This inspection visit took place on 05 April 2017 and was unannounced.

At the last inspection on 10 September 2015, we found one breach of regulatory requirements related to recruitment of staff. At that time we judged the service did not have effective recruitment practices to ensure staff were appropriately checked to make sure they were safe to work with vulnerable people. Following our inspection, the provider sent us an action plan which told us how they planned to make improvements. During this inspection we checked to see what improvements had been made and found the provider had reviewed their recruitment practices to ensure they were robust.

Northlands Village Rest Home provides accommodation for up to 16 older people who require 24 hour support with personal care. Respite care is provided subject to availability. The home is a large converted house with a secluded rear garden. There is a passenger lift to bedrooms on the upper floor. The home is situated in a residential area of Great Eccleston, close to local amenities. At the time of our inspection visit there were 16 people who lived at the home.

There was a registered manager 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.

We looked at the recruitment of three recently appointed staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs. We found staff were knowledgeable about the support needs of people in their care.

We found the registered manager had systems to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The environment was maintained, clean and hygienic when we visited. People we spoke with all said they were happy with the standard of cleanliness and hygiene at the home.

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. Staff confirmed there were always enough staff on duty to ensure peoples’ needs were met.

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. The provider had safe systems in place with regard to storage of medicines.

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

People told us they enjoyed the activities organised by the service. These were arranged both individually and in groups.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had rec

This inspection took place on 10 September 2015 and was unannounced. We last inspected Northlands Village Rest Home on 3 October 2013 and the service was judged to be fully compliant with the previous regulatory standards.

Northlands Village Rest Home provides personal care only, at the time of our inspection there were 15 people living at the home including one person receiving respite care. The home offers short to long term care. Accommodation is on two floors and provides fifteen single rooms. There are additional lounges, a dining room and a quiet library. A passenger lift provides easy access to first floor areas. Northlands is situated close to the village of Great Eccleston and is within easy reach of shops and local amenities, including the health centre.

There was a registered manager in place at the time of our inspection. 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 told us they felt safe at the home and with the staff who supported them. One person told us, “Yes I feel safe, it’s my home and I will stay here until the end of my days.” Another person said, “I’m very safe, they (staff) are patient, more patient than I am.”

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Staff members spoken with said they would not hesitate to report any concerns they had about care practices.

We observed staffing levels to be sufficient to meet the needs of the people at the home. People we spoke with and their relatives told us they had no concerns with regards to staffing levels. We discussed staffing levels with the registered manager of the home who told us that staffing did flex according to the needs of the people in the service and we were shown examples of this.

We looked at how medicines were ordered, stored, administered and recorded. We spoke with the senior carer who had responsibility for administering medication on the day of the inspection and observed medication being given to people over the lunch time period. All the medicines given were done so in a discreet manner and it was evident that the senior carer knew people well and how best to approach people when administering their medicine. We checked medication administration records (MAR) to see what medicines had been given.

The people we spoke with told us they enjoyed the food provided by the home. They said they received varied, nutritious meals and always had plenty to eat.

A number of the staff we spoke with had worked at the home for a number of years and we saw that staff retention rates were very good. Staff we spoke with all told us that they received good support from the manager of the home and peers. We saw that staff did receive training however some key areas were out of date such as safeguarding and Infection control.

We saw that policies and procedures were in place in respect of the MCA and DoLS however staff had little understanding of either. Staff we spoke with had not received training on the MCA and DoLS. Care staff were only able to give general answers about how they would obtain valid consent and had no detailed knowledge of the MCA or DoLS. We have made a recommendation regarding this.

We saw that people were involved in every day decisions about their life and how their care was delivered. We observed staff asking people what they would like to do at various times throughout the day and people told us they could ask staff for assistance and it was received in a timely manner.

Some of the information in people’s care plans was too brief or we could not find evidence that care plans were being followed or backed up by appropriate risk assessments or reviews. We have made a recommendation about this?

We saw that advocacy services were available for people to access if they did not have relatives or friends to act as a voice for them. Details of local advocacy services were available within the entrance / reception area of the home. We were told that advocacy was discussed with those people who may want to access it when they first came in to the home or if their circumstances changed.

People we spoke with and their relatives told us they knew how to raise issues or make complaints. We saw that the home had a complaints procedure and that it was made available to people, this was confirmed when speaking with people and their relatives. It was also on display within the home.

There was a registered manager at the service at the time of our inspection and we found no outstanding registration issues during the planning of the inspection.

None of the people living at the home or their relatives spoke negatively about the owner, manager, staff or culture within the home and people and relatives told us they could approach managers or staff with any issues they had.

We found one breach of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014 relating to Fit and proper persons employed.

You can see what action we told the provider to take at the back of the full version of this report.

We spoke to a number of people living at the home, relatives and visiting professionals who visited on the day as well as staff working at the home. People who lived at the home were positive about their experiences and the comments received reflected this. One person living at the home stated, "Everyone is lovely here and you get looked after and treated properly. I wouldn't want to be anywhere else". A realtive we spoke to told us, "I have been here when the ladies are dressing (name). It is the loving care with which they do everything for her. They are not over familiar but treat her like their own relative".

The design, layout and security of the premises was fit for purpose to meet the needs of the people living in the home. The design and layout of the building meant that people's dignity and wellbeing could be promoted effectively.

We found evidence that there was an effective recruitment process in place and found policies to back the process up. People living at the home spoke highly of the management and care staff, as did relatives and visiting professionals.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.

People told us they were happy with their care and support. Their admission to the home had been handled well and they had discussed the support they needed beforehand. One person told us, "My son arranged for me to come here. I have been here before for respite. I knew the home had a good reputation locally and I have decided to stay”.

We observed that staff interaction with people was very good. Staff engaged with them in conversations. They spoke to them respectfully, communicated well and appropriately, and offered assistance when needed. It was evidenced that where possible independence was promoted. People requiring assistance to eat was given this with dignity and patience.

People told us they were given the help and support they needed. They said staff was, “Lovely”, “Go the extra yard”, "Very good" and "Helpful.

We observed people in the home were relaxed around staff. They were able to express themselves freely and openly. People who were able to express themselves told us staff treated them well and they had no cause for concern. There were no rules to follow and no rigid routines.

We observed how people engaged with staff in various activities of daily living. Staff was always present around people and available to offer assistance when needed.

It was clear from observing the way they, and the staff interacted and worked together that their involvement in their care and support is both valued and promoted. People living at the home told us that they felt respected and well cared for. When asked if people's points of view were respected and considered, several people agreed saying that the staff and management do take account of people's views on the home and care provided.

People at the home said that they felt safe living there. One person said that if they suspected any abuse or ill-treatment was taking place then they would report it to the manager straight away.