We carried out a review of the data available to us about Northbourne Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Northbourne Court, you can give feedback on this service.
People’s experience of using this service and what we found
There were safeguarding procedures in place and the registered manager staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work at the home. There were enough staff deployed to meet people’s needs. There were procedures in place to reduce the risk of infections. There were effective systems in place for monitoring, investigating, and learning from incidents and accidents. People’s medicines were managed safely.
We have made a recommendation about the management of waste medicines.
People’s care and support needs were assessed when they moved into the home. Risks to people had been assessed to ensure their needs were met safely. Staff were supported through induction, training, and regular supervision. Staff had the skills and experience to support people with their care needs. People were supported to maintain a healthy balanced diet and they had access to health care professionals when they needed them. The design of the premises was meeting people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People and their relatives had been consulted about their care and support needs. People were provided with a range of activities to support their need for social interaction and stimulation. Staff understood the importance of working within the principles of the Equality Act and supported people in meeting their diverse needs. There was a complaints procedure in place. People had access to end-of-life care and support when it was required.
The registered manager and staff worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people, their relatives, and staffs views into account through surveys and meetings. There were effective systems in place to monitor the quality and safety of the service and any learning was identified and acted on. Staff told us they enjoyed working at the home and received good support from the registered manager and deputy manager.
Rating at last inspection. The last rating for this service was good (published 28 April 2018).
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice:
Arrangements were in place for relatives to visit people at the home safely. All visitors, including health and social care professionals were screened for symptoms of Covid 19 before being allowed to enter the home. They were supported to follow national guidance on wearing personal protective equipment (PPE) and social distancing. There were two purpose built visiting pods in the garden and a visiting room on the ground floor with access through a separate entrance. The pods and visiting room was cleaned between visits.
The layout of the premises and use of space promoted safety and good hygiene practice. Where people at risk of falls were isolated, one to one staffing was in place to reduce the risk of them falling. The manager and staff were working with the local authority's complex falls teams on analysing and reducing falls at the home. The home was clean and hygienic throughout and was following government guidance in relation to infection prevention and control.
The provider had appropriate arrangements in place for testing people using the service and staff for Covid 19 and was following government guidance on testing. We observed staff wearing appropriate PPE and socially distancing during our visit. The provider ensured all staff had received training on Covid 19, infection control and the use of PPE. Covid 19 risk assessments were carried out with Black Asian and Minority Ethnic (BAME) staff to ensure they could work safely at the home.
The home had business continuity and Covid 19 contingency plans in place that made provisions for safe care in the event of an emergency, or outbreak of Covid 19. The registered manager and staff worked closely with health and social care professionals to provide good care outcomes for people using the service. The registered manager told us they felt well supported by staff, the deputy managers and the senior management team. They took part in the providers weekly managers meetings where Covid 19 and any lessons learned were regularly discussed.
At our last inspection on 12, 13 and 14 January 2016 the service was rated Good overall. We rated the key question ‘Safe’ Requires Improvement because we had concerns about the high level of falls at the home. At this inspection we found the provider had taken action to monitor and manage the risk of falls appropriately at the home.
The home had a registered manager in post. 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.
All of the staff we spoke with said they enjoyed working at the home. Most said they received good support from the registered manager and unit managers. However some staff felt their contributions were not always recognised or that manager’s had not listened to what they had to say. We have made a recommendation about motivating staff and team building.
People told us they felt safe living at the home. Training records confirmed that staff had received training on safeguarding and there was a whistle-blowing procedure available and staff said they would use it if they needed to. There was a good staff presence at the home and staff were attentive to people’s needs. Action was taken to assess any risks to people and risk assessments and care plans included information for staff about action to be taken to minimise the chance of accidents occurring. Medicines were managed appropriately and people received their medicines as prescribed by health care professionals.
Staff had the knowledge and skills required to meet people’s needs. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Most people told us they enjoyed the meals provided to them and they could choose what they wanted to eat. People were supported to maintain good health and they had access to healthcare professionals when they needed them.
People had been consulted about their care and support needs. These needs were assessed before they moved into the home. Care plans and risk assessments included detailed information and guidance for staff about how people’s needs should be met. People’s privacy and dignity was respected. There were plenty of activities for people to partake in if they wished to do so. The home had a complaints procedure in place and people said they were confident their complaints would be listened to and acted on.
The provider recognised the importance of monitoring the quality of the service. They sought the views of people using the service, their relatives and friends through residents and relatives meetings and satisfaction surveys. The registered manager worked with other care provider’s and professional bodies to make improvements at the home.
At our inspection on 8 April 2015 we found several breaches of legal requirements. The systems for the management of medicines were not safe and did not protect people using the service. People were not supported by a sufficient number of staff to ensure that their needs were met. In addition people’s capacity to give consent had not been assessed in line with the Mental Capacity Act 2005 (MCA). We asked the provider to make improvements in these areas. We also recommended that specialist advice was obtained to deal with fluctuation of water temperatures and potential issues associated with water born infections. Following that inspection the provider sent us an action plan telling us of how and when they were going to make these improvements. They kept CQC informed of the changes that had been made.
At this inspection we found that significant improvements had been amde in all of these areas. We found that systems for the management of medicines were safe, the provider was acting in accordance with the MCA and action had been taken to support people with sufficient numbers of staff. However, we had concerns about the high level of falls at the home and have made some recommendations within the report about this issue.
Northbourne Court is a large care home located in the London Borough of Bexley. The home is registered to provide accommodation and support for up to 120 people and specialises in caring for people living with dementia. At the time of our inspection 112 people were using the service.
There was a manager in place who was in the process of applying for registration. 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 using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work.
We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.
The provider took into account the views of people using the service and their relatives and staff through surveys. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support from the manager. The manager and other managerial staff at the home conducted regular checks to make sure people where receiving appropriate care and support.
This inspection took place on 08, 09 and 10 April and was unannounced. At the last inspection on 11 March 2014 the provider met all the requirements for the regulations we inspected.
Northbourne Court is a purpose built residential care home which can accommodate up to 120 older people, some of whom are living with dementia. At the time of our inspection there were 109 people living at the home.
The previous registered manager had left in October 2014 and a new manager was appointed in February 2015. They told us they were submitting an application to register as 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.
We found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of medicines, staffing and arrangements to follow the Mental Capacity act 2005.
Medicines were safely stored and most were safely administered, although, we found procedures for the safe administration of medicines had not always been correctly followed. Not all staff were aware of the correct methods for the disposal of medicines. There was not always evidence that people’s capacity to make specific decisions had been assessed. There was not always enough suitably qualified staff to meet people’s needs on some units at meal times. You can see the action we have asked the provider to take at the back of the full version of this report.
There were some areas that required improvement. While care provided to people met their needs, records about their care were not always fully completed or up to date and did not always evidence their or their relative’s involvement in the plan of their care. We have made a recommendation to the provider to obtain further specialist advice in relation to water temperatures and checks to reduce risk of legionella.
People felt safe using the service. Staff were knowledgeable in recognising signs of abuse and knew how to report any concerns. Assessments were undertaken to identify people’s health and support needs and any risks to people who used the service. Plans were in place to meet people’s support needs. Safe recruitment procedures were followed and there were clear arrangements in place to deal with emergencies.
Staff respected people’s privacy, dignity and independence and engaged with them in a caring manner. They understood and responded to people’s diverse individual needs and were familiar with people’s histories and preferences. There was a complaints procedure in place and people told us they knew how to make a complaint if they needed to. Residents meetings had not been held recently but arrangements were in place to restart these on a monthly basis. People’s views were also sought through an annual survey and a comments and suggestions box was available.
The service had been without key senior staff including the registered manager for a few months and another senior staff member was providing support to one of the provider’s homes on a temporary basis during the inspection. This had affected the normal running of the service. There was a new manager in post who had identified most of the issues we found at the inspection, and, with senior staff at the service had a planned programme to address most but not all of the areas that we identified for improvement. The manager had clear goals of how they wished the service to develop. Staff were positive about the new manager who they said was approachable, visible in the home and open to any suggestions for improvement. There were systems to monitor the quality of the service and to identify issues that needed to be rectified which the manager had improved since being in post.
We carried out this inspection to check whether the provider had implemented improvements following our inspection on 12 and 13 June 2013 in relation to care planning, medicines management and quality assurance. At our inspection on 11 March 2014 we found the provider had implemented most of the improvements we required. For example, a new care plan format was in place and people's needs were assessed and care was appropriately planned and delivered. Some improvements had been made to medicines management such as more robust auditing and staff training. Quality assurance processes ensured that where actions were identified, relevant improvements were implemented.
We found that people were given choices, were involved in their care and were treated with dignity and respect. People's care needs were assessed and care was planned but people did not always have care plans in place that reflected their needs. People had an adequate choice of meals and they were sufficiently supported. We found medicines management was appropriate, however we had some concerns about the timing of medicines rounds. Staff were adequately supported through induction, training supervision and appraisal. The provider had systems in place to monitor the quality of the service, however these did not always ensure the necessary improvements were implemented.
The inspection team was led by a CQC inspector joined by an "practising professional"; people who have experience of delivering services and who can provide that perspective. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
We spoke to some people who used the service and also some relatives of people. People told us their privacy and dignity was respected and that staff were polite towards them. One relative told us they were involved in their family members' six monthly reviews but they did not know about the care plan.
A relative told us that they had concerns about the level of stimulation people received throughout the day and that staff did not have time to interact with people other than when performing tasks. Another relative told us there was lots going on during the day and people who used the service were stimulated.
People who used the service told us they enjoyed the food. One person said they rated the food 'eight out of ten'. Another person said their lunchtime meal was 'lovely.'
People told us they knew how to complain if they had any concerns. People who had complained or told us their complaints were listened to.
People told us that the home was well maintained and that they were able to do the things they wanted. They told us that they had their needs met and that they were able to make choices about their lives.