Northfield House

Northfield House is a residential care home providing care for up to 25 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 22 people using the service. People are accommodated in one adapted building.

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

The registered manager and provider had implemented new monitoring systems to continue to improve the quality of the service people received. While the new governance arrangements had brought about improvements, further improvement and time was needed to allow these systems to bring about and sustain good outcomes for all people.

People’s care records were not always current and reflective of their needs. The management team was aware of this shortfall and was taking action to improve people’s care records.

Whilst improvements had been made to promote people’s person centred care throughout the home, people might not have always received care which promoted their wellbeing and was personalised to their needs. People did not always benefit from fulfilling and stimulating engagement tailored to their needs.

People’s risks had been assessed and clear guidance was available for care and nursing staff to follow. Where people had specific healthcare needs, these were clearly documented.

The registered manager and provider were in the process of recruiting more staff to help drive the person centred culture they were embedding into Northfield House. While recruitment was ongoing the home was supported by consistent agency staff.

Improvements had been made in relation to people’s prescribed medicines. The management team had implemented new systems and had taken action to ensure people received their medicines as prescribed.

Systems were in place to ensure people were protected from the risks associated with their environment.

Staff supported people in the least restrictive way possible and in their best interests. Where people were living under Deprivation of Liberty Safeguards; staff understood the support they required.

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 were assured the service were working in accordance with government guidance.

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 requires improvement (published 13 October 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made, however the provider was still in breach of two regulations in relation to person centred care and good governance.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 24 and 25 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment), and a requirement notices in relation to Regulation 9 (Person centred care) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For the key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northfield House on our website at www.cqc.org.uk

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care and good governance in the Effective key question and Well-led key question, 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.

Northfield House is a residential care home providing personal and nursing care to up to 25 people. The service provides support to older people, many of whom live with dementia. At the time of our inspection there were 22 people using the service. People are accommodated in one adapted building and there is access to a decking area and garden.

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

People’s risks had not always been fully assessed. Risk management actions had not always been clearly developed to reduce or mitigate people’s risks. People’s risks had not always been reviewed when their health or circumstances had altered. This included risks associated with falls, prolonged immobility, seizures, the use of some medicines and evacuation in the event of a fire. In this respect, lessons about the management of these types of risks had not been fully learnt.

The provider had ensured all staff were familiar with the service’s post falls protocol which included what to do if the fall included a head injury. Senior staff who administered people’s medicines were aware of who was prescribed an anti-coagulant and aware of the increased risks of bleeding for these people, post fall. Not all staff were aware of the service’s seizure management protocol. Action had been taken to more closely monitor moving and handling practices and to ensure staff were trained and competent in this practice.

People’s medicines had not been effectively managed. People had not always received their medicines as prescribed. The processes for ensuring medicines errors were identified and addressed had not been operated effectively. This put people at risk of the impact caused from medicine errors.

Care and treatment plans had not always been developed to provide staff and other health care professional involved, clear information about people’s needs and how these should be met. This put people at risk of not receiving the care and support they required to protect them from harm and to meet their assessed needs.

People did not always receive the support they required to eat and drink. In one observed case a relevant care plan, providing staff with information on how to support the person in this area, was not followed in practice. In another case the person’s needs in relation to eating and drinking had not been assessed and a plan of care not developed.

The provider’s monitoring processes were not fully and effectively implemented. The areas where we found shortfalls had not been sufficiently monitored by the provider. This meant these shortfalls had not been fully identified and action not taken to ensure people received safe and appropriate care.

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.

Despite challenges in recruiting staff the provider had taken action to ensure there were enough suitably skilled and knowledgeable staff to meet people’s needs. Staff were provided with appropriate training and support, relevant to their role.

People had access to reviews by their GP and other services such as chiropody, optical reviews and dental support as required.

Arrangements were in place to keep the environment people lived in clean and safe.

Complaints and concerns were listened to and action taken to address these and to learn from these.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability.

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 2 July 2021).

Why we inspected

We received concerns in relation to post falls management and the management of prescribed anti-coagulants and the moving and handling of some people. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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. For those key questions not inspected, we used the ratings awarded at the last inspection where these key questions were inspected to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northfield House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the assessment and management of people’s health and care risks and the management of medicines 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.

Northfield House is a residential care home providing personal and nursing care to 25 people aged 65 and over. At the time of the inspection 24 people lived there. The service specialises in the care of those who live with dementia. Nursing care is provided by the local community nursing teams.

Northfield House accommodates people in one adapted building. The accommodation consists of 23 single bedrooms and one twin, all with toilet and washing facilities. There are ample communal rooms and additional toilets and bathrooms. There is easy access to a safe garden.

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

People were safe. There were systems and processes in place to assess and manage risks which could impact on people’s health, safety and well-being. The provider’s policies and procedures were updated and followed by the staff. Actions were taken to protect people from potential abuse, unsafe staff recruitment, poor care practices, infection and environmental risks, such as fire. A relative said, “They have been very strict about the COVID -19 regulations regarding visiting, which is actually reassuring.” There were enough staff in number and experience to support people’s needs. One person said, “If you ring a bell, they [staff] come.”

We were assured the service was following safe infection prevention and control procedures to keep people safe.

People’s medicines were managed safely, and people received their medicines as prescribed. There were enough staff with suitable experience to attend to people’s care and social needs and, to provide supervision where required. A relative said, “I came back today (from visiting) and felt reassured.” We observed staff defusing small altercations between people and responding to any form of distress to prevent further escalation. Another relative said, “I feel [relative] is safe and well cared for, they look happy, clean and tidy. I can see on the social media films that [relative] is happy.” There were processes in place to identify emerging risk and to learn from incidents which had taken place.

The service was well managed. Improved quality monitoring systems helped managers and the provider identify where improvements were needed to the service. A system for reviewing the progress of planned improvement actions was in place. A relative said, “I get the feeling they are always looking at ways of improving the service.” There was effective communication between provider, managers, staff and people’s relatives and representatives. This resulted in staff being kept updated with information and guidance they needed to complete their work safely and effectively.

Relatives felt comfortable in discussing any concerns they may have and people's representatives told us they felt well informed, included and updated about their relative's care and treatment. They also felt well informed and updated in relation to care home visiting guidance; regular updates had been forwarded to them. Relatives said, “They do call me if [relative] needs anything and they keep me informed. The manager, (manager’s name], is very friendly and approachable.” They [staff] are under a lot of pressure and considering that they do a lovely job.” Feedback was sought from people, their relatives and staff and was monitored and acted on where practicable to do so.

The service worked with commissioners of adult social care to ensure people could access the service’s specialised support as required. Staff had worked hard during the pandemic to ensure people had access to necessary healthcare and social care professionals as required.

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. In their daily work staff adhered to the principles of the Mental Capacity Act 2005 including Deprivation of Liberty Safeguards (DoLS).

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 requires improvement (published 21 November 2020).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

In August 2019 we carried out an unannounced comprehensive inspection of this service. A breach of legal requirements was found in relation to Good Governance. The provider completed an action plan to show what they would do, by when, to improve their governance systems. In September 2020 we carried out an announced focused inspection to check if they had followed their action plan. We found not enough improvement had been made to improve their governance systems and the management of risks associated with fire safety were insufficient to keep people safe in the event of a fire. Breaches of legal requirement were found, and we issued Warning Notices in relation to breaches of Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In November 2020 we carried out an unannounced targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We found the provider had taken action to improve fire safety as well as the support people would receive in the event of a fire. This breach of legal requirement had been met.

We undertook this announced focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This breach of legal requirement had been met.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northfield House on our website at www.cqc.org.uk.

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.

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.

Northfield House is a residential care home providing personal care and support to people aged 65 and over who live with dementia. At the time of the inspection 23 people were receiving care and support. The service can support up to 25 people.

People were accommodated in one adapted building across three floors. People had their own bedrooms with washing and toilet facilities. There were adapted bathrooms and additional communal toilets. People had a choice of communal rooms where they could relax and eat. A conservatory led out onto a decking area and a secure garden. There was car parking on site and additional car parking in the surrounding area.

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

We found improvements had been made to fire safety and how people would be supported in the event of a fire.

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.

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 inspection of this service took place on the 7 September 2020 and the rating for this service was Requires Improvement (published 19 October 2020). There were concerns in relation to fire safety and the support available to people in the event of a fire. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.Regulation 12 (Safe care and treatment).

Following our inspection on 7 September 2020 we issued a Warning Notice in relation to this which was to be met by 9 October 2020.

At this inspection we found improvements had been made to fire safety and the support people would receive in the event of a fire. The provider was no longer in breach of regulations and the Warning Notice had been met.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met. The overall rating for the service has not changed following this targeted inspection and remains as Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Northfield House on our website at www.cqc.org.uk.

Follow up

We will continue to liaise with the local authority’s fire safety team to ensure the service fully meets with the requirements the Regulatory Reform (Fire Safety) Order 2005.

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.

Northfield House is a residential care home providing accommodation and personal care to 24 older people who live with dementia at the time of the inspection.

Northfield house can accommodate up to 25 people in one adapted building which has an enclosed garden.

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

Fire evacuation procedures were not in place and fire drills had not taken place to test that people could be supported to safely escape if there was a fire. This placed people at risk of harm in the event of a fire.

Whilst some improvements had been made since the last inspection in relation to governance and oversight, systems were still not always effective in identifying and addressing quality concerns. Further improvements were needed in the monitoring of people’s care records and fire safety and ensuring identified shortfalls were robustly addressed. We have received some assurances from the provider that they had started taking action to mitigate the risks identified during this inspection.

The monitoring of the medicines management had been effective and had resulted in medicine errors reducing and improved support for staff who administered medicines.

Staff were aware of how to report their concerns in relation to safeguarding and poor care. Concerns raised including about staff’s behaviour, were investigated by the provider and actions taken to address any shortfalls. However, in some cases it had taken concerns to be raised for the shortfall to be identified and the provider did not always identify shortfalls such as incomplete records, through their own monitoring systems.

Infection prevention and control processes were in place to protect people and prevent the spread of infection. There was plenty of personal protective equipment (PPE) and improved arrangements to support staffs’ use of this in relation to current PPE guidance for COVID-19. Regular COVID-19 testing of staff and people took place, support to socially distance and isolate when needed was provided and support to remain in contact with family members in a safe way.

The views of people and their relatives had been sought and, where it was practicable to do so during the pandemic, these had been considered and acted on to help improve the quality of support and services provided to people.

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 Requires Improvement (report published 6 November 2019) and we identified one breach of regulation 17 Good Governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found although some improvement was evidenced at this inspection, not enough improvement had been made and the provider remained in breach of regulation 17. We also found a new breach of regulation 12 Safe Care and treatment. The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last three consecutive inspections.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also 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 coronavirus and other infection outbreaks effectively.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make further improvements in ‘Safe’ and ‘Well-led’ sections. Please see full report for detail.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northfield House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a repeated breach in relation to Good Governance as risk and quality had not been monitored effectively and shortfalls, when identified, had not been addressed before they could pose a risk to people’s safety. We also found a new breach in relation to Safe Care and Treatment; safe fire evacuation procedures were not in place.

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

Follow up

We will continue to monitor the information we receive about the service. We will follow up the provider’s progress in relation to their compliance with necessary regulations in line with our current regulatory methodology. If we receive further concerning information we will review this and decide on the action we need to take.

We will continue to work alongside the provider, commissioners of the service and the local fire safety team to monitor progress. We will meet with the provider and ask for an action plan to understand what they will do to improve the standards of quality and safety moving forward.

Northfield House is a residential care home which can provide accommodation and personal care to 25 older people. At the time of the inspection 20 people were receiving care. The home cares for older people, some who live with dementia. People are accommodated in one adapted building which has a sensory style garden and car parking.

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

At the last inspection in September 2018 we inspected the key questions Is the service safe? and Is the service well-led? We found the provider needed to make improvements to their quality monitoring system, people’s care records and how they sought and acted on feedback from people, relatives and professionals.

During this inspection we found the provider had met the actions outlined in their action plan, forwarded to us following the last inspection. However, their quality monitoring system was still not always ensuring effective and continuous monitoring of the service and improvement was still required to the quality monitoring of the service and maintenance of some records. Some areas of shortfall were not getting identified and addressed in a timely manner such as, the provision of staff supervision in accordance with the provider’s policy, consistent and effective auditing of care plan and risk assessment content, the monitoring of staff competency checks and some areas of cleaning and safety management. Although, to date, this had not impacted on people’s care and treatment, people’s safety was potentially at risk if shortfalls in service compliance and improvement progress continued to not be successfully identified and addressed.

We had received concerns that people’s health and welfare had been, and continued to be, neglected and that the management of the home supported poor practice. We followed up specific incidents, which had been reported to us. We therefore looked at the management of medicines, the general management of the home and the overall workplace culture. We found that best practice had not always applied; when responding to changes in people’s health and wellbeing and in record keeping. A lack of communication and team working had contributed to how two of the situations reported to us, had been responded to. This had contributed to a delay in people being medically reviewed. Staff actions were not the only contributing factor in this delay, ambulance waiting times and waiting to access GP advice also contributed. Ensuring staff had appropriate training, support and guidance was important so they were able to respond to changes in people’s physical and mental health effectively. There was evidence to show that action had been taken to improve staff knowledge and to ensure they had appropriate guidance. Current legislation; processes required under the Mental Capacity Act and Deprivation of Liberty Safeguards were followed. No-one in the home was being ‘wilfully imprisoned’. Action was taken by the registered manager, at the time of these incidents, to investigate and address shortfalls in practice. We found managers were not supporting poor practice.

Improvement to the quality monitoring of the service and the processes behind ensuring necessary action was taken for continuous improvement was therefore needed. For example, making sure that all support arrangements and processes were in place to ensure best practice was consistently maintained. To ensure changes in workplace culture and performance were identified and effectively addressed and, to ensure the adopted management systems and processes helped managers to remain compliant with regulations and ensure the provider’s policies and procedures are followed.

We recommended the provider seek immediate advice regarding their quality monitoring processes. You can also see what action we have asked the provider to take at the end of this full report.

People’s health and social care needs were assessed. Risk had been assessed and care was delivered in accordance with people’s needs and preferences. In two people’s case risk assessments had not been reviewed following changes in their health. We recommended that the provider review their processes for reviewing risk assessments.

There were arrangements in place for people’s health needs to be assessed and supported by external professionals and specialist practitioners where required.

There were enough staff in number and skill to meet people’s needs. Despite a large turn-over of staff in the last year, and further staff absences just prior to the inspection, action was being taken to staff the home appropriately and recruit new staff. Appropriate training was provided, and managers ensured care was led by experienced and knowledgeable staff.

People were supported to take their medicines as prescribed. Action had been taken to reduce the numbers of medicine recording errors, which potentially put people at risk of errors associated with their medicines. This action had been successful with no errors in the weeks leading up to the inspection taking place.

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 services policies and procedures supported this practice as did the training provided to staff. Legislation protecting those who lacked mental capacity was followed.

Measures were in place to reduce the risk of cross contamination leading to the spread if infection. The monitoring of cleaning needed to improve so that managers could be assured that the standard of cleanliness, both around the home and in the kitchen remained adequate.

Despite the lack of consistent formal staff supervision meetings, there was support and advice available to staff whilst they cared for people. Senior staff monitored the practical care provided to people and promoted a whole team approach to caring. Relevant staff training had been completed and arrangements were in place to develop staffs’ learning and development further. Staff felt supported and able to raise concerns.

We observed people receiving caring and compassionate care; staff were attentive to people’s needs and feelings. Staff knew people well and worked collaboratively with people and their representatives to ensure care was provided in a way which supported people’s wellbeing. Elements of the ‘Butterfly’ model of care had been adopted, meaning staff were supported to focus on people’s individuality and their feelings. Staff also worked with external health and social care professionals, and commissioners of care, to support people’s wellbeing and easy access to the home.

People were supported to eat and drink enough and, in a way, which suited their individual needs.

People were provided with help to enjoy social activities and activities which more personally meaningful.

People’s dignity and privacy was met, and people’s diverse preferences were understood, respected and met. The involvement of people’s representatives, relatives and friends in people’s care and social activities was valued by the staff. There were no restrictions on visiting and where appropriate and safe to do so, people were supported to go out from the home as and when they felt able to.

Information was provided to people and their representatives in a way which met their needs. People’s communication needs were met.

People’s end of life preferences and wishes were explored, and staff worked alongside other professionals to support a dignified and comfortable end of live. This included the person’s preferred pastoral support.

Managers were accessible to people and their relatives, so they could talk with them when they needed to.

Work had been done on promoting an open and relaxed workplace culture so both people’s and staffs’ wellbeing was maintained. At the time of the inspection staff and managers were working as one team to provide better outcomes for people. Staff spoken with were positive about the atmosphere in the home and how they as a team were being led and supported. There were arrangements in place for managers to formally communicate with people, relatives and staff and to obtain and listen to their feedback. Complaints were investigated and responded to.

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 the service was Requires Improvement (report published 20 November 2018).

Not enough improvement had been made to the service’s quality monitoring processes and the provider remained in breach of regulation. This service has been rated Requires Improvement for the second time.

Why we inspected – This was a planned inspection based on the previous rating and in response to concerns raised about the service.

We have found evidence that the provider needs to make improvements. Please see Is the service safe? and Is the service well-led? sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northfield House on our website at www.cqc.org.uk.

We carried out this inspection following anonymous concerns raised regarding the service in July 2018, these concerns were focused on the safety of people. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to /this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Northfield House on our website at www.cqc.org.uk.

At the time of our inspection, 23 people were living at Northfield House, one of these people was in hospital at the time of the inspection. Northfield House is based near the centre of Stroud. Northfield House has accommodation for people over three floors. The home has an enclosed garden which people could enjoy, as well as a lounge diner, and two other communal lounges, one on the first floor and one on the ground floor. This was an unannounced inspection.

We previously inspected the home on 17 August 2017. The service was meeting all the requirements and we rated the service as “Good” overall.

At this inspection in September 2018, we only looked at ‘Is the service safe?’ and ‘Is the service well led?’ questions. We found concerns regarding people’s recorded care assessments and shortfalls in good governance procedures operated by the registered manager and provider. At this inspection the service was rated ‘Requires Improvement’ overall.

There was a registered manager in place at Northfield House. 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 told us they were safe living at Northfield House. However, we identified shortfalls in people’s care records that could place people at risk of unsafe care or treatment. Where staff had identified risks to people’s health and wellbeing there was not always risk assessments or guidance in place on how to assist people to reduce these assessed risks. Staff we spoke with were able to tell us how they assisted people to reduce their risks and prevent them from avoidable harm.

People’s prescribed medicine stocks were managed well, however there was not clear guidance to assist people with their medicines which had been prescribed ‘as required’ such as pain relief or anti-anxiety medicines. Additionally, there were not always clear guidance in relation to how people’s covert medicines should be provided.

There were enough staff deployed to ensure people’s health needs were being met. There was some unexpected staff absence on the day of our inspection however care staff felt this was manageable. The registered manager had informal systems to learn from incidents and accidents and reduce future incidents of preventable harm and share this information with staff.

The registered manager and provider had some systems to monitor the quality of care people received at Northfield House, however these were not always robust or consistent. Audits were not always effective at identifying concerns that we found in relation to staff performance, people’s risk assessments and the management of medicines. There were not always robust and structured systems in place to seek and act on the views of people, their relatives or healthcare professionals.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At the time of the last inspection, there was one breach of regulation. At our comprehensive inspection on 26 April 2017 the provider had followed their action plan with regard to meeting the requirements of the regulations.

Northfield House is a care home based in Stroud and provides accommodation and support for up to 25 older people without nursing. People who use the service may have dementia. It is a detached property in a residential area with local amenities nearby. There were 24 people using the service at the time of the inspection.

There was a registered manager in post at Northfield House. 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 service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment to support people. Staff had a good awareness of safeguarding policies and procedures and felt confident to raise any issues of concerns with the management team. The registered manager had carried out the relevant checks to ensure they employed suitable people at Northfield House.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Where required, the service was adhering to the principles of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS). The environment had been adapted to meet the needs of people living at the home. People were supported to personalise their living spaces.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained peoples dignity. Where required, people were receiving end of life support which reflected their needs and preferences.

The service was responsive to people’s needs. Support plans were person centred and contained sufficient detail to provide consistent, high quality care and support. People were supported to engage in a range of activities based on their preferences and interests. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was well-led. There was a registered manager working at the service. Staff and people using the service spoke positively about the registered manager. Quality assurance checks and audits were occurring regularly and where issues had been identified action had been taken to address them. The registered manager and staff were aware of the vision and values of the service and worked hard to provide a person centred service to everyone living at Northfield House.

Northfield House is a care home based in Stroud and provides accommodation and support for up to 25 older people without nursing. People who use the service may have dementia. It is a detached property in a residential area with local amenities nearby. There were 18 people using the service at the time of the inspection.

There was a registered manager in post at Northfield House. working at the home for 28 years and had been the registered manager since June 2009. 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.’

Risk assessments were implemented but these were not always updated to reflect the current level of risk. This meant there were no clear guidelines for staff to follow to minimise risks to people.

There were suitable arrangements in place for the safe storage, receipt and administration of people’s medicines.

People and their families were provided with opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. This included meetings with staff members and other health and social care professionals.

People were supported to access and attend a range of activities. People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.

People’s needs were regularly assessed and care plans provided guidance to staff on how people were to be supported. The planning of people’s care, treatment and support was personalised to reflect people’s preferences and personalities.

The staff at the home had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLs). These safeguards aim to protect people from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

Where people lacked capacity, best interests meetings had taken place involving other professionals ensuring decisions were made in peoples’ best interests.

The staff recruitment process was robust and ensured the staff employed would have the skills to support people. Staff were knowledgeable about people. They had received suitable training to support people safely enabling them to respond to their care and support needs.

The service maintained daily records of how peoples support needs were met. Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way responding to their needs.

There was a complaints procedure for people, families and friends to use and compliments were recorded. We saw that the service took time to work with and understand people’s individual way of communicating so that the service staff could respond appropriately to the person.

The provider had quality monitoring systems in place which were used to bring about improvements to the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

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

We used the information we collected during this inspection, to answer one of the five questions which now form the basis of our inspections. Is the service safe?

Is the service safe?

We found some of the unsafe floor covering we identified as being unsafe had been replaced. The remaining areas were scheduled to be replaced the week after this visit on the 9 & 10 September 2014. Following the inspection the provider sent us a pictorial record of the remaining areas that were completed and a record of regular maintenance audits this year where action was identified to improve the environment. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

Staff told us that the home's computers were password protected with people's information securely stored on the system. We spoke with the registered manager who told us each staff member had their own password with different security settings applied depending on the staff member's job role within the home.

People confirmed that staff listened to them and acted appropriately to their requests. People told us 'I find the staff are approachable and helpful' and 'The staff are very busy but always have time to talk to me and reassure me that I am ok'.

We walked around the home and saw that the first floor corridor, second floor landing and the first floor lounge carpets were very worn and had areas of discoloration throughout.

During our visit we saw that three cleaning staff were on duty and the home was kept clean and well maintained. People that we spoke with confirmed that their rooms were cleaned daily and bed sheets changed regularly. Cleaning staff told us that they had all the equipment they needed to do their jobs.

We saw that people were asked for their consent to various aspects of their care and were included in the care planning process. Care plans that we viewed were reviewed regularly and risk assessments were in place to ensure that people were cared for safely.

We saw that staffing levels were sufficient to meet people's needs on the day of our visit. We did hear that weekend staffing levels could be a problem at times and that recruitment was taking place to try and address this.