Northview Lodge Nursing Home is a two storey purpose built nursing home in Sunderland caring for younger adults with dementia type illnesses, younger adults with acquired brain injury and people with enduring mental health needs in two self-contained units called Rose and Oak. On the day of our inspection there were 42 people using the service.

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

The inspection took place on 19 and 25 January and was unannounced. This meant the staff and the provider did not know we would be visiting. Northview Lodge was last inspected in May 2014. The service met all the regulations we inspected against at that time.

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 rel

During our inspection on 28 May 2014 we found the service type for Domiciliary Care Service is no longer relevant at this location, as well as the regulated activity for personal care. We requested for the provider HC-One to submit a variation application to the Care Quality Commission (CQC) to reflect these changes. At this inspection we checked that the essential standards of quality and safety were being met. We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• 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 spoke to three out of thirty two people living at Northview Lodge. One person told us staff were “brilliant”. They told us they were involved with their care plan from the beginning and that staff were really supportive. Another person said “I like living here” and “you cannot fault the staff”. The third person we spoke to said “it’s a lovely home.”

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.

The people who used the service told us the staff involved them in the day to day running of the home. People told us about their regular meetings with the staff. One person we spoke with told us, “There is always plenty of staff about”. Another person told us, “I don’t have to wait to see staff. They are always there”.

People told us they felt Northview Lodge Nursing Home provided a “safe” place for them. One person told us, “I know I am vulnerable out there, so I am safer here”. Another person told us, “I feel more confident in my self when I am here. The staff look after us well”.

Other comments from the people we spoke with included:

“The staff are good and they support me with all my needs”.

“They listen to what you had to say and they always ask you what you want”.

“I want to move out and the staff are helping me to get a place of my own to move to”.

People told us that they were happy with the improvement made to the home by the provider. They also told us that they were aware that there were further improvement works to be carried out.