Northlands Care Home (Northumberland)

Northlands Care Home (Northumberland) is a residential care home providing accommodation and personal and nursing care and treatment of disease and disorder to up to 39 people. The service provides support to people with a physical disability or medical need and older people, including people who are living with dementia. At the time of our inspection there were 37 people using the service.

People’s experience of the service and what we found:

People were not always protected from risk and actions to mitigate risks were not always in place. Lessons were not always learned when there had been accidents or incidents. The home was in organisational safeguarding because the local safeguarding team had identified a number of concerns. Actions had not always been taken to address these concerns or keep people safe. People told us there were enough staff to support their daily care needs. However, staff were not always deployed efficiently, and some areas of the home were not always well observed. We found some minor issues regarding support with medicines and infection control.

People were not always supported to access appropriate food and fluids. Care records did not always reflect the most up to date advice and fluid intake records indicated recommended fluid intake levels were not always met. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were subject to restriction on their freedom. Whilst these restrictions were to ensure their safety, actions had not been taken in line with the requirements of the Mental Capacity Act. Staff training required further action to address previously identified shortfalls.

Quality monitoring at the home was not consistent. Checks and audits failed to identify shortfalls in care and incomplete records. The provider had not written formally to individuals, offering explanations and apologies following accidents or untoward events. People were involved in care decisions and said staff treated them well. The provider was looking to address the shortfalls and had recently appointed a new quality manager who was working on improvements.

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 September 2019)

Why we inspected

The inspection was prompted in part due to concerns received about keeping people safe, delivering the right care to support people, 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 Northlands Care Home (Northumberland) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to managing risks at the home, ensuring people did not suffer from avoidable harm, supporting people to maintain a balanced diet, ensuring where people could not consent to care appropriate processes were followed, staff training and support, maintaining a robust oversight on the quality of care and responding to the provider’s duty under duty of candour.

We have made recommendations to the provider regarding improvements to staffing and the safe management of medicines.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Northlands Care Home (Northumberland) provides nursing and personal care for up to 35 older people. There were 29 people living at the home at the time of the inspection, some of whom had a dementia related condition. Accommodation was spread over three floors. People with more advanced dementia care needs lived in ‘Haven’ which was situated on the third floor.

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

At our previous inspection we identified a breach in relation to staffing levels. At this inspection, we found that action had been taken and there were sufficient staff deployed to meet people’s needs.

People said they felt safe and happy living at the home. One person told us, “I am at home now, that’s how I feel.” There were systems and procedures in place to help keep people safe. Medicines were managed safely, however medicines records were not always clear. This was being addressed by the provider.

Checks were carried out to make sure the building and equipment were safe. The environment had been redecorated and refurbished and met people’s needs.

People were supported by staff who were trained to meet their needs. Staff were undertaking additional dementia training to increase their knowledge and understanding in this area.

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 had a care plan which guided staff on how to deliver person centred care. People’s social needs were met. There was an activities programme in place.

The service was going through a period of change. The registered manager was leaving after managing the home for a number of years. A new manager had been appointed and was in post on the final day of our inspection.

During our inspection, several staff raised concerns about certain aspects of working at the home which affected the morale of staff. We passed these to the provider, registered manager and new manager for their attention. We have made a recommendation about this. The provider monitored the service and was already in the process of addressing some of the issues we found during the inspection.

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 17 August 2018). We identified a breach in the regulation relating to staffing. 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 this regulation.

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.

This was the first inspection of the service since it had re-registered because of a change of provider in March 2017.

Northlands is a care home. People in care homes receive accommodation and 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.

Northlands accommodates a maximum of 35 people who require nursing care or personal care, some whom may live with dementia or a dementia related condition. At the time of inspection 32 people were accommodated at Northlands Care Home.

A registered manager was 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.

People, relatives and staff were very positive about the changes that were taking place to make improvements since the change of ownership of the home. They told us the new providers were very friendly and approachable.

People said they felt safe and they could speak to staff as they were approachable. We considered that staffing levels needed to be reviewed and that staff were appropriately deployed to meet people’s needs in a safe, timely and person-centred way.

Improvements had been made to activities and entertainment but we considered people should have opportunities for stimulation and engagement with staff. Care staff were not always able to take the time required to interact and take an interest in people’s hobbies and activities. Staffing levels meant care was sometimes task-focussed.

The home was being refurbished. However, not all areas of the home were clean and well-maintained for the comfort and safety of people who used the service.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Risk assessments were in place and they identified current risks to the person. Records were in place that reflected people's care and support requirements and they were regularly reviewed to ensure they remained accurate. Staff knew the people they were supporting well.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way. However, we have made a recommendation about the management of medicines as records were not in place to demonstrate that people who received medicines covertly (without their knowledge) had this decision taken in their best interests.

Appropriate training was provided and staff were supervised and supported. Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. 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. Improvements were required to the documentation to evidence some best interests decision making.

Care was provided with kindness and compassion and people’s dignity was respected. However, improvements were required to people’s dining experience.

Menus needed to ensure people received a varied and balanced diet to meet their nutritional needs. We have made a recommendation about this.

The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection with regard to staffing levels, medicines management, people’s dining experience, environment and best interest decision making.

A complaints procedure was available. Staff and relatives said the management team were approachable. People had the opportunity to give their views about the service. There was consultation with people and family members and their views were used to improve the service. People had access to an advocate if required.

During this inspection we found a breach of Regulations 18 (staffing) 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.