We inspected Nunthorpe Oaks on 21 February and 7 March 2017. The first day of the inspection was unannounced, which meant the staff and registered provider did not know we would be visiting. We informed the registered provider of our visit on 7 March 2017. When we last inspected the service in July 2014 we found that the registered provider was meeting the legal requirements in the areas that we looked at and rated the service as good.

Nunthorpe Oaks provides care and accommodation for up to 56 older people some of whom were living with dementia. The service is purpose built with accommodation provided over two floors and this includes communal lounge and dining areas. There are garden areas surrounding the building. At the time of the inspection there were total of 54 people who used 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.

People received a consistently high standard of care because staff were led by an experienced and proactive registered manager. The staff team were highly motivated and enthusiastic, and committed to ensuring each person had a good quality of life. There was a clear management structure in place and oversight from the registered provider. There were systems in place to monitor the safety and drive the continuous improvement of the quality of the service provided. A comprehensive programme of audits and checks were in place to monitor all aspects of the service, including care delivery, accidents and incidents, health and safety, infection prevention and control and medicines. Audits resulted in clear action plans to address shortfalls or areas of improvement.

The registered manager displayed exceptional leadership qualities, drive and enthusiasm. They empowered staff to provide outstanding care that was tailored to individual’s needs. Without exception people, their relatives and professionals told us they experienced and we observed compassionate care from staff who strove for excellence. This ensured the service was run in the best interest of people who used the service.

People received care and support in an exceptionally personalised way. Staff knew people well, understood their needs and the way they communicated if they were living with dementia. Care was focused on people's wishes and preferences. This meant people were able to maintain their independence and achieve a good sense of self-worth and wellbeing. The impact this had on people was outstanding and had resulted in them being settled, content and helped them to lead as full and active lives as they wanted to.

Staff developed exceptionally positive and caring relationships with people and their families. Staff were very motivated and demonstrated a commitment to providing the best quality care to individuals in a compassionate way. People's privacy and dignity was maintained at all times during the inspection. Health professionals told us people received end of life care that was exemplary, and that staff worked closely with the community nursing team to ensure people and their family were treated with dignity and respect, and that their individual preferences were considered at all times.

People’s independence was actively encouraged. The registered manager and staff displayed clear resolve to make a positive difference to people's lives. Activities were invigorating, outings and events were well thought through, varied and in plentiful supply. Staff encouraged and supported people to access activities within the community. There were meaningful activities for people living with dementia.

Assessments were undertaken to identify people’s care, health and support needs.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. 

At the last inspection on 21 June 2013 the service was found to be meeting the regulations we looked at.

We inspected Nunthorpe Oaks on 22 July 2014.  This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. 

Nunthorpe Oaks is a residential care home providing personal care for up to 56 people and / or people living with a dementia.  At the time of the inspection there were 55 people who used the service.  Accommodation is provided over two floors and includes communal lounge and dining areas. There are garden areas surrounding the building.

The home had a registered manager in place.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

The registered manager and staff had been trained and had a good knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).  The registered manager understood when an application should be made, and how to submit one. This meant that people were safeguarded and their human rights respected.

We found that people were encouraged and supported to take responsible risks.  People were encouraged and enabled to take control of their lives. 

People told us that they were cared for and supported by suitably qualified, skilled and experienced staff. Staff told us there were sufficient staff on duty to meet people’s needs; however people who used the service disagreed with this.  Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff started work.

Staff who worked at the service were extremely knowledgeable about the care that people received.  Staff and people who used the service spoke of person centred care.  People who used the service and relatives told us they were very happy with the care that they received. 

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.  The majority of people told us that they liked the food provided; however some people thought that improvements could be made.

People were supported to maintain good health and had access to healthcare professionals and services.  People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments. 

People and relatives told us they were supported by caring and compassionate staff.  People we spoke with said they were happy with the care provided and could make decisions about their own care and how they were looked after.

We observed interactions between staff and people who used the service.  We saw that staff were kind and respectful to people when they were supporting them.  Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

People’s care and support needs had been assessed before they moved into the home. Care records we looked at detailed people’s preferences, interests, likes and dislikes and these had been recorded in their care plans; however care records looked at did not contain detailed evaluations of needs. 

We saw that people were involved in a wide range of activities.  We saw that staff engaged and interacted positively with people.  We saw that people were encouraged and supported to take part in activities.   Activities were arranged both on an individual and group basis.

Appropriate systems were in place for the management of complaints.  People and relatives told us that the registered manager was approachable.  People we spoke with did not raise any complaints or concerns about living at the home.

There were effective systems in place to monitor and improve the quality of the service provided.  Staff told us that the home had an open, inclusive and positive culture.

We spoke with 12 people who used the service and the relatives of two people. We also spoke with the manager, the head of care and four staff. People who used the service expressed satisfaction with the care and service that they received. One person told us, “I would have preferred to stay at home but I realised through my eyesight, I could not manage. If you have to be in a home, then you can’t beat this one, that is my opinion for what it is worth.” A relative we spoke with told us, “My father was in and out of four homes before coming here and believe me this has been the best one. Both my parents are here, I am very happy with the care they are getting.”

Where able, people could make their own day to day decisions and lifestyle choices. They could choose to participate in activities or spend time in their rooms. We saw people could maintain contact with their friends and family.

We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing. People's views were taken into account in the assessment and care planning process.

People who used the service were protected from the risk of abuse and told us they felt comfortable and safe with staff.

Staff received appropriate training and had regular supervision and appraisals.

The quality of the service was monitored and reviewed on a regular basis.

We observed part of the morning medicines round and saw medicines being administered to people in the main living area of the home. We noted that two people were given their inhaled medicine in the living area in front of other residents which does not fully respect their privacy and dignity.

We spoke with one person about their medicines and the care they received. This person said " I'm happy to take my medicines in the living room, the staff are good, and I get all my medicines on time.”

We saw that some people managed their own medicines and appropriate risk assessments had been completed and ongoing support was provided to do this safely.

We had completed an inspection of the home in August 2011 and this visit was aimed at looking at areas where improvements were needed. During this visit we spoke with seven people who used the service and two relatives. When discussing the service with people we concentrated on those areas where compliance actions were set.

People told us that the staff were very friendly and that the care was ''very good.'' One person said ''I've lived here for a number of years and found the staff are always at hand to help and really do care about me.'' One relative said ''We have been very impressed with the care and after all the press about poor care homes this is so much better than I expected. We are very happy with how my relative is looked after and find the staff to be very good and caring.''

During our visit we spoke to people who used the service. Everyone that we spoke to was satisfied with care and service provided. One person said, "The staff are quite good, I don't have any complaints. I am luckier than most as I'm still quite independent". Another person said, "This is my home now and I am quite happy and well looked after. The staff are kind and give me help when needed". We asked people about the food that was provided. People said, "The food is very good and you can have what you want". Another person said, "I'm quite satisfied with the food".

We spoke to two people living in the home about their medicines. Both said that they received all their medicines at the right time and care staff were helpful and supportive when giving medicines.

“Staff are very kind.”

“Yes I like it here.”

People at the home stated you could join in activities where you chose to and your wishes were respected if you chose to remain in your own room. One person said

“You don’t have to join in if you don’t want to.”

“Food not bad at all, Meat for lunch and biscuits and cakes to eat.”

“Food is excellent. On a Monday generally have the meat left from Sunday.”

“Well looked after.”

“You can keep your tablets in your own room if you like and it works well for me.”

One person told us they had found the recent building work very disruptive as they had to move rooms and some of their belongings were inaccessible to them for some time.

“Most staff are excellent but some just like to stand around talking”.

“Staff have been very good.”

“The staff are very kind.”

One person replied stating they could not follow the quality assurance questionnaire as it was “too difficult”.

When we carried out the inspection there were 43 people living at Nunthorpe Oaks Care Home. We spoke with five people who used the service and the relatives of three people. People who used the service expressed satisfaction with the care and service that they received. One person told us “It couldn't be better.” Another person told us “They are looking after me well.”

One of the relatives we spoke with told us they were happy with the staff who looked after their mum and the staff were very good. Another relative told us “Staff on the whole do their best.”

People told us they were able to make their own day to day decisions and lifestyle choices. They confirmed they had menu choices, could choose to participate in activities or spend time in their rooms. We saw people could maintain contact with their friends and family.

We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing. People's views were taken into account in the assessment and care planning process.

We found processes for the administration and management of medicines were not always been followed.