This inspection took place on 4 December and was unannounced. Subsequent days of inspection took place on 11 and 13 December 2018 and were announced.

Lothian House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Lothian House provides personal care for up to 48 people. At the time of our inspection there were 47 people living at the home who received personal care, some of whom were living with a dementia.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our last inspection in March 2016 we awarded an overall rating of good and rated the key question ‘is this service caring?’ outstanding. At this inspection we rated the key questions ‘is this service responsive?’ and ‘is this service well led?’ outstanding. Therefore, the overall rating has now improved to outstanding.

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 considered. People received personalised care that was extremely responsive to their individual needs. Without exception, people told us staff went ‘above and beyond’ to make sure people’s full range of needs were provided for.

People’s spiritual needs were actively promoted and supported. The service had excellent links with the local community; people told us how much they valued this. Feedback from professionals on the quality of care provided was excellent.

People, relatives, staff and external health and social care professionals consistently gave us exceptional feedback about the visibility and skills of the registered manager. Staff we spoke with were clearly proud of the service and how they contributed to supporting people with their needs in an holistic way. Staff were highly motivated to develop the service and said they were actively encouraged in this by the registered manager.

There were excellent quality improvement systems in place to ensure constant monitoring of and improvements to the care provision at this service.

Staff had received training in safeguarding and knew how to respond to any concerns. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service.

Staff training in key areas was up to date. Staff received regular supervision sessions and appraisals and told us they felt supported.

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 supported to have enough to eat and drink and attend appointments with healthcare professionals.

People and relatives told us staff were kind, caring and respectful. People’s independence was promoted without risks to their safety.

Care plans were detailed and person-centred and contained important information about people’s life stories so staff could get to know people well.

People and relatives knew how to make a complaint and were happy approaching staff or the registered manager if they had any concerns.

The inspection took place on 9 and 10 March 2016. The inspection was unannounced.

Lothian House is a residential care home based in Spennymoor, County Durham. The home provides personal care to older people and people with dementia. It is situated close to the Spennymoor high street, close to local amenities and transport links. On the day of our inspection there were 46 people using the service.

The home had a registered manager. 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 atmosphere was homely with a family feel that was warm and extremely welcoming.

Without exception we saw staff interacting with people in a person centred and extremely caring way. We spent time observing the support that took place in the service. We saw that people were always respected by staff and treated with upmost kindness. We saw staff being considerate and communicating with people exceptionally well.

We saw that people were encouraged to enhance their wellbeing on a daily basis to take part in activities that encouraged and maximised their independence and also contributed positively to the homely atmosphere, peoples wishes and the day to day running of the kitchen and around the home.

End of life care was care planned extremely carefully and in plenty of advance so that the person and their families were 100% involved in all decisions about their care, needs, wants and spiritual wishes. The service was working towards the GOLD framework (a national training and end of life accreditation programme) and the service also had an established and committed end of life champion within the staff team.

We spoke with a range of different team members; care, senior, kitchen staff, and maintenance staff who told us they all felt well supported and that the registered manager was supportive, and they were all polite, receptive, open and approachable.

Throughout the day we saw that people who used the service, relatives and staff were comfortable, relaxed and had an extremely positive rapport with the registered manager and also with each other.

From looking at people’s detailed care plans we saw they were written in plain English and in a person centred way and they also included a ‘one page profile’ that made excellent use of pictures, personal history and described individuals care, treatment and support needs. These were regularly reviewed by including family members and people. These plans were regularly updated by the care staff and the registered manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP, continence advisor or chiropodist.

Our observations during the inspection showed us that people who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes in a person centred way.

When we looked at the staff training records. They showed us staff were supported and able to maintain and develop their skills through training and unique development opportunities were accessible at this service. The staff we spoke with confirmed they attended a range of valuable learning opportunities. They told us they had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. We also viewed records that showed us there were robust recruitment processes in place.

We observed ho

Everyone we spoke with was complimentary about the care provided.

We observed staff providing care and support to people throughout the inspection. There was a calm, friendly atmosphere around the home and people were seen to respond positively to the staff throughout. The building was clean, warm and well maintained. Relatives said the home was “always warm and clean.”

People told us the staff treated them with dignity and respect. One person said “They are all lovely with you”. A relative told us “They (the staff) are lovely with my mam.”

We saw people were fully involved in any decisions about their care. One person said “The staff always consult me and ask if I need the doctor.” We also found care and treatment at the home was planned and delivered in a way which ensured people’s safety and welfare.

People’s nutritional needs were met. Comments from people included “The food is very nice.” Relatives said “There is a different menu seven days a week.”

During the inspection we found sometimes there were not enough staff on duty to meet the needs of people with dementia. After our inspection the manager told us she had discussed this with her quality manager and staffing levels were to be increased.

Everyone said they would have no hesitation in making a complaint if they were unhappy. Relatives told us they had raised concerns in the past and these had been dealt with to their satisfaction.

We visited this location on a weekday and were able to talk to four people who used the service. We were told that the staff were ‘great’ and ‘excellent’ and that the home ‘feels homely, clean and tidy’.

Comments were also made that staff ‘speak well’, ‘with respect’ and that ‘the bedrooms are comfortable’ and that the ‘food is nice.’ Further it was said that staff were always professional and friendly in their approach and that people who used the service had confidence in the staff.

People who used the service said that they had ‘no concerns’ and they confirmed that they knew how to discuss issues and with whom.

We observed staff providing care and support to people throughout the inspection. There was a calm, friendly atmosphere around the home and people were seen to respond positively to the staff throughout.

During our visit we found peoples’ care and welfare needs were met in a way which ensured their safety. People told us “I feel well looked after,” “The staff are very friendly, very helpful,” “The staff are good to me, they know my likes and dislikes,” “You have to speak as you find. They (the staff) are excellent in here” and “The staff do everything for you. Its beautiful here compared to the other place I lived.” Relatives told us “The stimulation is good here. There are always plenty of activities,” “When my mam broke her hip she was extremely well cared for” and “The lasses here are very good.”

We found the provider had made suitable arrangements to manage and store peoples’ medicines safely.

We also found the provider had taken steps to make sure only suitable people were employed to work in the care home. This was because thorough background checks had been carried out.

At out last inspection in December 2102 we found the provider was not safeguarding the health, safety and welfare of people who used the service. This was because there were not enough qualified, skilled and experienced staff to meet people's needs. At this inspection we found improvements had been made. We found additional staff had been provided to meet people’s care and welfare needs.

We saw the provider had a good system to regularly assess and monitor the quality of the service people received.