Archived: Northway House Residential Home

Northway House Residential Home is a care home providing accommodation and personal care to up to 29 people. The home specialises in the care of older people.

At the time of the inspection there were 14 people living at the home, one of whom was in hospital.

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

This was a targeted inspection which only looked at the heating at the home.

People lived in a home which was poorly maintained. Some radiators were not working which meant not all areas of the home were as warm as they could be. At the last inspection we identified a breach of regulations regarding the premises. Although some issues had been addressed not enough improvement had been made and the provider remained in breach of regulations.

Shared bathrooms did not have working radiators which meant people could not always bathe or shower in comfort.

The registered manager had taken action to minimise risks of people being cold. People had all been moved to bedrooms which had effective heating. We found all occupied bedrooms were warm and cosy.

One communal lounge area only had one working radiator and a portable heater had been purchased to raise the temperature for people using the room.

People were cared for by staff who had received training in infection prevention and control and were following best practice guidelines. This helped to minimise the spread of infection.

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 6 July 2022.)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check up on concerns raised with us by visiting professionals. Concerns raised were about a lack of heating at the home.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 not changed following this targeted inspection and remains requires improvement.

We have found evidence that the provider needs to make improvements. Please see the effective section of this full report.

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 Northway House Residential Home on our website at www.cqc.org.uk.

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.

Northway House Residential Home is a care home. It is registered to provide accommodation and personal care to up to 29 people. The home specialises in the care of older people. At the time of the inspection there were 16 people living at the home and one person was staying for respite.

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

People lived in a home which was not being well maintained and there was continued shortfalls in the recruitment of new staff. The provider had not ensured that staff were safely recruited which could place people at risk of being cared for by staff who were unsuitable.

People lived in a home where there was a lack of provider oversight of quality and safety. Although the manager had implemented systems to monitor quality, the providers nominated individual had no methods for checking quality or driving improvement.

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.

People felt safe and were comfortable and relaxed with staff who supported them. Throughout the inspection we saw relaxed, kind and caring interactions between staff and people. There were enough staff to meet people's needs. Staff spoke fondly and knowledgeably about the people they cared for.

People were cared for by staff who felt well supported by their colleagues and the management at the home.

Medicines were managed safely and effectively by staff who were trained and competent to do so.

Risks relating to infection prevention and control (IPC), including in relation to the COVID-19 pandemic were assessed and managed. Staff were following all up to date government guidance regarding infection prevention and control.

There was no registered manager at the home. An acting manager was in post who had ensured that the standard of people's day to day care was maintained. However, there was a lack of oversight from the provider to make sure all aspects of the service were monitored.

Rating at last inspection and update

The last rating for this service was Requires Improvement. (Published 2 December 2021)

At this inspection, we found the provider remained in breach of regulations regarding the recruitment of staff. We also found they were in breach of regulations regarding the maintenance of the building.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection.

We carried out an unannounced focused inspection of this service on 2 and 3 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We also looked at the Key Question, Effective at this inspection because we received other information of concern regarding the staff not seeking medical support for people in a timely way.

At this inspection we found the provider remained in breach of regulations.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed from Requires Improvement. This is based on the findings at this inspection.

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.

During this inspection we also carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

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

Enforcement

We have identified breaches in relation to the safe recruitment of staff and the maintenance of the building at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider and 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.

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

Northway House Residential Home is a residential care home. It is registered to provide care and accommodation to up to 29 people. The home specialises in the care of older people. At the time of the inspection there were 17 people living at the home.

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

People could not be confident that the provider had effective systems to monitor standards of care and safety. The recruitment of new staff was not robust. Systems to assess and monitor safety and quality were not always effective in ensuring improvements.

There was no registered manager at the home. An acting manager was in post who had ensured that the standard of people’s day to day care was maintained. However, there was a lack of oversight from the provider to make sure all aspects of the service were monitored.

People were happy with the care they received and felt safe at the home. People told us, and we saw, that staff were kind and patient when they supported them. There were enough staff to keep people safe.

People lived in a home where infection prevention and control processes helped to minimise the risks to people. The staff followed government guidelines in respect of COVID-19 which helped to keep people safe.

People received personalised care and support because staff had access to individualised care plans which set out people’s needs and wishes. Staff knew people well and how they liked to be assisted.

The staff worked with other professionals to ensure people’s healthcare needs, including end of life care needs, were met.

People were able to make choices about their day to day lives and follow their own routines. People told us they enjoyed the company of staff and other people. There was no dedicated activity worker and limited social stimulation for people who were unable to occupy themselves. The acting manager was addressing this issue.

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. (Report published December 2018.)

Why we inspected

This was a focussed inspection based on the intelligence held by the Care Quality Commission.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led.

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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well led sections of this full report.

We have identified two breaches of regulation in relation to fit and proper persons employed and good governance 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 Northway House Residential Home on our website at www.cqc.org.uk.

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.

Northway House Residential Home is a care home which provides personal care and accommodation to up to 29 people. The home specialises in the care of older people.

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

The provider had experienced difficulties sourcing appropriate training for staff to meet people’s increased mobility needs. However, this training had now been sourced to ensure all staff had the confidence and skill needed to safely support people.

People had access to appropriate equipment to make sure staff were able to support them in accordance with their assessed needs. One person said “The staff are nice. I feel safe in the hoist.”

Infection prevention and control measures minimised the risks to people and staff. Staff were working in accordance with up to date guidance including wearing appropriate personal protective equipment and screening visitors to minimise risks.

People felt safe at the home and with the staff who supported them. One person told us, “Staff are kind to you.”

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 12 January 2019.)

Why we inspected

The inspection was prompted in part due to concerns received about moving and handling practices and equipment. A decision was made for us to inspect and examine those risks.

We undertook this targeted inspection to check people were being supported safely in regard to moving and handling. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

As part of CQC’s response to the coronavirus pandemic we are conducting a thematic review of infection control and prevention measures in care homes. Therefore, this targeted inspection also looked at the infection control and prevention measures the provider had in place.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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.

Following the inspection in November 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well-Led to at least a good rating.

On 31 March 2018 we undertook an unannounced focused inspection of the home to check the most significant issues from the last inspection. The team inspected the service against one of the five questions we ask about services: is the service Safe? This is because at the last inspection the service was not meeting some legal requirements; we had significant concerns about a choking risk which had not been managed appropriately. During the focussed inspection, we found the registered manager had made the required improvements. Following this inspection, the rating of Requires Improvement did not change.

During this inspection, we found the required improvements from the last two inspections had been made and we rated the service good.

Northway House Residential 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. The service did not provide nursing care. Northway House Residential Home is able to accommodate up to 29 people in one adapted building. At the time of the inspection there were 23 people living in the home and another six people staying there for respite (short term) care.

There was a registered manager in post at the time of this inspection. 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.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems were robust.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the manager and provided feedback on the service.

During this inspection, we found the registered manager had made the required improvements. The registered manager had referred the person to a speech and language therapist for assessments and guidance. This information had been used to inform risk assessments and care plans. The assessments we looked at were clear. They provided details of how to reduce risks by following the guidelines or the person's care plan. Both the care plans and risk assessments we looked at had been reviewed regularly.

All staff we spoke with were aware of the person’s nutritional needs and preferences. Staff said, “We’re aware of [name’s] needs and the risks of choking”, “All staff have been trained what to do and there’s an emergency bell on the wall” and, “Since we’ve been reminding [name] not to eat too fast and drink, they’ve been fine.” Staff who worked in the kitchen were aware of the person’s needs and said, “We know how to prepare food for [name] and staff observe.”

We observed lunch. Staff discreetly observed the person and reminded them to take drinks regularly. After lunch we spoke with the person who told us, “I can eat what I want, I have choices what I eat and staff help me.”

The registered manager told us, “Learning from this has led to the initial assessment form being updated. We also get more information from professionals.”

Northway House Residential 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. The service do not provide nursing care. The service is able to accommodate up to 29 people. At the time of the inspection there were 26 people living at the service.

There was a registered manager in post at the time of this inspection. 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.

During this inspection we identified that improvements were needed in ensuring people were cared for safely. We identified concerns around risk management in relation to choking and requested the registered manager take immediate action to reduce this identified risk. We also noted that risks associated with people being permanently cared for in bed were not well managed. Where people had risks associated with fluid intake and monitoring this was not consistently safe. Where risks were identified in relation to people’s weight, actions to monitor their weight increase or decrease had not been completed as required.

Safeguarding systems to ensure people were not safe as referrals had not been made as required and current policies required updating to be in accordance with current legislation and regulations. Medicines management required improving, as we found medicines specific for the use at the end of a person’s life were out of date and there was a risk they may have been used. Improvements in relation to infection control practice was required.

The service had not met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). The registered manager had not made any applications for people living at the service and it was not evident they understood current legislation around DoLS applications.

People were not fully supported by the design and decoration of the service. We found that repairs to different areas of the service were needed, for example there was water damage on some ceilings and when it began to rain during the inspection staff used a bucket to catch dripping water. Staff understood the Mental Capacity Act 2005 (MCA) and had been trained in it, however improvements were needed to ensure that legal records relating to a person’s authority to make decisions on behalf of another had been obtained. Improvements were needed to ensure staff received frequent supervision and appraisal.

We found that some practices at the service were not person centred or in line with people’s preferences. For example, the service had set ‘Bath days’ for people and people that wished for more frequent bathing were being told it wasn’t possible. Care records did not always evidence how people’s physical needs would be met and personalised information about people was not consistent. We received mixed feedback on how involved people and their relatives felt in relation to care planning.

The service had failed to send legal statutory notifications to the Care Quality Commission as required. Governance arrangements were not robust as the shortfalls identified during our inspection relating to risks, safeguarding and medicines had not been identified by current arrangements. We received mixed feedback in relation to the leadership at the service and how involved the registered manager and head of care were in relation to care provision and being visible within the service.

People did tell us they felt safe at the service and were positive about staff. There were systems to support people in the event of an evacuation of the service. In general, positive comments were received about staffing and recruitment was safe. Staff spoke positively about their training at the service and there was an induction for new staff aligned to the Care Certificate. In general, access and referrals to healthcare professionals was timely.

People told us that staff were caring and we made observations to support this. People received information about the service and staff told us their aim was to treat people with respect, dignity and kindness. Staff knew the people they were supporting well and we saw kind and caring interventions between people and staff. People told us they were treated with dignity and visitors were welcomed at the service. People’s relatives had sent compliments to the service and given positive feedback on a national website.

Care records showed the service had made efforts to personalise them and risks assessments and associated care plans were reviewed monthly. People had the opportunity to participate in activities. Some community links with the local choir were formed and people were supported to do things they enjoyed before moving to the service. There was a complaints system in operation. The service had discussed end of life wishes with people who wished to and end of life plans were made. There was a system to communicate with people, their relatives and staff through meetings and annual surveys were completed.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, a breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. You can see what action we told the provider to take at the back of the full version of the report.

On the day of our inspection there were 27 people using the service. The summary is based on conversations with three people using the service, eight staff supporting them, a visiting health care professional and the provider. We looked at records and observed what happened at the home throughout our visit.

The service is currently without a manager but the provider is actively recruiting.

We saw that people were treated as individuals and with respect. We saw staff supporting a person who was upset and people being asked what they wanted and how they could be helped. One person told us 'It is quite pleasant. I'm happy here'. There was a homely, accepting atmosphere.

We found that the service was safe because people's needs were assessed and how those needs were to be delivered was planned in detail. This took into account people's individuality; strengths and vulnerabilities. Where risks was identified these were reduced without unnecessary restriction.

We found that the servicing of equipment and the review of fire safety risk was not fully up to date but otherwise there were no concerns with regard to the premises or safety, availability and suitability of equipment.

We found that medicines management did not ensure that mistakes or mishandling could not occur although there were some risk reducing systems in place.

We found the changes in the level of people's needs, management and staff sickness had raised the risk to people using the service. Despite many changes at the home staff were supported to provide a good service and promote people's wellbeing.

We spoke with twelve people who lived at the home. Some had lived at the home for many years, while others had moved in during the past year. Several people said they had not noticed any change in the care they received, although some people thought they were given less attention as a result. We discussed the situation with the provider and the manager, who gave us assurance that lots of meetings were held to discuss proposed changes and to give reassurance that individual needs continued to be a priority in the care delivered.

We saw there was a full activity programme in place which people enjoyed. One person told us the 'flexercise' session had helped their back 'enormously'. Another said 'we didn't half enjoy yesterday's visit out'. The activity coordinator encouraged people to join in group sessions, and supported people individually, if preferred.

Suitable equipment had been purchased to support people who had specialist needs.

We spoke with the provider, registered manager and clinical lead nurse who assisted with the inspection. We also spoke with three care staff and two newly appointed nursing staff. Two relatives we spoke with told us their relatives were comfortable and that the 'personal care was excellent'.

There were 27 people living at the home on the day of the inspection. Of these four people had nursing needs.

People told us that they were fully involved in life at the home. They said 'If we are not happy about something or if we want something changed, we only have to say and they sort it straight away' and 'they encourage us to make comments. They are always telling us that this is our home and I certainly feel that we are in charge.' One person said 'I feel completely in control of my life.'

Each person had a care plan which provided staff with up to date information about people's needs, abilities and preferences. We saw that people's healthcare needs were monitored and responded to.

The people we spoke with told us that they felt safe and well cared for. They made the following comments 'I feel really well looked after here and very safe' and 'all the staff are so kind. It's so reassuring knowing that someone is there when you need them.'

Formal systems for staff supervision were in the process of being implemented. Staff told us that they felt 'very well supported' and that the manager and deputy manager were 'very approachable.'

No concerns were raised with us during our visit to the home. The people we spoke with told us that they would feel confident in raising concerns if they had any.