Northfield House

About the service

Northfield House is a residential care home for up to eight younger adults living with a learning disability and/or autism. At the time of the inspection, eight people were living at the service.

Northfield House is a detached property. Bedrooms are across two floors with en-suite facilities, shared communal spaces and a shared bathroom.

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

The registered manager had made significant improvements at the service since the last inspection. However, there was further work to be done to make sure changes and new systems introduced were effective.

Risk around COVID-19 were not always reduced and staff were not always wearing personal protective equipment (PPE). The registered manager acted quickly to provide training to staff in this area.

Guidance for staff and risk assessments had not been reviewed after an incident which led to harm, this wasn’t identified by the providers systems and checks.

The environment was better maintained, and cleaning had improved since the last inspection. The home was more welcoming, and staff were passionate about how they could further improve the service and lives of people they supported.

Staff, families and professionals all remarked on the improvements made especially around communication, responsiveness and acting on feedback and suggestions.

People took part in activities and their sensory needs were being met. This was a work in progress to ensure activities were more in line with people’s personal choices. People were encouraged to learn new things and plan new goals.

Changes to the layout of the home meant people had space when they needed it and noise levels were more manageable for people who preferred this.

People were involved in meal choices and making meals where they were able. The use of pictures and Makaton to communicate with people was encouraged. The registered manager was exploring the use of technology to empower people to communicate their needs and choices. At the time of the inspection, improvements had not been implemented.

Staff had the relevant training and checks in place to work with vulnerable adults.

We made a recommendation about the continued work needed around application of the mental capacity act and best interest decisions.

One family member told us, “[Person] is happy and I can see the difference in the way things are run. [Person] seems happy to go back, after a visit they asked to go back to the home.”

Another family member told us, “The staff look after [person] like a relative. We now get regular updates. Staff are happy when they visit with them.”

Based on our inspection of the safe, effective and well-led domains; the service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

People were supported by staff to pursue their interests and try out new activities for the first time in their local community. The service gave people care and support in a safe, clean environment that met their sensory and physical needs. More was being done to refurbish bedrooms and improve the sensory experience for people. People had personalised their bedrooms and changes had been made to the layout of the home that worked better for people and their needs. Staff communicated with people in ways that they preferred.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Staff knew people’s individual ways of communicating, using body language, sounds, Makaton (a form of sign language) and pictures. Some staff had the necessary skills to communicate using Makaton and more was being done to ensure all staff had those skills to improve communication.

People could take part in a range of activities and pursue interests that they enjoyed. The service was at the early stages of developing tailored activities for some people and had started to support some people to try new meaningful activities, that enhanced and enriched their lives. Some people were being reintroduced to activities that had not been available to them throughout the pandemic as restrictions were lifted.

Right Culture

Peoples quality of care, support and treatment was improving because staff had received training and were working with specialists to meet their needs and wishes. Staff knew and understood people well and were responsive. More work was needed to engage people in a meaningful way and improve their quality life. The registered manager had improved engagement with people families and staff were taking a proactive approach to develop the service. Staff valued and acted upon people’s views.

People’s quality of life was improving as the service’s culture improved, people’s needs, and quality of life was becoming the focus of the service. The registered manager had plans to increase the use of technology to improve people’s ability to communicate and be more empowered and involved in their 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.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 11 October 2021) and there were five breaches of regulations. 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 and however the provider was still in breach of two regulations.

At our last inspection we recommended that the provider reviewed their recruitment processes. At this inspection we found that they made improvements and recruitment checks were now in place.

We also recommended that the provider reviewed their practices around the Mental Capacity Act in line with best practice guidance. We found that work had started to improve in this area, but further work was still needed.

This service has been in Special Measures since October 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We used this inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We also assessed whether the service is applying the principles of Right support right care right culture.

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.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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 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 breaches in relation to safe care and treatment and person-centred care at this inspection.

You can see what action we have asked the provider to take at the end of this full 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 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 for up to eight younger adults living with a learning disability and/or autism. At the time of the inspection, eight people were living at the service.

Northfield House is a detached property. Bedrooms are across two floors with en-suite facilities and shared communal spaces and bathroom.

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

Risks to people were not identified and managed to prevent avoidable harm. Accidents and incidents were inconsistently documented by staff and not reviewed by management. There was a lack of action taken to safeguard people. Medicines were not managed safely, and there was a lack of learning when things went wrong. One relative told us, “I’m not happy, its difficult handing your precious child over to someone, you want to trust them.”

The environment was unclean and in a poor state of repair. Communal areas were not therapeutically beneficial to the people living at the service due to noise levels and design. Guidance around COVID-19 was not always adhered to by staff which put people at risk.

Staff had not received appropriate training, supervision and support despite working in a challenging environment. We made a recommendation about safe recruitment checks and practices.

Communication with external professionals and agencies was poor and they told us they had concerns about the service. People were not actively supported to be involved or to improve their independence. One staff member told us, “Care could be better from some staff, there could be more interaction with people, getting them to do more for themselves and not de-skilling them. People are capable but not encouraged.”

The provider did not have effective quality monitoring systems in place that identified all issues and ensured these were addressed in a timely manner. Management and leadership were inconsistent. An interim manager from another service has supported the service whilst awaiting a recruitment of a new manager.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We have made a recommendation around the use of the mental capacity act.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our inspection of the safe, effective and well-led domains the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were not always encouraged to be independent where they were able. The environment did not meet the needs of the people and at times impacted on their well-being. Care was not always person-centred or appropriate to meet people’s needs, taking into consideration their preferences. More could be done to include and empower the people using the service. The management of the service did not ensure people were at the centre of the service. The culture and shortfalls in the service did not lead to safe and effective care of people. The management team recognised and had identified actions needed to address shortfalls. Since the inspection, they have started to work with partner agencies to improve the care provided.

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 23 May 2019).

Why we inspected

The inspection was prompted due to concerns received about medicines, staffing and management of risk and incidents. A decision was made for us to carry out a focused inspection to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

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.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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 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 breaches in relation to person-centred care, good governance, staffing, safeguarding, care and treatment and the environment at this inspection. Please see the action we have told the provider to take at the end of this report.

During the inspection we sent the provider a letter of concern which outlined the areas of concern. They responded to this letter.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

If the provider has not made enough improvement within this timeframe and there is still a rating of

inadequate for any key question or overall rating, we will take action in line with our enforcement

procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

Northfield House provides care and support for up to eight people with a learning disability or autism in one adapted building. At the time of the inspection eight people were using the service.

People’s experience of using this service

The principles and values of Registering the Right Support other best practice guidance ensure people with a learning disability or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support. People's support focused on them having as many opportunities as possible for them to lead an active life.

Staff provided people with timely support to people and they knew how to intervene in the least restrictive and positive way. This approach had fostered positive relationships between staff and the people they supported.

The registered manager was keen to make changes that would impact positively on people’s lives. They had taken appropriate action to identify and minimise risks including risks associated with medicines. Where needed additional staff training and support had been provided to improve staff performance and drive continuous improvement.

Staff were safely recruited and when we visited we found the service was adequately staffed. Appropriate safeguarding procedures were followed.

People were protected by the prevention and control of infection.

Effective systems were in place for measuring outcomes for people who lived at the service. These were used to highlight areas for improvement and promote safe, consistent care.

We received positive feedback about leaders and the registered manager. Staff told us that they felt supported by the manager and senior management team.

Rating at last inspection

At the last inspection the service was rated good (published 7 December 2017).

Why we inspected

We received concerns in relation to the management of medicines and risk management. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during inspection activity so we did not inspect them. The ratings from previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. The overall rating for the service has remained Good based on the findings and ratings of Key Questions Safe and Well-led 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.

Follow up

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

We carried out an announced inspection of this service on 10 October 2017. The provider was given notice the week before we visited because the location was a small care home for younger adults who are often out during the day; we needed to be sure that someone would be in. This was the first inspection of this location since it was registered under a new provider, Action for Care Limited, in December 2016. At the time of our inspection, there were seven people using the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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 understood their responsibility to safeguard adults who may be at risk of abuse. Robust recruitment checks were completed and sufficient staff were deployed to provide safe care to people who used the service. We made a recommendation about medicines management although overall medicines were managed safely.

Positive behaviour support plans were used to promote people’s wellbeing and safety. The use of these had resulted in improved outcomes for people who used the service. Care plans and risk assessments were detailed and these guided staff on how to provide safe care and support.

We observed the service to be well maintained and the registered manager completed regular audits to monitor the quality and safety of the environment.

Staff had received appropriate training and support for them to fulfil their roles effectively. People were supported to have maximum choice and control of their lives and staff support people in the least restrictive way possible; the policies and systems in the service support this practice.

Staff supported people to eat a varied, nutritious diet. People had access to a range of healthcare services to maintain their health and well-being.

Staff were observed to be respectful and positive relationships had been established. Staff supported people to engage in a wide range of activities and to access the community.

Staff demonstrated a good understanding of people’s needs and could communicate effectively with people. People’s care and support was kept under review to ensure it met their needs and care plans were detailed and person-centred.

Systems were in place to gather and respond to feedback. The registered manager completed a range of audits and spot checks to monitor the quality and safety of the service. People told us the registered manager was approachable, supportive and responded to feedback.