Nunthorpe Hall

We found the following examples of good practice.

¿ Innovative approaches were used to manage the risks of cross infection. All aspects of the home had been reviewed.

¿ Staff went the extra mile for people. They were flexible to needs to people and care was adapted to manage a recent outbreak. Staff carried out increased checks of people and prompted with extra drinks and snacks.

¿ People were supported to maintain their well-being. They had regular contact with their loved ones and they were encouraged to walk in the grounds of the home.

¿ Staff were supported with flexible working hours and well-being packages. They had been given additional uniforms and received extra support when they were off work with Covid-19.

¿The home had good engagement with professionals. Communication cards had been developed for people who had limited communication skills or where masks were a barrier to communicating.

¿ Staff received regular checks to make sure personal protective equipment (PPE) was worn correctly. High risk touch points in the home were continually cleaned. Robust cleaning schedules were in place.

Further information is in the detailed findings below.

Nunthorpe Hall is a care home providing personal care to 27 people aged 65 and over at the time of the inspection. The service can support up to 35 people.

People’s experience of using this service and what we found

Feedback about the service from people and those close to them was remarkably consistent and exceptionally positive. There was a well-established staff team who had worked at the home for several years.

The whole staff team were incredibly enthusiastic and passionate about the services they provided. They were highly motivated and said they were proud to work at the home and deliver a high quality, caring service. Staff at Nunthorpe Hall demonstrated that they were extremely committed to making a positive difference to people's lives. They were exceptionally caring and often went the extra mile to support people to a more fulfilled life.

The service was entirely flexible and changes or adaptations were made to meet people's current needs and choices. A person said, "I certainly feel fully very well-looked after here." There was excellent communication with external professionals to ensure services achieved positive outcomes for people including some people being supported to return to their own home.

People were extremely well-cared for, relaxed and comfortable. Care was completely tailored to each individual, risks were very well-managed. One relative commented, "We are pleased [Name]'s free movement and independence are encouraged, rather than suppressed even when such a course may be tempting."

Staff demonstrated an excellent understanding of each person's support needs and their personal preferences. They knew people and their histories very well. One person commented, "Staff are so helpful and patient. They are always extremely upbeat and so ready to help you. They always seem happy here." Staff training at the service was up-to-date and bespoke training was provided. The management team supported staff and encouraged them to become skilled and knowledgeable. The provider had ensured resources and skilled staff were available to support people.

The service was dedicated to ensuring continuous quality improvement to make a real difference for people. Highly person-centred care enriched people's lives, helped them to achieve their dreams and led to extremely positive outcomes. An extensive range of individual activities were available to promote people’s well-being. Staff supported people to maintain people's links with family and friends. Regular newsletters were produced to promote everyone's involvement in the service. This included ongoing communication about the large variety of activities and clubs that were available. There were also very positive opportunities to connect with the community, including partnership working with a local school.

People and their relatives were involved and supported in decision making. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s equality and diversity as unique individuals with their own needs was respected by staff.

The building was grand, accessible, light and spacious for the comfort of people. One person said, “It’s like living in a hotel.” People, relatives and staff were confident about approaching the registered manager if they needed to.

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

Rating at last inspection

The last rating for this service was good (published 30 July 2016). There was also an inspection on 1 February 2018 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Kitchen and care staff were aware of people’s special dietary requirements and personal preferences. Records were kept to ensure people enjoyed a suitable, healthy diet. People were given a wide choice at mealtimes and were also encouraged to maintain a good level of nutrition with a number of food related activities.

People and their relatives were exceedingly happy with the high standard of care being delivered. Staff spoke to people in an extremely caring and friendly manner. Staff took time to chat with people and care did not appear rushed or task driven. Staff were particularly mindful of respecting people’s privacy and dignity. Staff were very happy in their job and had a positive attitude about the care provided by the service.

The service was working towards the Gold Standard Framework in end of life care. Care plans were in place to inform staff of the person’s end of life wishes and ensure they were respected. We saw that information on advocacy services was available and two people had an advocate at the time of our visit so that their views were heard and their rights upheld.

Care plans contained a good level of detail regarding people’s individual care needs and preferences. Plans were written in a person centred way which meant people received support tailored to their personal needs. People and their relatives were involved in care planning and reviews.

People had access to a very wide range of meaningful activities which were tailored to individual needs. Staff were aware of the risks of social isolation and visited those people who chose to stay in their room to provide one to one activities and engage in conversation. We observed the positive outcome of this social stimulation in the way people interacted and engaged. Relatives were able to visit at any time and were made to feel very welcome.

The service had an up to date complaints policy that was made available in a communal area and was also included in the welcome pack given to each person on arrival and kept in their room. Complaints were properly recorded and investigated in line with the policy.

Regular quality assurance checks were undertaken by the registered manager. A comprehensive schedule of audits was kept showing how frequently they should each be undertaken and ticked off when completed. Any issues identified were recorded and an action plan put in place.

Staff meetings were held regularly and staff told us they provided an open forum for discussion about topics affecting them or the service.

Annual surveys were conducted with people using the service, relatives and visiting professionals and action plans were put in place if any issues were identified.

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

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 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.