Northfields

Northfields is a residential care home providing personal care and support to up to seven people with a learning disability and or autistic people. At the time of our inspection there were six people using the service. The service consisted of one large bungalow, with shared communal spaces, and each person had their own bedroom with ensuite bathroom.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: 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. However, records relating to capacity assessments and Deprivation of Liberty Safeguard (DoLS) applications were not regularly reviewed to ensure people were being supported in the least restrictive manner. The premises were homely, and people’s bedrooms had been personalised based on their own preferences.

Right Care: Care records were under review at the time of the inspection and we identified areas where improvements were required to ensure safe consistent care was provided. People’s support was personalised and catered to their specific wants and needs. Staff provided support in a dignified way to protect people’s privacy and maintain their feeling of self- worth. Staff were trained appropriately to support people and knew them well.

Right Culture: Staff and the management team at the service spoke positively about people within the service and wanted people to live their best lives. We identified areas were governance of paper records and processes had not been maintained putting people at potential risk. Such as medicine records not clearly evidencing topical cream applications, risk assessments and care plans not being regularly reviewed or robust.

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 requires improvement (published 14 March 2020). The service remains rated requires improvement. This service has not achieved a rating of good overall for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

Enforcement

We have identified a breach in relation to the governance and oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Northfields is a residential care home providing personal care to up to seven people with learning disabilities; the home was full at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The provider had made service-wide improvements since our last inspection and were no longer in breach of regulations. Most of the concerns we found previously had been due to there being only one staff member on duty in the service at night. This had resulted in people receiving care that was not safe, dignified or person-centred. Following that inspection, the provider introduced a second staff member on each night, and we found, at this inspection, that this had mitigated several risks. We found people were receiving care and support that was safe, timely and individualised to meet their needs.

The governance system the provider had in place, together with the senior management team’s oversight, had driven improvements. However, the system needed to continue to be embedded and developed to ensure all areas of the service were covered and that they were effective in promptly identifying and rectifying issues. For example, some issues we identified on this inspection had not been identified by the provider’s governance system. This included poor record keeping in relation to pressure care for one person and safety checks on lifting equipment.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 were supported by staff who had the necessary skills and abilities to meet their needs, had been trained and received ongoing and effective support; they had been safely recruited. People told us staff were kind, caring and respectful.

The service worked well with others to ensure people received the care they needed and that it was person-centred; their health, social and nutritional needs were met. People received their medicines safely and they were protected from the risks associated with abuse and infections due to the procedures in place. End of life care was planned for considering people’s wishes.

All the people we spoke with told us the service had improved since our last inspection and were happy with the quality of care delivered. No concerns were raised, and people told us that if they did have concerns, they would feel comfortable raising them within the service. They told us staff and the management team were effective, supportive and approachable and had worked hard at making the necessary improvements; our inspection confirmed this.

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

Rating at last inspection and update

The last rating for this service was inadequate (report published 5 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve; this was discussed with the provider. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 5 September 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Northfields is a residential care home providing personal and nursing care to seven people with learning disabilities and autism .

The care home accommodates seven people in two linked bungalows. At the time of the inspection visit there were seven people living in the home.

The service was developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. We found that the service had deteriorated since it’s last inspection and was no longer fully meeting these principles.

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

The service did not always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; people did not always receive safe, person-centred care according to their individual needs and preferences.

Risks to people concerning their health and environmental risks were not always recognised and adequately mitigated. There were concerns about the cleanliness in the home.

There were not enough staff at night to ensure people were safe and their needs were met properly. This negatively impacted their independence, comfort and dignity.

Shortfalls had not been identified and sufficiently acted upon by the provider. There was not always evidence of learning from incidents and improving the service accordingly.

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 did supported this practice. However, records around mental capacity, consent and best interests’ decisions required improvement.

People did not always receive individualised care according to their needs and preferences. Care plans were not always consistent and accurate.

Initial care plans did not always contain sufficient guidance for staff, and care plans were not properly developed in a timely way.

People were supported to have a choice of meals and enough to drink.

Staff knew people well and had built good relationships with them. Staff worked well as a team and supported people to go out and follow their interests.

Medicines were stored and administered safely.

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 January 2017), with requires improvement in the responsive key question.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements in all key questions. We have identified four breaches in relation to risk assessment, safe staffing levels, person-centred care and governance at this inspection. Please see the full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This unannounced inspection took place on 12 October 2016 and was carried out by one inspector.

At the time of the inspection there was 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.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

People felt safe and relatives said that they had no concerns about the arrangements that were in place to keep people safe. Although risk assessments were in place these did not always include information for staff about how the risk could be minimised. Staff had an understanding of how to protect people from harm and knew what action they should take if they had any concerns.

Staffing levels ensured that people received the support they required at the times they needed it. The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the home. People were involved in the recruitment procedures, with only the most appropriate staff being selected for a job.

Staff were kind and compassionate when working with people. They knew people well and were aware of their preferences, likes and dislikes. People’s privacy and dignity were upheld.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt and reliable access to healthcare services when needed. People were provided with a choice of food and drink that they enjoyed.

Support plans were in place detailing how people wished to be supported and these had been produced in conjunction with people using the service. People had agreed what care and support they needed and were fully involved in making decisions about their support. People participated in activities within the home or in the community and received the support they needed to help them to do this. People were able to choose how they spent their time and what activities they participated with.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the registered manager if they needed to. The complaints procedure was available in different formats so that it was accessible by everyone.

People had confidence in the registered manager and the way the home was run. The registered manager ensured the staff team were well supported and there were opportunities for people and staff to provide feedback about any improvements that could be made, and these were listened to and acted on.

At our last inspection we found that we were not able to conclude that the service was as safe as it should be. Although staff understood how to meet people's needs we found that records were not kept up to date to reflect people's current needs. This included care records where the manager had identified an update was needed. This meant people were at risk of receiving unsafe or inappropriate care. We also found that people's personal records were left accessible in communal areas of the home. This meant that people's confidentiality was not properly protected. We asked the provider to tell us how they were going to make improvements in order to comply with the law about record keeping.

Is the service safe?

This inspection was carried out to check that record keeping practices had improved. This was so that we could be sure that this element of concern for the safety of the service had been addressed properly.

Although we spoke with four people living in the home, their feedback did not relate to the way their records were kept. Three people were enjoying watching the tennis together. One person was looking at magazines. Staff spoke with them respectfully and offered people choices of drink during the afternoon. They also offered people choice for their evening meal.

We reviewed the care records for four people living at Northfields and spoke with staff about people's needs. We found that records were held in locked cabinets, so that people's confidential information was properly protected.

We found that all of these people's plans of care and the assessments of risk to which they were exposed, had been updated. Where a person's needs had changed quickly this was clearly reflected in their file. The advice that had been given to the service by other professionals was included in the records. Staff were able to tell us about these changes and the outcomes of recent appointments. The information they gave us was consistent with what was in their plans.

We concluded that improvements had been made in respect of records, to ensure the service people received was safe.

Below is a summary of what we found.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People were treated with respect and dignity by staff. People told us that they liked the staff who worked with them.

Medicines were managed in a way that ensured they were safely recorded and administered.

We found that, since our last two inspections, improvements had been made to the way the safety of the service was monitored. Regular checks were now being made to ensure fire detection systems worked properly and that staff knew what to do in an emergency if a fire broke out.

Systems were in place to ensure that the safety of the service was monitored. This reduced the risk to people and helped the service to continually improve.

Although staff understood how to meet people's needs we found that records were not always up to date, even though some of them had been identified as needing an update to reflect people's current needs.

The home had procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We were given an example of how the manager had taken advice to see whether an application was needed regarding deprivation of liberty for someone living at the home. This meant people would be safeguarded as required. We provided information to the manager about a recent legal decision regarding DoLS so that further advice could be taken if required.

Is the service effective?

People's health and care were discussed with them. Specialist advice regarding mental health, behaviour, dietary needs, communication and swallowing difficulties had been sought where this was appropriate. It was clear from our observations and speaking with staff that they understood people's care and support needs. We asked people if they felt staff did their jobs properly and supported them well. They told us that they did. People said they were involved in discussions about their care and one person had helped to write part of their plan of care.

Is the service caring?

We saw that people were supported by attentive staff. There was a lot of laughing and good humour. People told us they felt well treated by staff. One person told staff, "You're lovely old people." Another person said, "Staff are alright. They treat me right." One relative had commented on their survey that the person they visited '...is so well cared for I cannot fault the staff.' They went on to write, 'Northfields is brilliant.'

We observed that staff respected people's privacy and knocked on bedroom doors before entry. We also observed that staff had the skills to distract someone who was becoming agitated and to calm the person. Our discussions showed that staff understood the impact of dementia for people living in the home.

Is the service responsive?

People were able to engage in activities inside and outside their home, with staff support as needed. People were also able to discuss how the home was being run at 'service user meetings'. Staff were able to give us examples of where people's needs had changed and how they were arranging for further advice in relation to their care. They were also able to tell us how people's concentration and ability fluctuated during the day and how they would explain and discuss things at the times when the person was most alert.

One person was supported to manage their own medicines because they wished to do so. They also told us, "We have meetings so we can talk about things."

Is the service well led?

The service had a quality assurance system so that shortfalls were identified and addressed promptly. This meant that the quality of the service could be improved where necessary.

We found that, despite identifying in January 2013, improvements were needed to the storage of records this had not been properly addressed. Confidential records were not held securely.

Staff spoken with were clear about their roles and responsibilities.

We found that the service kept detailed support plans and risk assessments for people, which were updated regularly to ensure they reflected people's current needs. We spoke with two people using the service, and one person told us, "I go to work in a charity shop on Tuesdays". This means that the staff at Northfields are enabling people and supporting people to be independent and find meaningful occupation.

In March 2013, we told Northfields they needed to make improvements to the decor of the home and with carrying out checks on the fire alarm systems. We found that they had made improvements to the decor and that people had involvement in this. However, they had failed to ensure that checks on the fire alarm system were being carried out weekly as required. This meant they could not always guarantee the fire alarm system was operational.

We found that the service undertook the appropriate pre-employment checks to ensure that staff had the right skills, background and qualifications to provide care to people.

We found that there was an effective complaints procedure in place at Northfields. At the time of visit, Northfields had not received any complaints about the service.

We found that records kept regarding people's care and treatment were extensive but a few gaps were noted. People's care and support was developed with them and reflected their needs and preferences.

We saw that people with specific requirements relating to nutrition and hydration were catered for appropriately and professional support and guidance on nutrition was adhered to.

The premises were secure and generally in good order. However, as the fire alarm had not been tested on a regular basis there was a risk that should a fire break out that the alarm was not operational which would jeopardise people's safety.

Staffing arrangements were in place to ensure that sufficient numbers of qualified and experienced staff were available at all times. The home had recently recruited three more staff which meant that recent reliance on bank or agency staff would be reduced. This would result in better continuity of care for people living at Northfields.

The provider had a complaints procedure in the event of any grievances arising.