Archived: Northgate House (Norwich)

Updated 3 April 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Prior to the inspection, we reviewed information we had received about the service such as notifications. This is information about important events, which the provider is required to send us by law. We also looked at information sent to us by the provider and from other stakeholders, for example the local authority and health care professionals.

We also used the information the provider had sent us in their action plans and management monitoring reports sent to us following our last comprehensive inspection in April 2017. This included what action they had taken to address shortfalls, and how improvements were being implemented, monitored and maintained.

This inspection was unannounced and carried out by two Inspectors.

During the inspection, we spoke to four people who used the service. Some people could not tell us their views about the care and support they received, as they were unable to communicate with us verbally, therefore we spent time observing interactions between people and the staff who were supporting them. We also observed the care and support provided to people and the interaction between staff and people throughout our inspection.

We spoke with the registered provider, operations manager, the supporting manager, four care staff, two senior care staff, and the cook. We also spoke with three relatives.

To help us assess how people’s care and support needs were being met we reviewed the care records of six people who used the service including risk assessments, management of their medicines and monitoring charts in relation to care support provided. We also looked at medicines management, staff recruitment files, staff training records and systems for assessing and monitoring the quality and safety of the service.

Updated 3 April 2019

Northgate House is a residential care home providing accommodation and care for up to 22 older people, some living with dementia, in one adapted building across two floors. People in care homes receive accommodation and nursing or personal care as a 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 time of this inspection, three people were using the service.

This service has a history of non-compliance with continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Seven inspections of this service had taken place since December 2014, three of these inspections with an overall rating of ‘Inadequate’ and four rated ‘Requires Improvement’.

This unannounced inspection took place on 10 September 2018. At this inspection, we found that there were four continued breaches relating to safe care and treatment, staffing, mental capacity and governance. There was one further breach of a regulation relating to safeguarding people.

We took enforcement action following an inspection of the service on 19 April 2017 where the service was given an overall rating of ‘Requires Improvement’ as we found the registered provider had continued to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We placed conditions on the registered provider's registration to submit monthly reports to us setting out how they would assess, monitor and where required, take action to improve the quality and safety of the care and support provided to people living at Northgate House.

At the last inspection carried out on 7 March 2018, we found that there were continued serious concerns in relation to the quality and safety monitoring of the service. There was a continued failure to ensure people were protected from the risks associated with improper operation and management of the service including the premises. The service was in breach of seven regulations, which were Regulations 9, 11, 12, 14, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not provided with safe care. Oversight and management of the service was chaotic and disorganised. There continued to be insufficient governance arrangements in the service and therefore was still not effective in mitigating the risks to people's health, welfare and safety.

Following our comprehensive inspection on 7 March 2018, we formally notified the provider of our escalating and significant concerns. We asked the provider to inform us immediately of the urgent actions they would take with immediate effect to protect people and raise standards. We received a response to the urgent action letter on 12 March 2018, followed by an action plan addressing the concerns on 13 March 2018. This contained a basic action plan. We placed conditions on the provider’s registration to restrict admissions to the service. In response to our findings we notified the local safeguarding authority. Since our last inspection, the local authority has supported people who they commissioned care for to move to other locations.

At this unannounced inspection on 10 September 2018, we continued to have major concerns regarding the lack of action taken by the provider to ensure a safe service was provided. There was a continued lack of effective leadership and we found the provider continued not to have effective systems in place to provide safe, good quality care. There were three continued breaches and one further breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which we found, relating to safeguarding people. In addition, there was a breach of Regulation 18 of CQC Registration Regulations 2009.

The service continued to operate without a registered manager in post, and there had not been a registered manager for two years. 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 operations manager was currently acting as home manager and had submitted an application to register with CQC as the home manager. This application remains pending with CQC. For the purpose of the report we have referred to this person as the ‘manager’ throughout. There was a new deputy manager, who was not working on the day we inspected.

Risks to people’s safety and wellbeing had not always been identified and those that had been identified were not always mitigated. There remained concerns around medicines administration with no records around people’s prescribed topical creams and no guidance provided for staff for the administration of PRN (as required) medicines. Other medicines were given as prescribed.

Recent visits from environmental health inspectors and external auditors such as fire safety experts and a health and safety management auditor highlighted a number of areas where action was required by the provider to improve the safety of the environment and protect people from the risk of harm. Whilst the manager told us they had rectified these shortfalls, we found this was not always the case.

Staff had some knowledge of safeguarding from training, however people were not always properly safeguarded from the risk of abuse.

Accurate records of staffing available to meet people’s needs were not maintained. We were unable to ascertain exactly what hours staff had worked and when because the staffing was not accurately reflected in the rota. It was not clear from records maintained that all staff responsible for delivering personal care and support with mobilising people safely were competent in their roles. Staff received some training relevant to their role, however there was not always evidence of sufficient training for all staff delivering personal care. It was unclear whether there was consistent staffing at night to meet people’s welfare and safety needs.

The manager lacked understanding in their roles and responsibilities in relation to the Mental Capacity Act 2005. Best interests’ decisions were not always made when they were needed, and there remained a lack of understanding around consent. It was not clear how assessments of people’s capacity to consent to care were made.

Accurate, contemporaneous records of people’s care were not always kept because records did not reflect actual care delivered.

There continued to be poor leadership with a lack of effective oversight and governance of the service. The manager presented in a manner that lacked openness and transparency in carrying out the regulated activity. Health and safety checks were lacking and action had not been taken when external auditors had identified areas of risk to people’s safety.

There continued to be a high turnover of staff which did not provide continuity of care for people who used the service. There had been a further change of two managers since our last inspection. There were recruitment checks carried out to ensure that staff were suitable for the work they were employed to perform. However, the manager did not always maintain and record an oversight of staffs’ competency to ensure that staff remained suitably qualified to care for people in a safe way.

Care plans contained information about people’s hobbies, interests and social history. However, there was mixed feedback as to regularity of activities and the quality of support provided.

Relatives told us they could approach staff with any concerns, but they were not always resolved quickly. The provider had received some compliments.

There was a choice of meals available and people received enough to eat and drink. Staff supported people to access healthcare professionals and appointments.

On 13 March 2018, CQC used its urgent powers to restrict admissions to the service. This means that it can no longer admit people to live in the home. On 19 July 2018, CQC sent a Notice of Decision to cancel the provider’s registration of this location.

The provider appealed against this decision to the First Tier Tribunal (Care Standards) under section 32 (1) (b) of the Health and Social Care Act 2008. The appeal hearing was due to be held on 11 February 2019. The provider withdrew their decision to appeal and therefore the Notice of Decision was upheld. The location is no longer registered with CQC, and is no longer able to provide a regulated activity.

Other stakeholders including the local authority supported people and relatives to find other homes or alternative care arrangements.

Full information about CQC's regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded. You can see the enforcement action we took at the end of this report.