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 avoidable harm. At our last inspection completed in November 2023 this key question was rated requires improvement. At this assessment this key question remains requires improvement. During our assessment we found a repeat breach of regulations with respect of safe care and treatment. We identified continued shortfalls with the safe management of medicines and safe environments. People did not receive their prescribed medicine as required which placed them at risk of harm and staff did not always ensure the environment was safe. You can find more details of our concerns in the evidence category findings below. The service internal audits did not always identify the risks we found during our site visits; however, the manager was responsive to our findings and started to take action to address these.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives were positive about the manager, they confirmed they felt listened to and were confident the manager would act on concerns.

Staff confirmed they were involved in daily handover meeting to share information, group supervisions, 1:1s and staff meeting. They confirmed these included discussions about any concerns which had been raised or identified and actions to take to prevent reoccurrence. Staff told us they had the opportunity to share their learning and development and felt confident to share their ideas with managers, which would be listened to. The manager described how they shared information with staff to help ensure concerns are acted on and lessons learned.

We could not be assured the provider had always taken action in a timely way where concerns were identified by other professionals. For example, some issues found at this inspection were also highlighted at the previous CQC inspection completed in November 2023 and some of the concerns identified by the Fire service in 2021 had not been rectified by the service at the time of our assessment visit. There were systems to place to promote a culture of learning. Daily '10@10 meetings were held as well as handover meetings between staff shifts to discuss people’s current and changing needs and to reflect on any learning, additional monitoring, and improvements. The manager completed a 'Managers Action and Improvement Learning Plan' monthly. We reviewed these for the months of March, April and May 2024 and found these included audits and spot checks for a range of areas to support effective and safe care provision. For example, we found reviews of mealtime experiences, audits of care records and care being delivered and reviews of any safeguarding concerns and incident/accidents in the last month. The findings from these checks were analysed by the manager with actions being taken and plans developed to mitigate any concerns or risk identified. On review of the Managers Action and Improvement Learning Plan’s we noted improvements in aspects of the service. For example, within February 2024, 17 incidents had occurred, this reduced to 14 in March to 9 in April and May 2024.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People felt safe living at Northcott House Residential Care and Nursing Home and were happy with how they were cared for and supported. One person told us, “I have always felt safe here. It’s a nice place to live.” A relative told us, “This was the best home I’d seen. They get things done and look after [person]. When I leave here and go home, I don’t worry about them.”

The manager understood their safeguarding responsibilities and described the actions they would take should a safeguarding concern be identified. Staff had received safeguarding training and knew how to prevent, identify and report allegations of abuse. One staff member described the actions they had taken and said, "I have done safeguarding training, if I was concerned about anything I would go straight to the manager. If I needed to I would report to the safeguarding team or CQC.” Another staff member told us, “We are all [staff] very responsive, any concerns or issues would be dealt with straight away.” Staff described improvements in the service since the arrival of the manager and felt able to raise issues, listened to and supported. A staff member said, “Staff now work together better, we have more direction, the atmosphere’s better and people and staff seem much happier."

We observed a calm and relaxed atmosphere within the home and there was no evidence of closed cultures. We witnessed staff speaking with people with kindness and supporting them in a kind and gentle way. Staff mostly responded promptly when people needed support, which reduced the risk of harm.

There were policies and procedures in place in relation safeguarding people, and these were being followed by staff and management. Processes were in place to deal with and investigate any safeguarding concerns identified or raised. Findings from investigations were reviewed during the assessment process and no concerns were identified. Accident and incident records demonstrated when an accident or incident occurred actions were taken as required. For example, neurological observations were commenced following an unwitnessed fall, 999 contacted as required and wound management plans implemented as needed. Records of complaints demonstrated complaints were reviewed and actions taken where required. Records showed if a complaint was received the manager would meet with the complainant to discuss the issues and actions that would be taken going forward to address the issue and prevent reoccurrence. There was an understanding of the Deprivation of Liberty Safeguards (DoLS). Most best interest decisions records demonstrated involvement with relevant people, including people’s relatives as required. The manager was able to share copies of valid Lasting Power of Attorney (LPA) records which detailed in what capacity they could make decisions on behalf of people.

People and relatives spoken with felt staff understood specific risks to people and that these were managed well. A person said, “The staff are all good and they keep an eye on us.” Another person told us, “I have always felt safe here.” A relative said, “I’ve got no complaints about her personal care or her comfort.” A person described actions staff had taken following experiencing a fall and were happy with the way this was dealt with by the staff. We reviewed the accident and incident records linked to this fall and identified appropriate action had been taken at the time of the fall, including contacting healthcare professionals in a timely way and completing appropriate health checks as per best practice guidance. People spoken with told us they could speak with staff about risks, views and feeling. A person said, “They [staff] said to me, ‘Do you want to sit and talk about anything?’ I thought about it and said, ‘Yes please.’ It starts with everyday things and then it goes on to what really bothers me. They’re good at getting to that.”

Discussions with staff showed they had good understanding of how to manage risks linked to people's individual care and support needs. Staff were trained in the use of equipment and had access to people's individual risk assessments via the online system. Staff were confident that they had all the relevant information to manage risks. A member of staff said, "We [staff] can access people's risk assessments easily and these are helpful, they contain all the information we need to help ensure people are kept safe." Staff confirmed they were kept up to date when people's needs changed and risks were communicated with them in various ways, for example in electronic care plans, in daily handovers and staff meetings.

Observation of staff's practice during inspection visits showed staff were attentive and responsive to people's needs. We found risks to people's care were well managed and we did not identify any concerns about staff's practice, such as during support with moving or handling or nutritional support. We observed staff supporting people safely following people’s individual care plans and risk assessments.

Since the appointment of the new manager relatives spoke of an improvement in communication and felt they were better informed and provided with frequent updates about people’s wellbeing, including risks to their safety. Most risks had been assessed and recorded, along with action staff needed to mitigate the risk. For example, risk assessments were in place for people at risk of falling, skin integrity, nutrition, dehydration and mobility were required. However, we found for one person there was no detailed care plan or risk assessment in place for a person with diabetes and a breathing impairment. This was discussed with the manager, and these were immediately developed. Monitoring charts were in place in relation to specific care required to mitigate risks. These included charts to demonstrate people’s positions had been changed for those at risk of pressure damaged, food and fluid intake was monitored for people at risk of malnutrition and dehydration, and bowel movements monitored as required. A review of these recorded highlighted risk assessments and care plans were followed and demonstrated risk mitigation measures were taken as required. We reviewed a wound chart for one person who had a pressure sore, this was well completed and showed improvements in the wound. These improvements demonstrated effective care was being provided.

Although people and relatives did not highlight any concerns in relation to the safety of the environment, comments about the size of some bedrooms and the need for redecoration were received. For example, a relative said, “Her room is very small and there’s not much room because of her chair. I think the décor needs a lick of paint in some areas.”

Staff told us equipment was available for moving and handling and they received training to carry out their role safely. The manager described the actions they took to ensure the environment was safe, however acknowledged some of these systems had not been effective as the concerns we found had not all been identified. The manager agreed these systems would be updated and reviewed to ensure people's safety. The providers representative responsible for the homes health and safety confirmed that following our first day in the home they reflected on our findings and concluded they did not have current and up to date training on some aspects of environmental safety. They confirmed this was being addressed.

We carried out a tour of the home during all our site visits. On our first site visit we found a number of environmental factors which posed a risk to people. For example, we found large furniture items, such as wardrobes were not secured safely to walls within 5 people’s bedrooms, therefore people were at risk of harm and injury should these fall. We observed fire risks were not safely considered or managed. For example, we saw some doors were wedged open which meant they would not close automatically in an emergency and several bedrooms doors lacked cold smoke seals and intumescent strips. Therefore, should there be a fire outbreak people would not be protected from smoke, fire or fumes behind closed doors of the maximum time possible. We found window restrictors were not in place for all windows that required them, and a number of doors were not locked and secure as required. This included doors to boilers, electrical equipment and rooms where chemicals were stored. These concerns were discussed with the manager who assured us these issues would be resolved. On our last site visit we saw action was or had been taken to address the issues we found, and the number of unlocked doors was markedly reduced, However, one room which contained chemicals and a boiler room was unlocked during our walkaround of the service on arrival. Therefore, more work needed to be done to ensure changes in staff practice was sustained and embedded. During our assessment visits we saw some areas of the home were being modernised and redecorated.

The processes and systems in place to ensure the environment was safe were not effective. For example, the legionella risk assessment dated 18 January 2024 were not detailed or robust. We could not be assured water temperature checks had been completed appropriately to ensure water was maintained at the correct temperature to kill the bacteria. Fire risk assessments were not robust or effective and did not identify the issues we found on inspection. Additionally, we found lack of actions had been taken when previous safety concerns had been raised in relation to fire safety. Other processes were in place including daily management walk arounds of the service and the completion of a planned maintenance checklist. These was not effective as this did not identify the issues that we found on inspection. These concerns included, but not limited to, unlocked doors, unsecure large items of furniture and window restrictors were not in place for all windows that required them. These concerns were discussed with the manager who assured us action would be taken to address the issues identified.

We received mixed views from people and relatives in relation to the staffing levels. People and relatives’ comments included, “There’s not enough staff, they’re worked off their feet. They’re very busy although they are very, very nice and they sort out most problems”, “There’s not enough staff in the dining room. There’s not enough to assist people with eating and then their food goes cold. People can’t eat it”, “Sometimes they come quickly. It depends on who’s on and how many are on” and “I would say I get as much help as I need, and they come quickly if you’re really concerned.” People and relatives felt care was received from well trained staff. A person said, “The staff are very good; they all seem well trained.” Another person told us, “Oh gosh, yes, they know what they’re doing.” A relative said, “The staff seem to understand his problems. They know about his physical problems and about the dementia.”

Staff were positive about the staffing levels in the home and told us staffing levels were sufficient to meet people's needs and provide people with the support they required. Staff felt supported in their roles and received one-to-one sessions of supervision and regular training. The manager and deputy told us they would be available to staff when required which also meant they were able to monitor staff to ensure people's needs were met safely and in a timely way.

We observed staff were mostly available to people and responsive to requests for support in a timely way. However, during our site visit on day one of the assessment, two people told us they had been waiting 'a long time' for staff to support them to access toileting facilities. Neither of these people was able to confirm how long they had been waiting. Inspectors requested these people be supported by staff and this was provided immediately. With the exceptions highlighted above, throughout the assessment we observed a relaxed atmosphere in the home and saw staff had time to chat to people and support them in a calm and unhurried way.

Although we received mixed views of staffing levels the processes in place to monitor staffing levels were robust. For example, call bell audits, staffing level dependency tools, staffing audits and systems in place to gather people and staff feedback in relation to staffing were all completed frequently. We also saw evidence that actions had been taken to address staff shortfalls were required. We checked the recruitment records of three staff and identified the required pre-employment checks had been effectively completed to ensure only suitable staff were employed. Staff had an induction into the service. Processes demonstrated staff were trained in relevant subjects and the manager monitored compliance with training. Staff received formal support such as supervision, appraisal, and checks on their competency.

Staff were clear about their role in managing the risk of infection. Staff told us they had training and gave examples of where personal protective equipment such as gloves were needed. Staff members told us there had been improvements in the cleanliness of the home since the arrival of the new manager. A staff member said, "Things are happening, we now have additional cleaners and we (staff) have been asking for new towels and bedding for months, it never happened. When the manager arrived, we had these immediately.”

On the first day of our site visit we observed there were areas of the home, especially some bathrooms and toilets that were worn and poorly maintained. These areas could not be effectively cleaned and were visibly dirty. However, other bathrooms and toilets viewed had been recently refurbished and within these rooms no cleanliness issues were noted. Other infection, prevention and control concerns were observed during our first site visit, including, but not limited to, not all waste bins were pedal operated, a number of clinical waste bins did not contain clinical waste bags, yet staff had continued to put soiled items in these bins, stained and unclean toilet brushes in bathrooms and out of date face masks. These shortfalls placed people at risk of harm and ill health. All these concerns were shared with the manager who were aware of some of these issues and was in the process of addressing these, There was a marked difference between the cleanliness of the service between day one of the site visit and the last day of our visit and the home was visibly cleaner. Additionally, outdated masks had been removed, clutter had been removed from areas of the home and toilet brushes had been replaced.

Just prior to our assessment the service was visited by outside professionals who commented on the poor cleanliness of the service. The manager told us they had also identified shortfalls in the infection control practices and cleanliness of the service through the providers audit processes. This had resulted in additional housekeeping staff being employed. The manager had implemented more robust processes to help ensure continued and sustained improvement in this area. The provider had a programme of refurbishment and an action plan in place. These demonstrated plans were in progress to ensure all bathrooms and toilets within the home were refurbished to a safe standard. Records showed, and staff told us they had completed training in infection prevention and control. Where infection outbreaks had occurred, this was reported to external agencies as required. Staff had access to up to date policies and guidance about how to keep people safe from the risk of infections. Staff wore appropriate clothing to minimise the risk of the spread of infection.

We identified significant concerns in relation to medicines management. People were not always receiving the medicines they were prescribed, medicines records were not always accurately maintained and incorrect doses of medicine were administered. We found concerns people had not been receiving medication for pain relief, blood thinners and constipation. The shortfalls identified meant people were at risk of not receiving essential medicines, resulting in them being at significant risk of harm and ill health.

Staff told us they had received training in the safe management of medicines. However, on review of the homes electronic medicine system used we could not be assured staff fully understood this system or used it appropriately to help ensure medicines were ordered in a timely way or that medicine had been given appropriately. For example, whilst the system indicates there was no stock in the building some staff were coding the reasons for not giving as ‘resident asleep’ or ‘resident refused’.

There were significant shortfalls in medicine processes. Governance and management systems in place had failed to identity the issues and concerns we found during our assessment in relation to safe management of medicines. These concerns, included but were not limited to; people were not always receiving essential medicines as prescribed, or receiving incorrect doses, medicines were not ordered in a timely way to ensure people had access to these to allow be given as prescribed, where people were prescribed ‘as required’ medicine (PRN) detail plans in relation the administration of these medicines were not in place and staff had not received effective training in using the electronic medicine system. The shortfalls identified meant people were at risk of significant risk of harm and ill health. The concerns found were discussed with the manager who agreed immediate actions would be taken to ensure peoples safety.