Northcott House Residential Care and Nursing Home

Northcott House Residential Care and Nursing Home is a care home that can provide personal and/or nursing care to up to 55 people. At the time of the inspection, they were providing support to 53 people, some of whom lived with dementia and the frailties of old age.

People’s experience of the service and what we found

Risks to people were not always consistently assessed and managed. Risk assessments and care plans did not always contain the information staff needed to ensure the provision of safe and effective care.

People were not always receiving their medicines safely and according to prescriber’s instructions. Governance and management systems were not always effective in identifying shortfalls. When shortfalls were identified systems and practice was not always updated to prevent reoccurrence. The registered manager responded to the shortfalls identified at inspection and acted on them to make the service safe. These changes will need to embed into practice to be sustainable.

People, staff, and relatives remarked on a number of positive changes to the service in recent months. These included an extended activity team to aid people’s engagement and wellbeing. Changes were made to the menus following people and relatives’ meetings, and an ongoing programme of refurbishment of the building to improve the environment.

People and their relatives described staff as being kind and caring. There were safe systems in place for the recruitment of staff. Staff received a raft of training and the registered manager told us they were seeking further knowledge development opportunities for staff around supporting people living with dementia.

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

The last rating for this service was Good published 8 August 2019.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, personal and nursing care and staffing. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Northcott House Residential Care and Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safety and governance 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.

Northcott House Residential Care and Nursing Home is a care home that can provide personal and nursing care to up to 55 people. At the time of the inspection they were providing support to 52 people, some of whom lived with dementia.

People’s experience of using this service

People were supported by staff who showed kindness, compassion and respect towards them. They told us they felt safe and listened to living at Northcott House Residential Care and Nursing Home.

Staff’s knowledge of people’s history, preferences and risk associated with the care and support needs was good. 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.

Recruitment practices remained safe and there was sufficient staff to meet people’s needs. People were protected from avoidable harm, received their medicines as prescribed and infection control risks were managed appropriately.

Care records were person centred, gave accurate guidance to staff and reflected that staff responded to people’s changing needs. People were satisfied with the activities provided and felt they had enough to do.

The management team were open and transparent. They understood their regulatory responsibility. No one had any complaints and felt the management team were open, approachable and supportive. Everyone was confident the registered manager and provider would take the necessary actions to address any concerns promptly. Feedback about the management team demonstrated they listened and took any feedback as an opportunity to make improvements for people.

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 requires improvement (published 13 July 2018). 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 the provider was no longer in breach of regulations.

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.

Northcott House Residential Care and Nursing Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Northcott House provides nursing and personal care. It provides support for up to 55 older people, some of whom live with dementia. At the time of our inspection there were 41 people living at the home. Accommodation is in a very large building with long corridors and over two floors.

At our last inspection in September and October 2017 we found multiple breaches of the legal requirements. People did not receive safe care and treatment and the management of medicines was unsafe. This was a breach of Regulation 12. The deployment of staff was not appropriate to meet the needs of people and staff had not received appropriate support and training in order to deliver their role effectively. This was a breach of Regulation 18. Care was not always planned or delivered in a person centred way and this was a breach of regulation 9. People’s consent was not always sought and where it was needed the Mental Capacity Act 2005 had not been applied. This was a breach of Regulation 11. Whilst the provider had systems in place to monitor and assess the safety of the service, these had been ineffective in identifying concerns and driving improvement. This was a breach of Regulation 17. The service was rated as inadequate in each key question and overall. It was placed into Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Since our last inspection a new manager had been appointed and had applied to become 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. Since this inspection visit they had become the registered manager. Throughout the report we have referred to them as the manager.

Whilst improvements had been made to the assessment and management of risks to people’s safety, further work was needed to ensure this approach was consistently applied.

Medicines were now managed safely. Staffing levels had improved and were now appropriate to meet the needs of people. Staff training had been enhanced and competency assessments were taking place regularly. Staff felt supported and were receiving supervisions to support them in their roles.

Care planning and delivery was improving and we observed staff mostly responded promptly to changes in people’s needs, although this was work that needed further embedding into the service to ensure consistency. Where applicable, mental capacity assessments had been undertaken and we consistently saw and were told that people’s permission was sought before staff provided care.

People were protected against abuse because staff had received training and understood their responsibility to safeguard people. Concerns were reported and investigated. The provider’s recruitment process ensured appropriate checks were undertaken to ensure staff suitability to work in the home. People and their relatives felt the home was always clean and well maintained. Equipment was managed in a way that supported people to stay safe and people were supported to maintain good health and had access to appropriate healthcare services.

There was a process in place to deal with any complaints or concerns if they were raised. People told us they knew how to complain and we saw complaints were investigated and outcomes shared with people and staff.

Prior to people moving into the home, assessments were undertaken to ensure the home and staff could meet the person’s needs. Staff were aware of the need to treat people as individuals and ensure care reflected their individual needs. People were supported to ensure they received adequate nutrition and hydration. Staff worked well as a team and people were supported to maintain good health and had access to appropriate healthcare services.

People and their relatives provided positive feedback about staff. Observations reflected people were comfortable and relaxed in staff’s company. People were cared for with kindness and compassion. People’s privacy and dignity was respected and they were encouraged to be involved in making decisions about their care.

Communication and team working had improved. The registered manager had reinforced staff roles and was open to suggestions and feedback. Staff felt supported by the registered manager and able to raise concerns at any time. They were confident these would be addressed. People and their relatives were confident to raise concerns if they needed to and spoke positively about the registered manager’s approach. People, their families and staff had the opportunity to become involved in developing the service. Systems and processes to monitor the service had improved although further work was needed to develop and embed these.

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 the report.

Northcott House Residential Care and Nursing Home is a care home that provides nursing care. It provides support for up to 55 older people, some of whom live with dementia. At the time of our inspection there were 47 people living at the home. Accommodation is in a very large building with long corridors and over two floors.

At the time of our inspection visit there was a registered 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.

The last inspection of the service was March 2016 and we rated this as overall “Good”.

At this inspection we found serious concerns about the safety of the service. People were placed at risk of harm because appropriate measures had not been implemented to identify and assess risks. In addition, measures had not been taken to ensure that risks for people were minimised and medicines were not always safely managed. Staff lacked knowledge of those at risk of choking and measures were not in place to minimise this risk. Skin integrity was poorly managed placing people at risk of injures. Clinical observations which could indicate health concerns were not understood and acted upon. We could not be confident people always received their medicines as prescribed.

Staffing levels varied throughout the inspection and there was no system to ensure these levels met people’s needs. Call bell response times were poor and people’s comments indicated staffing levels may not be appropriate to meet their needs.

Timely referrals to other healthcare professionals were not made and recommendations from other professionals were not acted upon when concerns for people were identified. People were not always satisfied with the food. The support to eat and drink was disorganised and staff lacked the knowledge required to ensure people received the support they needed. Monitoring of people’s food and fluid intake was poor. Person centred care did not take place. Care plans lacked personalised information about how people’s needs and preference could be met and as people’s needs changed, staff did not respond to these. Staff were not supported through effective supervision and competency assessment to deliver safe and appropriate care.

Although people said their privacy was respected and their independence encouraged, staff approach to support was task orientated and people at times felt uncared for and forgotten. The manager and provider had not ensured the service was safe which demonstrated a lack of a caring approach.

There was a lack of leadership in the service and the registered manager was not visible. Some staff felt the registered manager was unapproachable. Audits to assess the quality of service provision were not completed regularly and were ineffective in identifying improvements needed. The registered manager and provider had no oversight of these. Action plans were not developed to ensure improvements were made. A complaints procedure was in place and records kept of how these were investigated. However, when staff raised concerns these were not acknowledged or appropriately investigated. Notifications required by CQC were not submitted.

Although staff demonstrated an understanding of the Mental Capacity Act 2005 they could not evidence how they had applied this. Staff did have knowledge of those people subject to Deprivation of Liberty Safeguards and understood what this was for. Staff understood their responsibility in relation to safeguarding people. Recruitment practices aimed to ensure staff were safe to work with vulnerable adults.

Due to the concerns we found we made referrals to the local authority and told the registered manager and provider to take immediate action. Following the inspection we received an action plan from the provider detailing how they would address the immediate risks to people.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Northcott House Residential Care and Nursing Home is registered to provide accommodation, nursing and personal care services for up to 55 older people, and people who may be living with dementia, a physical disability or sensory impairment. At the time of our inspection there were 49 people living at the home. Of those, 25 had a residential service and 24 had nursing needs which varied from people who were relatively independent to people with complex care needs. People were accommodated in single rooms with a number of shared areas which included a lounge, a dining area, a conservatory and a smaller sensory lounge.

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. The registered manager was on leave during our inspection. We mainly spoke with the deputy manager.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. Arrangements were in place to store medicines safely.

Staff received appropriate training and supervision to maintain their skills and knowledge. They were aware of the need to gain people’s consent to their care and support, and of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff complied with the principles of the Act where people did not have capacity to make certain decisions.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs and preferences. People were supported to access healthcare services, such as GPs and older people’s mental health teams.

People told us they had caring relationships with their care workers. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy, and dignity.

Care and support were based on plans which took into account people’s needs, conditions, and preferences. Care plans were updated as people’s needs changed, and were reviewed regularly. People were able to take part in individual leisure activities which reflected their interests. Shared activities were available if people wished to take part.

The home had an open, friendly atmosphere in which people felt able to make their views and opinions known. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided.

This is a summary of what people told us and what we found.

Is the service safe?

People told us they felt safe and comfortable in the home. They said care and treatment were only given with their consent, and if they had a problem they were confident it would be dealt with appropriately.

We found the service had systems in place to ensure people were protected from the risk of abuse. They carried out the necessary checks before staff started work and there was a robust recruitment process in place.

People's individual care plans contained measures to maintain the safety of people's living environment. Appropriate risk assessments were in place to ensure people's safety and welfare. Arrangements were in place for foreseeable emergencies to keep people safe and comfortable.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The manager at Northcott House had a good understanding of the Mental Capacity Act 2005, DoLS and their responsibilities. Where people lacked capacity they were protected because the provider followed the appropriate guidance and code of practice. There were no DoLS in use at the time of our inspection. The service had applied for DoLS in the past and followed the correct procedure.

Is the service effective?

People told us that they were satisfied with the care and support they received. One person said staff 'do their best for you'. Another person said, 'It's all fine. I have no complaints.'

People were cared for in an environment that had been suitably adapted, with a variety of areas, both inside and outside, where they could spend time according to their choice.

We found people's care and support were based on thorough assessments and detailed and personalised support plans. Systems were in place to ensure care was delivered according to people's plans. We found the provider acted in accordance with legal requirements where people did not have capacity to make decisions about their care and treatment.

Is the service caring?

People using the service told us they got on well with their care workers and other staff and had a good relationship with them. One said, 'They are nice girls.' Another told us, 'The carers are very good.'

Staff we spoke with were motivated to provide good care. They knew about people's needs and how they preferred to have their care delivered. One member of staff said, 'It's like a second family.'

We observed positive, friendly interactions between staff and people who used the service. Staff took time to make sure people understood, spoke clearly and made eye contact with the person they were talking to.

Is the service responsive?

People told us they had been involved in their assessments and care planning, and that their views and preferences were taken into account. They told us staff listened to them. People's care plans were individualised and person-centred.

We found the service had systems in place to ensure the care provided was appropriate to peoples' changing needs. If routine checks and screening procedures identified a possible concern, the service responded appropriately. People were supported by other healthcare providers as appropriate.

Is the service well-led?

Staff told us they were supported to deliver quality care and they received training in the basic subjects for adult social care, such as consent and the safeguarding of vulnerable adults. They said they were confident if they raised concerns with the manager or senior staff, they would be dealt with properly.

Systems were in place to regularly assess and monitor the quality of service provided. Risks were assessed and appropriate action plans were in place. There were processes in place to review and learn from incidents, accidents and complaints.