Northwood Nursing Home

Northwood 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.

At the last inspection in July 2017 we found that people’s liberty was being restricted unlawfully and the governance systems in place were not robust.

At this inspection we found that the service had worked hard to improve the safety, liberty and welfare of people at the home and now demonstrated good outcomes for people.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People felt safe and staff knew how to mitigate risks to people’s health and wellbeing. Medicines were managed safely and infection control practice adhered to. Safety checks and fire drills were completed appropriately.

People’s individual risk assessments in care records had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded when needed.

Staff demonstrated a good understanding of safeguarding procedures and signs of possible abuse. They told us they reported any concerns to senior staff on duty or their manager and they were aware of the whistleblowing procedures if they needed to elevate any concerns externally to local safeguarding authorities.

Staff were knowledgeable about people and were able to promptly identify changes in people’s needs.

Staff and people who lived at the home were knowledgeable in safety protocols and were provided with the opportunity of attending both fire safety and health and safety training to help ensure they were confident and able to maintain their own safety in case of an emergency.

People were looked after by enough staff, who were trained and supported to help meet peoples` individual needs.

Staff were recruited through robust procedures which ensured that staff working at the home were of good character and were suitable to work with the people they would be supporting.

People were supported to take their medicines safely by staff who had received training and had their competencies checked.

People`s consent to the care and support they received was obtained and staff worked within the principles of the Mental Capacity Act 2005 for people who lacked capacity to make certain decisions to ensure that the care and support they received was in their best interest.

People told us, and we observed, that the service provided a healthy and varied diet and in sufficient amounts to maintain people`s health and well-being.

The environment has been improved with some areas being redecorated and updated since the last inspection took place. The home was maintained to a safe standard.

Staff told us they received regular training and updates to ensure their skills and knowledge remained current in relation to their job responsibilities. Staff were well supported through a range of methods including work based observations, team meetings and individual supervisions.

People told us that staff were flexible and responsive to their needs and preferences. People told us and we observed that the care and support they received met their needs and was personalised to suit each individual. Professionals involved in the service were positive about the service and how it operated.

People were offered a range of activities both within the home and were also supported to access the local community.

The service was well managed. There was clear and effective leadership at the service with staff having well defined roles and responsibilities. The management was open and transparent. The registered manager had worked hard to improve the quality of the service provided which helped the service to operate in a productive way. There were systems in place to monitor and manage the overall quality of the service and this included getting regular feedback from the people who used the service.

People were supported to give feedback through regular meetings and had a representative to put forward their views. People told us they felt fully consulted and involved in all aspects of the running of their home.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

Northwood Nursing Home is registered to provide accommodation and support for up to 35 people with health conditions, age related frailty and people living with dementia. It also provides nursing care. At the time of our inspection there were 30 people living in the home.

When we last inspected the service on 23 and 30 September 2016 we found breaches of regulations 9, 11, 12, 14, 17 & 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was insufficient care planning in place to ensure people’s individual needs and choices were being met, people’s choices and preferences were not being upheld and their nutritional needs not being met.

There were ineffective systems in place to keep people safe, people’s dignity was not always respected or maintained. We found that people’s liberty was being restricted unlawfully and people were not always recruited with the necessary communication skills to provide safe care and treatment to people.

The provider’s governance systems were not robust and had failed to identify concerns we found as part of the inspection. We took action using our regulatory powers and imposed a condition on the provider’s registration to provide the Care Quality Commission with monthly action plans to ensure people were kept safe and their health and welfare was maintained. We also placed the service in Special Measures and kept the service under review along with referring our findings to the local authorities safeguarding and commissioning teams.

Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements.

At this inspection we found that the service had improved. People told us they received care and support that met their individual needs. People were involved in the development, planning and review of their care.

Staff knew people well and treated them with dignity and respect. Care plans had been improved and were now more personalised and contained detailed information about people’s support needs.

We found although record keeping had improved, some records were still inaccurate.

Staff knew how to recognise and respond to any allegations of abuse. However we found that people’s medicines were not always being managed or monitored safely and individual risks to people were not always reported or managed effectively.

People were supported by sufficient numbers of staff who were recruited through a robust process which helped ensure staff were suited for the roles they performed. Staff were inducted and received on-going training and support. Staff had individual supervisions and, team meetings in order to share good practice and discuss any concerns.

Although people were supported to make their own decisions, and to retain where possible, their everyday living skills, we found situations where people’s liberty was being restricted.

We found that people views were obtained through resident meetings with the registered manager. Although the service demonstrated they had improved the systems and processes in place to monitor the service in order to continue to improve the standard of care and support for everyone who used the service, this was still an area that required improvement.

Northwood Nursing Home is registered to provide accommodation and support for up to 35 people with health conditions, age related frailty and people living with dementia. It also provides nursing care. At the time of our inspection there were 30 people living in the home.

Although there was a manager in post they are not yet registered with the Care Quality Commission to manage the service. We were informed that they had submitted an application to become the manager in July 2016. 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 appeared unkempt and the support provided for their personal hygiene needs was not of a consistently good standard. People were placed at risk from pressure relieving equipment which was not being monitored effectively.

Recruitment processes were not always consistent in ensuring staff employed at the service were suitable to carry out their responsibilities and meet people`s needs. For some of whom English was not their first language we found they did not always understand the questions we asked them or what we were saying to them. The majority of the people who lived at the home had limited communication and therefore it was difficult to fully assess how this impacted on their health and welfare. We also noted that people were not required to complete a numeracy and literacy test in all cases prior to them commencing employment at the home.

The majority of staff understood how to promote and protect people’s rights and maintain their privacy and dignity. However, we observed several instances where members of staff failed to respect people’s privacy or dignity.

Engagement with activities and hobbies was limited. Loud music was playing in conjunction with a television within the main communal lounge area. We observed people were uninterested in either option and staff made no attempt to engage with people or offer people alternative choices of activities.

People’s care plans lacked detail or accurate information relating to people’s care and were not subject to regular review. Care plans were not person centred, and did not always contain sufficient detail to ensure they reflected people’s current needs and choices.

People were supported to take their medicines by appropriately trained staff. However, we found the process for the administration of medicines was not consistently safe.

Staff received support through induction and a training schedule with a mixture of E learning and face to face training. However training was not consistently effective in providing staff with the appropriate skills to help them meet the needs of the people who lived at the service. Staff told us that some of the training was completed at home and we could not be assured that staff were competent following completion of the training, especially for people whom English is their second language.

The service was not consistently well led and had not identified many of the issues we found during the course of our inspection. Where areas of concern had been identified appropriate actions had not been put in place to address these. Records were not completed in a timely way. Some of the staff were positive about their experience of working at the home while others were less positive.

The risk assessments in place were not personalised or detailed enough to support staff to keep people safe.

People’s consent was not always obtained prior to care and support being delivered. We found that not all staff understood the principles of the Mental Capacity Act. We found that people’s human rights had been unlawfully restricted. Staff did not always support people to make decisions and follow the legal requirements outlined in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberties Safeguards (DoLS).

Staff told us people were able to choose their own meals and the meal choices were completed the day before. There were no snacks or drinks for people to freely access because tea and coffee was only provided during set times during the daytime and evenings. The quality of the food we observed being served to people was of a poor quality and people who chose to have a vegetarian diet were given meals containing meat.

There was little engagement between staff and people who used the service and the care provided was very 'task orientated'. Some people who were more able had developed relationships with staff who treated them kindly.

Staff were knowledgeable about safeguarding procedures and we saw that they had received training. They were able to tell us what actions they took to keep people safe from possible abuse. However during our visit we observed one person being restrained and restricted from moving freely around the home.

People had access to health care professionals to make sure they received care and treatment to meet their individual healthcare needs. Staff supported people to maintain their health where possible.

There were systems in place for recording, investigating and responding to complaints. People and their family members knew who to speak to if they wanted to raise a concern.

The systems in place to monitor and review the quality of care provided failed to identify aspects of people’s care which placed them at risk of harm.

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.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with all confirmed that they felt safe living at the home. One person told us 'I feel very safe here'. We reviewed six care plans and were able to see that care plans were person centred and were regularly reviewed. We saw evidence that people and/or their relatives were involved in the care planning process. Risk assessments were regularly reviewed and provided information and guidance to staff on how to minimise potential risk to people.

Staff we spoke with knew where the policy was kept and knew how to make a referral should they have suspicions that a person using the service was being abused. We saw evidence that staff had received training in safeguarding vulnerable adults.

Health and safety checks were regularly undertaken by the manager and the provider to ensure that the home was safe for people to reside in.

Is the service effective?

We looked at the risk assessments and the care records of two people who lived at the home. We found these provided details of what people were able to do for themselves as well as what support they needed.

We saw evidence that people who used the service had a capacity assessment, which held details on people's ability to make decisions. Where the provider had made applications to the local authority in respect of Deprivation of Liberty safeguards (DoLS), we saw this was recorded, monitored, reviewed and closed once the risk to the person cease to exist. On the day of our inspection the provider did not have any DoLS applications opened.

Is the service caring?

A relative we spoke with said 'staff are kind and considerate'. During our inspection we observed staff members assisting people with task in a kind and patience manner. We heard staff asking people for their consent before providing support or undertaking any task. People and relatives we spoke with all said that staff were caring and polite.

Is the service responsive?

During our inspection we observed that staff responded in a timely manner when people asked for help. People were supported by staff to access services in the local community.

Is the service well-led?

A relative we spoke with said the home was 'very well organised'. We saw that the service had a quality assurance system in place, which sought the views of people who used the service. We saw that audits had been undertaken in a number of areas by the provider.

During our tour of the home we saw that several people's bedroom doors had been left open, we noted that people's care plan did not show that people were given a choice as to whether or not they liked their bedroom door left open. We saw evidence that the provider had sought consent from people in relation to care and support.

We observed that a section of the ceiling in the lounge was in disrepair and was leaking, there was a bowl situated under the leak however the carpet was extremely wet. There were no warning signs informing people that the area was hazardous and the area had not been cornered off. This meant that the provider had not taken appropriate action to ensure that people were kept safe.

Staff had received training in how to safeguard people from abuse, however staff were not always clear as to how they could report allegations of abuse outside the home. We saw that there was enough staff on duty to meet the needs of the people who used the service; however some staff had not received regular supervision and an annual appraisal.

The provider has systems in place to assess and monitored the quality of the service and the home had a complaints policy and procedure in place.

People said that they were given choices for their meals, and there was also a choice of activities in which they could participate. A few people commented that the food did not always taste good, but most people found it satisfactory. We noted that the menu planning had reflected the diverse needs of people, and had accommodated their requests and preferences.

The lunch included a choice of hot meals, a selection of fresh fruit as well as a hot pudding for dessert. Soft drinks, tea and coffee were provided. We observed that staff were supportive with people who needed assistance during the meal, which was unhurried.

Several people we spoke with said that staff showed them respect, and took

account of their likes and dislikes. A person commented, "Staff take me to the shops. I buy what I like to eat. The staff are reliable and very pleasant."