Northwick Grange

We found the following examples of good practice.

Staff had received training in Infection Prevention Control and donning and doffing of Personal Protective Equipment (PPE). All staff were observed wearing PPE in line with current government guidelines.

The home had PPE stations on every corridor throughout the building with supplies of PPE, hand gel and clinical waste bins. All staff we spoke with told us of the procedure in place for safely donning and doffing PPE.

The home was visibly clean and regular cleaning schedules showed cleaning routines were strictly followed by staff.

The home used a digital record keeping software which enabled families to see records in real time and communicate directly with the staff through a messaging facility.

To promote peoples wellbeing, the provider purchased technology to enable video calls between people and their family and friends.

Northwick Grange is a residential care home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. The service can support up to 30 people in one adapted building.

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

• Staff understood risks to people’s safety and supported them to stay as safe as possible.

• There were enough staff to care for people at times people wanted assistance.

• People were supported to have their medicines safely and checks were undertaken to ensure these were administered as prescribed.

• The risk of infections and accidental harm was reduced, as staff used the knowledge and equipment provided to do this.

• Staff spoke affectionately about the people they cared for. People were confident to request support and reassurance from staff when they wanted this, and staff took time to provide this in the ways people preferred.

• People told us staff respected their rights to make their own decisions about their lives and care. Where people needed support to make some decisions staff assisted them, using people’s preferred ways of communicating.

• Staff had received training and developed the skills they needed to care for people, through induction and on-going training. People told us staff knew how to help them and knew what to do if they suspected anyone was at risk of harm.

• People had good access to other health and social care professionals and staff followed any advice given.

• 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.

• People enjoyed living at the home and were complimentary about the way it was managed.

• People, relatives and staff told us they saw the provider and registered manager regularly and found them approachable.

• Staff ensured people had opportunities to do things which they enjoyed, and people were supported to keep in touch with others and religious practices that were important to them.

• The views of people, relatives and other health and social care professionals were considered when people’s care was assessed, planned and reviewed, so people’s needs continued to be met, and based on people’s preferences.

• Procedures were in place to take any learning from complaints and to further improve people’s care.

• People’s wishes for their care at the end of their lives had been planned and the views of their relatives considered.

• The registered manager and provider checked the quality of the care provided and encouraged suggestions from people and staff to improve people’s care further.

• The registered manager kept up to date with best practice developments, so they could develop the care provided further

Rating at last inspection.

The last rating for this service was Good [the report was published 01 February 2017].

Why we inspected

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.

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

The home is registered to provide accommodation and personal care, and the treatment of disease, disorder or injury for a maximum of 30 people. There were 25 people living at the home on the days of the inspection.

Since the last inspection the registered manager left the service and a new manager had been appointed five weeks prior to our inspection but had not yet registered with CQC. 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.

At the last inspection on 10 and 12 May 2016 we asked the provider to take action to make improvements as care was not provided in a person centred way as people were not given adequate support to maintain their appearance. Improvements were also required to in checks and audits to ensure they were robust enough to take action to improve standards. The provider submitted an action plan to us telling us how they were going to put things right to improve people’s experience of living at the home.

This inspection found some improvements had been made, the provider had followed their plan and legal requirements had been met. Relatives and staff told us the cleanliness of the home had improved and our observation supported this. Care was provided in a person centred way and people were supported to maintain their appearance and checks were now made on the experiences of people living at the home.

However, we did find that some areas still required improvement. For example, although group activities were in place that people enjoyed, people did not always receive support to engage in individual activities that meet their personal needs. Processes to record complaints and safeguardings also need improve to ensure that learning was taken to improve future outcomes for people.

People were safe and well cared for and staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and to ensure people who used the service were safely supported.

People were cared for by staff who had a good understanding of protecting people from the risk of abuse and harm and who understood how to meet their individual care needs safely. Staff knew their responsibility to report any concerns and were confident that action would be taken.

People needs were met promptly. Both relatives and staff said that there were sufficient staff numbers to meet people’s needs and we saw staff responding to people in a timely way.

The assessment of people’s capacity to consent had been completed. People’s rights and freedoms were respected by staff. Staff understood people’s individual care needs and had received training so they would be able to care for people in the best way for them.

People told us they enjoyed meals times and were positive about the choice of food they received. There were good links with health and social care professionals and staff sought and acted upon advice received, so people’s health needs were supported.

People using the service were positive in their feedback about the service. They told us they felt staff were caring and that they knew how to look after the people who lived at the home. Relatives said people’s privacy and dignity was maintained and our observations supported this.

People were encouraged to express their views and give feedback about the service. Relative’s said staff listened to them and they felt confident they could raise any issues should the need arise.

A new manager had been appointed and both relatives and staff told us improvements in the management of the home had been made. Staff spoke highly of the new management team and of the teamwork within the service. Staff were supported through team meetings and training to provide care and support in line with people needs and wishes. The quality of service provision and care was monitored and actions taken where required to improve people’s experience of living at the home.

The home is registered to provide accommodation and personal care, and the treatment of disease, disorder or injury for a maximum of 30 people. There were 26 people living at the home on the days 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.

People were cared for by staff who had a good understanding of protecting people from the risk of abuse and harm. Staff knew their responsibility to report any concerns and were confident that action would be taken.

Relatives told us the cleanliness of the home could be improved and we made observations that supported this. We found some equipment, for example tray tables and walking frames, were dirty.

Staffing arrangements did not provide a person centred approach to meeting people’s needs at all times. People and staff told us people sometimes had to wait for support. The registered manager told us that staffing levels were based on the dependency of people and occupancy levels and a new member of staff had been appointed to increase staff numbers.

Staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and to ensure people who used the service were supported and they told us they were supported by the management through supervisions and team meetings.

The assessments of people’s capacity to consent had been completed. People’s rights and freedoms were respected by staff. Staff had received training so they would be able to care for people.

People’s nutritional needs were met. People told us they enjoyed their food and were given a choice of meals and were supported with drinks throughout the day.

People liked the staff who cared for them, however their dignity was not respected. People wore marked and creased clothes and they had not been provided with person centred support to maintain their appearance.

People told us they staff respected their choices however care records we viewed did not show when people were involved in reviewing their care and relatives said communication could be improved.

People were supported to access health care professionals and staff were responsive to the advice received in providing care.

People told us activities had improved, however we found people did not always receive support to engage in meaningful activities to meet their personal needs.

The management team had systems in place to check and improve the quality of the service but checks and audits were not robust enough to ensure that actions had been applied in practice to improve standards.

Feedback from people and their relatives has been sought to help develop and improve the service provided to people.

You can see what actions we told the provider to take at the back of the full version of this report.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with eight of the people using the service and one of their relatives, three care staff supporting them and looking at three people's care records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us that they felt safe. One person told us, "I feel safe here". Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

People's independence, rights and choices were protected because the provider had procedures in place to gain people's consent to the care and support they received. Where people were not able to give consent the provider had acted in people's best interests and met legal requirements.

Staff knew about risk management plans and we saw that they supported people in line with those plans. This meant people were cared for in a way that protected them from harm.

The manager ensured that staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way.

Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that an application had needed to be submitted for one person and that this had been completed in line with legal requirements.

Is the service effective?

People's care needs were assessed with them. All of the people we spoke with told us they were involved in their care planning and reviews of care. We saw that care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the staff. This meant the provider worked well with other services to ensure people's health care needs were met.

Staff were well supported and trained to ensure they effectively met people's needs.

Is the service caring?

People were supported by care staff that were kind and caring. We saw that care staff gave people encouragement and respected their privacy and dignity. One person told us, "The manager and the staff are very kind to us".

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service and the provider acted on comments and suggestions that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. This was because staff discussed people's care needs with them on a regular basis. People told us staff would always do their best to make sure they were happy.

Is the service well led?

The provider had quality assurance and risk management systems in place. We found the registered manager checked that risks were managed effectively.

The provider sought the views of people who used the service. Records seen by us indicated that shortfalls in the service were addressed

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure that people received a good quality of care. Staff told us the home was well organised and they felt supported by their manager.

The people we spoke with told us they were happy with the home and the staff. One person told us: 'The staff are lovely to me. I have a joke with them.' Another person said: 'The atmosphere here is good. I feel very fortunate to be here.'

We watched staff as they cared for people. They provided care and support that met people's needs.

We found that staff knew about the needs of the people they were caring for. We looked at care records for three people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

We found that people were able to have a choice of suitable and nutritious food and drink in sufficient quantities to meet their needs.

We found that people's medicines were managed appropriately. This ensured people received their medicines as prescribed.

We saw that there were enough staff available to support people to meet their needs in a way that they wanted.

There was a system in place for people to make complaints if they were not happy with any aspect of the service.

The people we spoke with told us that they were happy with the home and the staff. One person told us, “The staff are good as gold,” and another said, “The staff are always very pleasant and helpful.”

One of the visitors said, “The home’s handy and it’s got a nice atmosphere. It’s got a nice feel.” They were pleased with the care their relative was receiving and told us, “He’s looked a lot better since he’s been here.”

Staff knew about the needs of the people they were caring for. We looked at care plans for two people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

We found the equipment that was used in the home was maintained appropriately and that staff had been trained in its use.

We saw that staff were trained to an appropriate standard and we saw records which showed that the provider was regularly monitoring the quality of its service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.