Audits were carried out regularly to ensure that staff were competent and that any errors would be quickly identified and action taken to reduce their reoccurrence.

Care was effective and people received care based on best practice and the latest advice from external professionals. Care plans were detailed and personalised. This had not been consistent over time, but this had been identified and action taken to update all peoples’ care plans. People’s consent was sought, where this was possible. Where people could not consent, their care was delivered in their best interests after consultation with family and external professionals.

There were a number of people subject to Deprivation of Liberty Safeguards (DoLS) and these had been managed by the service, with referrals for local authority authorisation being made appropriately. The service had a system in place to ensure that renewals were requested promptly.

Staff were recruited robustly and received training based on the needs of people using the service including dementia awareness. Staff had undergone an induction period and their mandatory training was up to date.

People were supported to eat and drink and maintain a balanced diet. Staff supported people at mealtimes in a dignified way. We observed a calm and relaxed mealtime experience. The service monitored people’s weights and took further action if needed. Visiting health care professionals told us the care and support offered was effective.

Care interactions observed were positive and there were good relationships between people and staff. All staff we spoke with knew people’s needs well and spoke about them in a positive manner. People and their families were encouraged to express their views and be actively involved in making decisions about their care and support. There was evidence of people’s involvement in their in

We considered our inspection findings to answer 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 -

Is the service safe?

Risks were fully assessed and managed as part of people’s care planning, to make sure their care was delivered safely. Suitable arrangements had been made for supporting people with their prescribed medication to maintain their health and well-being. People were cared for in a safe and comfortable environment that was adequately maintained. Health and safety checks were carried out and equipment was serviced regularly.

Is the service effective?

We found that care was suitably planned to meet people’s needs and preferences. People said they were happy with their care and most were settled and content living in the home. They said, “I get whatever help I need”, and, “I like it here and don’t have to worry about anything. It’s not the same as being at home but the staff look after me”. A relative told us she had looked at many care homes and felt that Northbourne was just right for her mother and met her needs.

People were given support to meet their nutritional needs, including provision of special diets and being assisted with eating and drinking. Dietetic advice was sought when needed and the care and catering staff worked in a co-ordinated way to ensure people were properly nourished. A varied diet was provided and people had choices of food and drinks.

Is the service caring?

People were cared for by staff who knew them well and supported them in the ways they preferred. Our observations confirmed there were flexible routines and people did things at their own pace and were not rushed. People told us the staff were kind and caring and treated them with respect. One person said, “The carers are all nice. They talk to everyone politely and I’ve never seen any of them be unkind”. Another person commented, “They’re friendly, always asking you how you are and if you need anything”.

Is the service responsive?

People’s diverse needs and wishes were taken into account when their care was being assessed and planned. Care was kept under regular review and adapted in response to people’s changing needs. Health care services, including specialist support, were accessed to ensure people received appropriate care and treatment.

People were supported in meeting their social needs, and to be involved in the community and maintain relationships with their families.

Is the service well-led?

A registered manager was in post. The manager and staff understood the ethos of the service and their roles and responsibilities. Quality assurance processes were in place to ensure that standards were maintained. People we spoke with confirmed they had opportunities to give their views on the running of the home and felt they were listened to. They were satisfied with their care and expressed no concerns about the quality of the service they received.

Some people who used the service had complex needs which meant they could not share their experiences. We used a number of methods to help us understand their experiences, including carrying out an observation, speaking with people who could share their experiences and speaking with visiting relatives.

People who used the service were given appropriate information and support regarding their care. People’s privacy, dignity and independence had been promoted and this helped to increase their sense of self-esteem and well being.

People’s needs had been assessed and care and support was planned and delivered in line with their individual care plan. A relative said, “Mum is happy, clean and most of all loved by the staff”. The expert by experience said, the home is “…run by a great team of carers who go out of their way to put residents first …while still maintaining a high level of cleanliness, safety, comfort and sense of belonging to all residents”.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough qualified, skilled and experienced staff to meet people’s needs. The provider had an effective system to regularly assess and monitor the quality of service, and to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

People using the service and relatives spoke positively about their experiences of the care and support they received at the home. Their comments included, “They do their best for me”; “We have peace of mind and no cause for concern”; “I can’t fault the care”; “The meals are varied and very good”; and, “They look after me very well”.

Some people who used the service had complex needs which meant they could not share their experiences. We used a number of methods to help us understand their experiences, including: carrying out an observation, speaking with people who could share their experiences and speaking with visiting relatives.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People experienced care, treatment and support that met their needs and protected their rights. People's needs had been assessed and care and support was planned and delivered in line with their individual care plan. The expert by experience told us the home was, “Excellent – all carers work very hard to ensure residents are comfortable and have everything they want. Alison and her staff are to be commended for their dedication to the well-being of all their residents.”

People were protected from the risk and spread of infection. The home was clean and hygienic throughout, and there were no unpleasant odours. Staff had received training in how to prevent the spread of infection.

The expert by experience told us, “Residents were clean. The home itself was very clean – no smell. Rooms were clean and homely – toilets, bathrooms – excellent.”

There was an effective complaints system available and people told the expert by experience they would feel comfortable raising concerns with the home’s staff.