Northlea Court Care Home

We found the following examples of good practice.

• Systems were in place to help prevent people, staff and visitors from catching or spreading infection. Every staff member and visitor had their temperature taken at the door and were given appropriate PPE to wear. Every visitor had to have a lateral flow test, complete a health declaration and use hand sanitiser upon entering the home.

• The environment was very clean and hygienic. The provider had increased cleaning hours in the hom. This allowed more regular cleaning of frequently touched surfaces such as door handles and handrails.

• The registered manager monitored PPE stock levels on a weekly basis to ensure adequate amounts of PPE were available.

• Staff had undertaken training in Infection prevention and control (IPC) as well as putting on and taking off their PPE. There were dedicated IPC champions in the home who provided additional training. They also observed staff to ensure they were competent in IPC practices.

• Staff supported people’s social and emotional wellbeing. People received visits from relatives in a dedicated lounge and visits complied with government guidance. People were also supported to keep in touch with their family members via video or telephone calls.

• People and staff were taking part in the COVID-19 regular testing programme.

Further information is in the detailed findings below.

Northlea Court Care Home is registered to provide personal and nursing care for up to 50 people. At the time of the inspection there were 43 people using the service, some of whom were living with dementia. Bedrooms are situated on two floors with people being able to access communal lounges and dining areas.

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

People spoke positively about the care and support they received. Comments included, “Staff are really lovely I get on well with all of them” and “Staff are very pleasant and helpful, they will always help if you need anything.” We observed lots of positive and caring interactions between people and staff. However, we observed some staff were more confident and skilled when communicating with people who were living with dementia than others.

Effective systems were in place to monitor the quality of care provided and identify any areas of improvement. We have made a recommendation about the registered manager ensuring their quality monitoring system included checking the experiences of people who are living with a dementia related condition. This was to make sure that best practice guidelines were followed.

People told us they felt safe living at Northlea Court Care Home. One person told us, “I feel secure and happy in my room and safe.” Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. Measures were in place to ensure people were protected from the risk of harm or abuse. Staff all felt confident any concerns raised would be listened to by management and actions taken to address them.

People’s care plans contained detailed assessments and individual information to ensure people’s care needs were met. People had access to a range of activities. There were safe medicine administration systems in place and people received their medicines when 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.

People and relatives had opportunities to share their views and make suggestions on how the service could be improved. Complaints and concerns were taken seriously and had been dealt with appropriately.

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 31 July 2017).

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.

Northlea Court Care Home is registered to provide accommodation for up to 50 people. At the time of the inspection there were 47 people using the service, some of whom were living with dementia.

The home had a registered manager who had been registered since May 2013. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Appropriate arrangements were in place to protect people using the service from abuse or any concerns in relation to their safety. Staff had received training in identifying and responding to safeguarding concerns. Risks were assessed and mitigating actions identified to ensure people’s care was delivered as safely as possible. Safe recruitment procedures had been followed.

The breach in relation to staffing had been met. During this inspection we saw the atmosphere in the home was calm and relaxed. People’s requests for assistance were met promptly. Staffing levels were now determined based on people’s needs. Feedback from some people and relatives was that more staff were needed during busier times of the day. We have set a recommendation that the provider considers their feedback and reviews the deployment of staff throughout the day.

Staff received training and support to effectively meet the needs of the people they cared for. We saw training was up to date and well monitored. Staff were supported to further their personal development through regular supervisions and an annual appraisal.

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

Care plans were specific, based on assessed needs and regularly reviewed to ensure they remained up to date. We saw evidence that staff had liaised with healthcare professionals an incorporated their advice into records.

People were positive about the food on offer in the home. Where people needed support to eat this was provided in a compassionate way by staff. Kitchen staff were aware of people's dietary needs, and a choice of meals were always available. We saw some food and fluid charts were unavailable to view, we fed this back to the registered manager who told us they would address this.

People we spoke with and their relatives told us they were happy with the care provided. We observed staff were friendly and respectful towards people. Staff knew people and their needs well. A range of activities continued to be offered for people to participate in. People and their relatives were aware of the complaints procedure. We saw complaints had been responded to in line with the provider's policy.

The provider's quality assurance system was in-depth and covered a range of checks and audits to ensure standards at the service were being maintained and improved. Representatives from the provider visited the home regularly to provide feedback on the service and to highlight any areas for improvement. The quality assurance system included monitoring any identified actions for improvement to ensure they were carried out. The registered manager was a visible presence. People, relatives and staff told us the service was well run.

Northlea Court Care Home is registered to provide accommodation for up to 50 people. At the time of the inspection there were 31 people using the service, some of whom were living with dementia.

The home had a registered manager who had been registered since May 2013. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff were aware of the need to safeguard people from abuse and had a good understanding of potential abusive situations. They told us they had received training in relation to this area and were able to describe the action they would take if they had any concerns. Records showed that any safeguarding issues had been dealt with appropriately and relevant authorities notified.

At the previous inspection we found proper fire safety checks had not been undertaken. At this inspection we noted outstanding work from a fire safety audit had been completed and proper fire safety checks were being carried out regularly. Additional checks on risks around the home, such as water temperatures and on lifting equipment were also being carried out. At the previous inspection we had noted emergency call buzzers did not operate between floors, meaning staff could not always be summoned quickly in urgent situations. At this inspection we the saw the system had been revised to ensure any emergency calls were audible throughout the home.

People told us they did not have to wait long for support and help. We noted there were long periods when no staff were visible around the home and lounge areas were not regularly checked to ensure people were safe and well. The regional manager told us staffing had been reduced because of the number of people living at the home. We noted there had been a significant number of unwitnessed falls at the home over the past five months, including five in the lounge areas. Staff told us they felt there were not enough staff on duty at times and this meant people sometimes had to wait for support. Suitable recruitment and vetting procedure were in place.

We found medicines were appropriately managed, administered and stored safely. Audits on the safe administration of medicines were undertaken. We found some issues with regard to topical medicines and records. Topical cream records held in people’s rooms were not always completed and did not reflect the records made by nurses on the main MAR sheets.

Staff told us they had the right skills and experience to look after people. They confirmed they had access to a range of training and updating. Records showed completion of online training was high. Additional training had been undertaken by the provider’s trainers to enhance staff skills. Staff told us, and records confirmed regular supervision and annual appraisals took place.

People told us meals at the home were good and they enjoyed them. Alternatives to the planned menu were available. Staff supported people with their meals appropriately and in a dignified manner. Kitchen staff demonstrated knowledge of people’s individual dietary requirements. Diet preference/ requirement sheets were reviewed and updated regularly. Where people were on food and fluid charts, to help monitor their intake, these were completed well and up to date.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff understood the concept of acting in people’s best interests and the need to ensure people made decisions about their care. Records showed people had provided their consent or that best interest decision had been made. The regional manager confirmed applications had been made to the local authority to ensure appropriate authorisation and safeguards were in place for those people who met the threshold for DoLS, in line with the MCA. We noted the provider had failed to notify the CQC about the outcome of DoLS applications as they are legally obliged to do so.

People we spoke with and their relatives told us they were happy with the care provided. We observed staff treated people patiently, appropriately and with good humour. Staff were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with ready access to general practitioners and other health professionals. Staff were able to explain how they maintained people’s dignity during the provision of personal care and demonstrated supporting people with dignity and respect throughout the inspection.

Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care. Care plans also reflected advice from visiting professionals such as speech and language therapists. A range of activities were offered for people to participate in and people told us they could choose to take part or not. People said they enjoyed the activities, especially trips out. We joined people for a quiz which they enjoyed.

The regional manager told us there had been no formal complaints within the previous 12 months. Information about how to raise a complaint was available around the home. People said they knew how to make a complaint and that they would speak with the manager if they had any concerns.

The provider had introduced a new system of electronic audits and checks. These dealt with individual’s care and welfare along with broad reviews of the home and the environment. There was also an electronic system for people, relatives, professionals and staff to record their views of the home and the management. The overwhelming response was positive. The regional manager said any concerns were logged and action taken to address them.

People told us they knew the manager and she toured around the home regularly. Staff told us they felt the manager was supportive and approachable. They said there was a good staff team at the home. Regular staff meetings took place and workers said they were able to raise issues for discussion.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Staffing and Good governance. We also found a breach of the Health and Social Care Act 2008 (Registration) Regulations 2009; in that the provider had failed to notify us of events they are legally required to do so. You can see what action we told the provider to take at the back of the full version of the report.

People were protected from unsafe or unsuitable equipment because the provider had in place suitable systems and checks to ensure regular maintenance and upkeep of equipment. We found that baths and showers were fully working and were accessible. One person told us, 'You can have a bath or a shower anytime you like. You just have to ask the staff.' Call systems were in operation, so that people could summon help to their rooms. One person told us, "They do come. You don't have to wait too long, maybe a couple of minutes."

The manager told us that since our previous inspection a number of actions had been taken to improve the standard of care. We saw assessments of people's needs had been undertaken and care plans reflected the needs identified. Staff we spoke with told us about the care people received and had good knowledge of their care plans. One person we spoke with told us, "The carers look after me very well."

We looked at the medicine records of people who used the service. We noted all the Medicine Administration Record (MAR) sheets were complete and there were no missing signatures. The provider had established record sheets for the application of topical creams. MAR records contained daily and weekly audit sheets. We concluded medicines were safely administered and appropriate arrangements were in place in relation to the recording of medicines.

We examined the records of five people who used the service. We saw each person had a care plan that had arisen from an assessment of their needs. Care plans were detailed and had been updated. Where people had particular needs, then these were documented. Other care records were up to date and complete, such as; the recording of people's blood sugar levels, checks on people's bedrails and the recording of people's weight. We concluded people's personal records were accurate and fit for purpose.

We included in our inspection a review of care and welfare and medicines management because of information of concern received from other organisations.

During our inspection we looked at four care plans of people who used the service and spoke to three people.

Assessments of people's needs were carried out to highlight areas of care. Risk assessments had been undertaken and updated on a monthly basis. However, we found that referrals on to other services for support and advice had not always been progressed. This meant the person may not get the help needed and staff may not know the best way to support the person.

Overall, we found appropriate arrangements were in place for recording the administration of medicines. However, we saw two people each missed a prescribed medicine for five days because a further supply had not been ordered. In addition, we saw records for the administration of creams and ointments by care workers were poorly maintained.

We found records were not always maintained or updated appropriately. Care plans did not always reflect people's identified risks or changed care needs and that there was no indication one person had been reviewed by wheelchair services.

We spoke with some relatives at the inspection and with one person over the phone. Some of the relatives we spoke with said that they had been unhappy over the past few months about the care. All these people said that their concerns had been raised at the time but several changes of manager had eroded their confidence about the way the home was run. People stressed to us that the staff were kind and approachable. One person said, "The staff have a nice manner with people, management has recently been a difficulty, it has not affected the care but it affects my confidence." Another person said," The matter has been raised and I will be talking to the new manager about it. The staff know what I expect but I feel that if I am not here it may not happen. But the staff are very caring towards Mum." One of the people at the home said,"The staff are lovely lasses, they will do anything for you, the meals are decent and we had a coffee morning this morning."

We saw staff attend to people's needs in private and without undue haste or delay. Call buzzers were answered promptly but staff were kept busy all through the shift.

We saw that mealtimes were relaxed and people were assisted discreetly and with regard to their dignity. People's choices regarding whether they joined the activities were respected. Records contained some unexplained gaps but were securely stored and accessible to staff.