This inspection took place on 1st February 2018 and was unannounced. This meant the provider and staff did not know we would be visiting. This was a comprehensive inspection.

Nunthorpe Hall provides personal care for older people in a large Grade 2 listed building set within its own grounds. The home is registered to provide accommodation for up to 29 people. At the time of the inspection 24 people were using the service.

Nunthorpe Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service was last inspected in March 2016 and the rating for this inspection was good. At this inspection we found the service remained good.

Safeguarding policies protected people from harm. Staff knew how to identify and report suspected abuse. Risks to people were identified. Detailed assessments provided guidance for staff about how risks could be minimised. Emergency contingency plans were in place. Records showed that maintenance and equipment checks were undertaken to ensure the environment was safe. The environment was well maintained. Robust infection control practices were in place. Sufficient numbers of staff were on duty with the right skills to support people's needs. Recruitment practices reduced the risk of unsuitable staff being employed. Medicines were managed safely.

Staff received the training they needed to be able to carry out their role effectively and had regular supervision and an annual appraisal. 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 received a varied, nutritious diet which met their preferences and dietary needs. People had access to external professionals to monitor and promote their health. The premises were suited to meeting the needs of the people living there.

Staff members were kind and caring towards those who used the service with privacy, dignity and independence consistently promoted. Interactions between people and staff showed that staff knew the people they supported well. Care plans were personalised. The policies and practices of the home helped to ensure that everyone was treated equally.

Plans of care were person-centred and reviewed regularly. People had access to a range of activities and leisure opportunities and were encouraged to maintain personal relationships. The service had a clear complaints management process. End of life policies and procedures were in place.

The home had clear vision and values. The management team completed regular audits and sought feedback. Meetings for staff and people using the service were held regularly. This enabled people to be involved in decisions about how the service was run. The service worked in partnership with a range of health and social care professionals. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications.

This inspection took place on 29 March, 16 May and 18 May 2016. The first and second day of the inspection were unannounced. This meant the registered provider did not know we would be visiting.

Nunthorpe Hall provides personal care for older people. It is registered to provide care to a maximum of 29 people. It is a large building set within its own grounds. People who live there are able to access the grounds. Accommodation is provided over two floors. There are two dining rooms, a large lounge, library and large entrance hall where people who use the service can sit. The upper floor is accessible by lift. At the time of our inspection there were 27 people using the service.

The service had 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.

People and their relatives told us they felt that care was delivered safely. There were systems in place to protect people from the risk of harm. Individual risk assessments were in place and covered key risks specific to the person such as moving and handling and falls. These documents were regularly reviewed and updated as required.

The service had an up to date safeguarding policy in place. Staff had received up to date safeguarding training and demonstrated a good knowledge of the principles. They were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were also aware of whistle blowing procedures.

The service had policies and procedures in place to ensure that medicines were ordered, stored and administered safely. Accurate medicines records were kept and regular auditing of both records and stock took place. All those staff who administered medication had received the appropriate level of training and were regularly observed to ensure their competence.

Staff levels were calculated using a dependency tool. We were told and observed there were sufficient numbers of staff on duty to support people’s needs.

Accidents and incidents were appropriately recorded and analysed so that any trends could be identified.

We saw that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. These checks included obtaining a minimum of two references including one from a previous employer and a Disclosure and Barring Service check to ensure that staff were safe to work with vulnerable people.

Appropriate maintenance checks had been regularly undertaken to ensure that the environment was safe. We saw up to date certificates in areas such as gas safety, fire equipment and portable appliance testing.

Staff received appropriate training and had the skills and knowledge to provide support to the people they cared for. This included specialist training specific to the needs of the people using this service such as dementia and stroke awareness. Training was refreshed regularly in line with the training policy.

There were up to date policies in place regarding the registered provider’s approach to MCA and DoLS. The management team expressed a good understanding of the processes relating to MCA and DoLS and staff had received training in this area. We saw evidence of consent and best interest decisions on people’s care files.

Staff received regular supervision and annual appraisals to monitor their performance and felt that they received a good level of support in these sessions.

People were supported to access external health services such as dentists and opticians to ensure their general health and wellbeing. People were also referred to services such as the falls team or dietician where a need had been identified

Our inspection team was made up of one inspector. We gathered evidence against the outcomes we inspected to help answer the five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We looked at a range of records, spoke with the manager, deputy manager, cook and two staff of varying grades. We also spoke with the provider of the service and administrator. We observed the interactions between staff and people living at Nunthorpe Hall, spoke with six people who used the service, one relative and also a district nurse.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at Nunthorpe Hall. Staff we spoke to understood the procedures which they needed to follow that ensured people were safe.

There were effective systems in place for the ongoing maintenance and servicing of equipment. There were also good systems in place in respect of fire safety and fire training.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff had received training in relation to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. We were informed that further training was going to be planned and that there would be a review of the MCA documentation within individual people’s care records.

People were aware of the complaints procedure and there were systems in place for monitoring complaints.

Is it effective?

People all had their needs assessed and had individual care records which set out their care needs. People told us that they received the care and support they needed.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

We found that nutritional screening had been carried out for people who used the service. This meant that people received timely and appropriate intervention if they lost weight. We saw that people were supported to have adequate nutrition and hydration.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence contained within people’s care records. We also spoke with a district nurse who confirmed that the staff responded appropriately to people’s changing healthcare needs.

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect, kindness and gave people gentle encouragement.

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records provided a good level of information to staff on what care and support people who lived at Nunthorpe Hall needed.

People's preferences, interests, aspirations and diverse needs had been recorded and people’s life story books had been completed. Care and support had been provided in accordance with people's wishes.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

It is well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a registered manager, who was supported by a deputy manager. There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

People who used the service, their relatives and friends had opportunities to attend regular meetings and to also give feedback about the service via an annual survey. The last survey report was reviewed as part of this inspection; this had been completed in October 2013.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people told us.

During the inspection we spoke six people who used the service and a district nurse. We also spoke with the manager, deputy manager, three staff of varying grades and the cook.

People who used the service told us that they were happy with the care and service received. Comments included, “We are definitely treated with dignity and respect, they are all very kind.” “We can talk to the staff, if you had any concerns you could go to any of them.” “They give me the reassurance that I need.”

Everyone we spoke with told us that they liked the food that was provided and that there was a plentiful supply of snacks and drinks. We were told that there was a good variety, that food was well presented and that portion sizes were sufficient. One person said, “You just have to tell them what you want to eat and they will provide it.”

Staff comments included, “It is home from home for people.” “There is a good staff team who deliver good care to people.”

A district nurse we spoke with said, “Communication is really good, there is always a member of staff available and they are really prompt at contacting us for anything

As a result of some information of concern we visited the home at 6.25 am. This was part of an out of normal hours pilot project being undertaken in the North East region. We spoke with four people who lived at Nunthorpe Hall, the deputy manager and four staff as well as the proprietors. One person said, “I fitted in straight away.” “I like it here, particularly the care that the carers give. We are all looked after really well.” “I am confident that the carers are fully aware of my needs.”

We found that people received care that met their individual needs. People's care records were up to date, well written and reflected their personal care and support needs. We found that where people had additional medical or nursing needs other health care professionals were involved in a timely way.

We saw that Nunthorpe Hall was clean, odour free and well maintained. There were good systems in place for ongoing cleaning and infection control.

We found that there were sufficient staff available to meet people's needs and appropriate skill mix. All the people spoken with were very positive about the staff at Nunthorpe Hall. They said, "The staff are wonderful, always available to you.” “I have used my call bell and I haven’t had to wait too long.”

We found that people were provided with information about making complaints. People told us that they would be confident to raise concerns if they needed to.

People who lived at Nunthorpe Hall received care and support which gave them choices and enabled them to make decisions about their daily living. They were supported by staff who were knowledgeable about them and treated them with respect and in a way which maintained their independence and dignity.

People were cared for in accordance with their needs because risk assessments were carried out and care plans written to manage risks. These were kept up to date because they were reviewed regularly. When people’s health needs changed, health professionals were called to meet those needs. Staff underwent a robust recruitment process to ensure that they were suitable to work in a care environment and pre employment checks were carried out to ensure the safety of people who lived at Nunthorpe Hall.

The service ensured that people had the equipment they needed to maintain their safety and independence. Equipment was serviced accordingly and checked to make sure it was safe for use. The service also carried out other quality checks and gave people the opportunity to give feedback about their experiences and the support they received. People who lived at Nunthorpe Hall only had positive comments to make.

During our visit we spoke to three people who used the service. One person told us "yes, I make my own decisions". They said they had visited the home before deciding to move there and thought it had been the right decision. They also said the staff were "marvellous". Another person said "I'm quite happy here".

We also talked to two people who used the service about how they managed their own medicines. One said that they got any help or support that they need from the staff and liked to manage some of their medication but liked staff to manage the others. The other person looked after all of their medication and confirmed that when staff order their medicines they get them in time.