Northview Lodge Nursing Home

We found the following examples of good practice.

• Systems were in place to prevent people, staff and visitors from catching and spreading infections. The home were extremely proud to have had no known cases of Covid-19. The home supported people as far as possible with social distancing.

• Staff had undertaken training in putting on and taking off PPE, hand hygiene and other Covid-19 related training. Nominated staff who had received additional training to be infection control leads monitored staff practices to ensure high standards and correct procedures were followed. Additional cleaning of all areas and frequent touch surfaces was being carried out.

• Staff supported people’s social and emotional wellbeing. Additional activities had been planned within the home during lockdown to positively support people through a period of extreme change to their routines. People were supported to have face to face or telephone contact with friends and relatives through an appointment system. National guidance was being followed to ensure visits took place at a safe social distance. Infection prevention and control measures were in place to avoid potential transmission with others.

• The home was following national guidance for anyone moving into the home. Staff worked with people and their relatives to ensure they were aware of isolation procedures should they be needed. People were supported by a dedicated staff team who helped reduce any feelings of isolation and loneliness reduced. This included a range of individual social activities and contact with friends and family.

• Infection control audits and checks were carried out. The registered manager spoke positively about the hard work and dedication which staff had shown, which had helped to minimise the impact of the pandemic on people’s health and wellbeing. The provider continuously passed on important information about Covid-19 to staff.

The inspection took place on 6 March 2018 and was unannounced. This meant staff did not know we were visiting.

We last inspected Northview Lodge Nursing Home on 19 January 2016 and rated the service as Good. At this inspection we found the service had improved to Outstanding.

The service had a registered manager who was on duty during the course of our visit. 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 registered manager had recently achieved a quality director post for the provider and would be leaving their role at Northview Lodge Nursing Home. However a new manager had been appointed and was working a transitional handover and would be registering with the Care Quality Commission in the near future.

People received outstanding care. People who used the service and relatives described staff as very caring, kind and compassionate who wanted the very best for the people they supported.

People were involved in their care and support and staff respected their privacy and dignity. The staff team also worked to ensure people’s important relationships were maintained and families were supported and welcomed at the service even when their family members were no longer there.

Independence was promoted by staff, who clearly understood the principles of promoting people as valued community members. Staff had an excellent understanding of people's diverse needs, preferences, routines and personal histories.

People had exceptional access to advocacy support and independent advocacy services told us they were welcomed by the home.

People were fully involved in their care and support and lead active and fulfilling lives. The service was highly responsive and supported people to achieve their hopes, dreams and aspirations.

People were supported to be active citizens of their community. With the right approach and support, some people had developed their confidence and skills that enabled them to gain qualifications.

People had been supported to experience holidays and staff had been creative and used innovative approaches in supporting people to pursue their interests, hobbies and personal goals. This had led to people’s improving their relationships with family and friends.

People's care plans focussed on their individual needs, creating a person centred approach in the delivery of care and support.

People told us they knew how to make a complaint. They felt enabled to raise any concern and feel confident it would be addressed.

The registered manager was experienced, dedicated and passionate about providing everyone both people and staff, with the right support that enabled them to grow and develop.

The service had recently achieved an award for the use of innovative technology and several individual staff had been awarded external regional and national prizes in their field.

The registered manager had developed an open and inclusive service, they had a clear vision and set of values based on social inclusion that the staff fully understood and adhered to. Staff felt listened to, supported and involved in the development of the service. People who used the service and relatives received opportunities to share their views, experience of the service and were involved in developing the service further.

Governance was well embedded in the service. Processes were in place that continuously assessed and monitored the quality of the service and that included audits carried out by people using the service.

People remained safe because staff had received appropriate training and the provider had systems and processes in place to support people from avoidable harm.

People received support from a team of staff that provided consistency and continuity. Safe staff recruitment checks were carried out before staff commenced employment.

People received appropriate support with the administration, storage and management of their prescribed medicines. People and staff were aware of the importance of infection control measures and had received appropriate training.

People were supported by staff that had received an appropriate induction and ongoing support and training.

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

Staff were aware of people's nutritional needs and promoted healthy eating. Systems were in place to share information with external services and professionals when required. People received appropriate support to maintain their health and achieve good health outcomes.

Northview Lodge is a care home with accommodation for up to 45 people who require nursing or personal care, some of who are living with mental health problems. At the time of the visit 36 people were using the service.

The service had a registered manager who had been in post for 5 weeks. 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 previous registered manager had not deregistered with the CQC. This is being addressed outside the inspection process.

Relatives and people were very positive about the service. They were satisfied with the care and support they received at Northview Lodge. One relative said, “It is a really good place.” One person said, “We all get along and I can have my room how I want it. I like that.”

Staff had a clear understanding of safeguarding and whistleblowing. They were confident that any concerns would be listened to and investigated. Staff knew how safeguarding alerts were managed in the service. One staff member told us, “I would report any concerns to the manager, they would complete an alert to the safeguarding team.” The registered manager had a record of all safeguarding alerts which showed appropriate action had been taken.

The service also had processes in place to manage complaints, accidents and incidents. Records were kept along with immediate actions, which showed the service responded to situations and learnt lessons from such events to reduce risk. Relatives knew how to make a complaint and were confident the service would respond appropriately.

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make some decisions, and the Deprivation of Liberty Safeguards (DoLS) to make sure people were not restricted unnecessarily.

Recruitment practices at the service were robust, appropriate and safe. All necessary checks were carried out before staff commenced employment, which meant suitable staff were recruited. We viewed staffing rotas and found the service employed enough staff to meet people’s needs.

The service used an electronic system for training, with moving and assisting and first aid being delivered in a class room environment. Mandatory training was up to date for all staff. Staff received regular supervisions and appraisals.

Policies and procedures were in place to ensure medicines were managed in a safe way. Records were up to date with no gaps or inaccuracies found. Staff were trained in the safe handling of medicines and received regular medicine competency checks.

Care records demonstrated person centred care with peoples’ choices, independence and preferences being acknowledged. People had access to a range of activities in the home and in the wider community. People’s dietary needs were assessed and monitored to ensure they had a healthy diet. One person said, “The food is lovely, lots of it and we have a choice.” People were able to make snacks and drinks in communal areas.

People’s healthcare needs were regularly monitored and assessed. Contact was made with other health care professionals, such as GPs, community nurses and the mental health team. Staff knew how to communicate with people in an accessible way using gestures and body language.

Support was given in a respectful and caring way. Staff maintained people’s dignity and promoted independence in a sensitive manner. Relatives felt involved in their family member’s care and were kept fully informed of any changes. One relative said, “I am in a couple of times a week so I am kept up to date with [family member].”

Staff and relatives felt the home was well managed by a supportive registered manager. One care worker said, “They give us a lot of support.” One relative said, “There are meetings being arranged to discuss [family member’s] care.” There were no concerns raised by the other health and social care organisations we contacted.

The service had an effective quality assurance system which ensured different areas of the service were monitored in a timely manner. Regular audits were carried out by the registered manager and operations manager. A development plan and business case were in place for service improvements.

Records were in place to show the service carried out appropriate health and safety checks. The service had current certificates in place for health and safety, such as gas safety and electrical installation certificates and portable appliance testing. Risk assessments were in place to cover work practices. For example, moving and assisting and infection control.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found.

Is the service caring?

We saw that people were treated with dignity and respect by staff who were friendly and considerate. Staff were attentive to people and spent time talking with them to reassure and occupy them. There was a pleasant, welcoming atmosphere in the lounges where people spent time. People who used the service told us they were well cared for. One person commented, "They treat us all alike, there's no favourites'. If they can help you, they help you.'

We spoke with three relatives who were all impressed with the quality of the care. Their comments included, 'The staff are always helpful and very caring.'

Is the service responsive?

We observed that staff provided personalised care and support. They respected people's wishes and followed their agreed plan of care. People and their families were encouraged to be involved in making decisions about their care and treatment. A relative told us, 'The nurse came to meet up with us and went through all of his care notes and we were able to discuss some issues there and then.'

Another relative told us the senior manager and staff were open and friendly and they felt confident about raising any issues or concerns with them. A relative commented, 'If I had any complaints I would tell one of the staff and staff listen to what people want'.

Is the service safe?

We saw that people's needs were assessed and care delivered in line with their assessed needs. We saw that that people had access to professional staff and that they had regular appointments with healthcare professionals and therapists. This meant there were systems in place to help maintain their health and wellbeing. One person we spoke with told us, "Sometimes I become anxious and frustrated but know people will help and support me'.

We observed that staff responded in a caring and compassionate way to people's needs and had a good understanding of people's individual likes and dislikes. We saw staff were warm, amiable and supportive and spent individual time with people. One person we spoke with told us, 'The staff in here have been wonderful to me in helping me to meet up with my family regularly.' CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had made several applications under these safeguards and notified CQC about these. These applications had been approved by the responsible local authority or were in the process of being considered. We found appropriate policies and procedures were in place and relevant staff had been trained to understand when an application should be made and how to submit one.

We saw that risks to people's safety had been identified and assessed to ensure that appropriate care and support was provided to keep people safe. For instance, some people had bed safety rails fitted and safety mats placed by their beds to reduce the likelihood of serious injury if they were to fall out of bed.

Is the service effective?

We found that people who were using the service received the care and support they needed. The staff we spoke with could describe how they met people's needs. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person who used the service told us, 'Staff are great and the food is good as well.' A relative told us, 'My nephew is settled in here and is getting well looked after.'

People were happy with the care that was delivered, and particularly the social stimulation and trips away from the home provided by staff. One person told us, 'I love going to the cinema and the swimming baths.'

Is the service well led?

Staff we spoke with felt supported by the manager and people felt the service was managed effectively. A relative told us, 'We have no worries when we leave here.' There were effective quality assurance systems in place. Regular audits were carried out to check people were cared for appropriately, for instance in respect of their physical wellbeing and nutritional status. Medication systems were audited to confirm staff were following safe practice. Audits of the equipment and how they were used was carried out regularly to make sure people were protected from serious injury.

We found people's privacy, dignity and independence were respected and people experienced care, treatment and support that met their needs and protected their rights. We found medicines were safely handled and people were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider had an effective system to regularly assess and monitor the quality of service that people receive.