Archived: Northcott House Residential Care and Nursing Home Also known as 1-684385445

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. The provider was previously in breach of the legal regulation for safe care and treatment in relation to medicines management. Improvements were found at this assessment and the provider was no longer in breach of this regulation. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff understood when and how to report incidents. Incidents were investigated and reviewed to identify areas for change and any themes.

Staff told us lessons learned were shared with them during handover, daily meetings, or via secure messaging. One staff member said, “We have a meeting at 10am everyday where all incidents are discussed with leads of departments and one carer attends from each unit. They also bring up any incidents from the day before in case anyone wasn’t there. I will always ask when I come into handover about any incidents/accidents. If I’m not sure I will always ask someone.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People were assessed prior to moving to the service to ensure their needs could be safely met.

Records showed people were referred to other healthcare professionals when needed. There was a weekly GP review and nurses told us it was easy to contact a GP for advice between weekly video calls. People’s relatives told us people were supported to attend appointments.

Staff told us they worked well with health and social care professionals and had developed good working relationships. There were clear processes to ensure people’s current information was safely shared and we saw records of this during the inspection. One health professional told us, “The staff are good at referring people to us. I would say they are very on the ball. In the last 12 months there has been good communication, and they do take on board what we say.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Overall people’s relatives said they felt confident their loved ones were safe living at the service and had seen staff supporting people safely and kindly. One person’s relative told us, “I have no question that [person] is well looked after and is very safe in Northcott House.”

Staff had received safeguarding training and knew how to raise concerns. For example, one staff member said, “It’s about protecting the person’s health and wellbeing to protect them from harm, abuse and neglect. If I had any safeguarding concerns, I would speak to the manager or the nurse in charge.”

There were safeguarding and whistleblowing procedures in place. The management team understood their responsibilities regarding the action to take to protect people from harm and we saw examples where action had been taken to protect people where required. The necessary internal documentation was completed including accident/incidents logs, body maps and falls protocols. The provider ensured referrals and notifications were made to both the local authority and the Care Quality Commission in a timely manner.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had been assessed for risks such as skin damage, falls and choking. Risks had been regularly reviewed, including following any incident such as a fall, when risks could increase. When risks were identified, care plans provided information for staff on how to reduce the risk of harm to people. Pressure relieving equipment we looked at was set correctly and records showed staff changed or supported people to reposition regularly. Staff knew which people needed this kind of support. For example, one staff member said, “There are a few people who are on two hourly repositioning, and we always make sure they are comfortable. We check their air mattress is correct and make sure they use pressure cushions when sitting on chairs.”

Some people had been assessed as at risk of choking. Staff were able to tell us which people were at risk, and how the staff supported them to reduce the risks, such as positioning and any textured dietary requirements. The chef was kept informed of people’s dietary needs and was provided with speech and language therapy (SALT) guidance for those people who required a modified texture diet.

Some people had been assessed as being at risk of malnutrition or dehydration. In these instances, care plans included information for staff such as food preferences, frequency of monitoring people’s weight and any specialist advice that had been sought. When people were having their food and fluid intake monitored, records showed people were provided with enough to eat and drink. We saw people being offered regular drinks and snacks during both days of the inspection.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Fire and health and safety systems and equipment were well-maintained and serviced at regular intervals. For example, the provider had up-to-date fire risk assessments in place for the building and personal emergency evacuation plans for everyone who lived at the home.

Staff told us they had received fire training. One staff member said, “We have done the training in person and on-line. We have a fire warden who comes in and does the in-person training. We have this once a year. [Maintenance staff] do the fire drills every now and again, normally this is on a Friday.” Fire drills were carried out during the day and at night.

Although we saw some areas of the environment which were worn or required attention, we were informed, and we saw on both days of the inspection, that refurbishment plans were underway. For example, we saw some rooms being redecorated whilst we were on site.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We received mixed feedback from people and relatives about staffing levels. We saw the service used a dependency tool to calculate staffing levels and skill mix and rotas we looked at were in line with dependency tool recommendations. During the inspection we saw staff were visible around the building and call bells were answered in a timely manner. Call bell audits were carried out to monitor response times. Although some people’s relatives told us they felt call bells were not always answered quickly enough, other people’s relatives told us they were. Staff told us they felt there were enough of them on duty. For example, one staff member said, “We have enough staff. I think the problem is walking. It’s a big building and walking from place to place takes up a lot of time.”

Safe recruitment processes were followed. Staff completed an induction programme at the start of their employment and had their competencies assessed. Regular supervisions took place, although the records we looked at showed these had occurred following any incidents, rather than general well-being supervisions. However, we did see records of staff welfare checks and heard how staff were supported when unwell for example.

Staff gave positive feedback about the training they received. Some staff commented on the accessibility of the on-line training videos and told us they found these easy to follow and gain learning from. Staff completed training both online and in person. The service had a designated training room, supported with training equipment.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff had been trained in infection prevention and control and told us there was enough equipment available such as gloves and aprons.

There were audits in place to oversee the cleanliness and safety of the environment. The service was visibly clean and tidy. People told us the housekeeping staff were on duty every day. For example, one person said, “It’s very clean in here. They come in and hoover every day. They will wash the floors every other day, it’s lovely smelling stuff. They’re [housekeeping staff] very good.”

There was handwashing signage and facilities throughout the building. There were appropriate clinical waste facilities and colour coded cleaning materials. Food safety was maintained. Kitchen monitoring checks were in place.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. The service had changed pharmacy supplier and there was now a named staff member responsible for overseeing medicines management.

People received their medicines on time. Good stock control was maintained. Medicines, including controlled medicines and thickener, were stored safely. The room temperature of 1 clinical room was noted to be above 20C at 11.10am and we saw staff had recorded the temperature earlier that morning. We discussed this with a deputy manager who showed us a revised temperature monitoring form with twice daily checks that was implemented that day. This meant the provider could assure themselves the temperature in the room did not go above manufacturer guidelines at the warmest time of the day.

Medicine care plans and PRN (as required) protocols were in place. Staff were trained and had their competencies to administer medicines assessed. Regular medicines audits were carried out. Medicine incidents were reported and investigated. People’s relatives told us, “The staff tell me about medication changes, and I do discuss them with the nurse.”