Northlands House Care Home

• Northlands House Care Home is registered to accommodate a maximum of 101 service users. The home is situated in Southampton close to the city centre and provides care mainly to people with general nursing needs or a physical disability. At the time of the inspection there were 83 people living at the home

• For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk.

People’s experience of using this service:

• People and their visitors gave us positive feedback about all aspects of the service they received.

• One person told us, “I never thought that I’d live anywhere but my own flat but now I’m here I’m really pleased. It’s so much more peaceful here than the hospital and no mobile phones to bother me.”

• Since our last inspection the provider had made improvements to staffing levels and to their processes for notifying us of certain events.

• People received care and treatment from staff who felt valued. There was a high level of morale among staff.

• We saw caring and compassionate relationships between staff and people they supported.

• People’s care and treatment were based on records that were thorough, detailed and up to date.

• People’s care and treatment met their needs and reflected their preferences.

• There was a wide range of activities and entertainments which reflected people’s interests, choices and previous experiences.

• Management processes were thorough and methodical, including processes to make sure people received care and support in a safe environment. There was a positive, open and empowering culture.

Rating at last inspection:

• At our last inspection (published 3 February 2018) we looked at the safe and well-led key areas and rated them both requires improvement.

Why we inspected:

• This was a planned inspection based on the date of and rating at the last inspection. At the last inspection we found breaches of three regulations. The provider sent us an action plan with dates when they planned to be compliant with those regulations. At this inspection we checked that they had made and sustained those improvements.

Follow up:

• We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

We undertook this unannounced focused inspection on 28 and 29 November 2017. The inspection was in response to a number of concerns which were raised with the Care Quality Commission and by the local authority safeguarding team. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led?

No risks or concerns were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The inspection was conducted by two inspectors and a nurse specialist advisor.

Northlands House Care 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.

Northlands House is registered to accommodate a maximum of 101 service users. The home is situated in Southampton close to the city centre and provides care to people with physical disabilities and those who may have dementia. The home is over three floors with communal areas on each floor. There were 80 people living in Northlands at the time of our inspection plus a further two who were in hospital.

There was not a registered manager at the service at the time of the 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. At the time of the inspection the manager had submitted an application to register to the Care Quality Commission and was registered between the inspection and our report being finalised.

We found there were not enough staff to meet people’s physical care needs. People waited a long time for staff to respond to call bells. People and staff felt there was not any time to talk and chat to people unless they were supporting them with their personal care or eating. Staff said they were stressed and worried about the quality of care they were providing.

The provider did not ensure that all notifiable incidents that affect the health, safety and welfare of people who live at the home were reported to the Commission, which they are required to do by law. When people died at the home, staff completed the relevant notifications but there was a delay in sending them through. It is important for providers to notify the Commission so that we are kept informed and aware of any issues of concern developing.

The provider had policies and procedures in place designed to protect people from abuse. Risk assessments identified when people were at risk from every day activities. Personal protective equipment, such as aprons and gloves were readily available to ensure the risk of cross infection was minimised. People received their medicines as prescribed by staff who were trained and assessed as competent. Lessons were learnt and improvements made when things went wrong.

The provider promoted an open and transparent culture in the home. People and staff were involved in the everyday running of the home and action was taken to address their ideas or concerns.

There was a quality assurance system of audits in place to monitor and assess the quality and safety of the service provided. The manager and provider worked with the local authority safeguarding team to address any safeguarding concerns.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and breaches of the Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 01 and 04 November 2016 and was unannounced. Northlands House Nursing and Residential Home provides accommodation and care for up to 101 older people, who require nursing care. There were 89 people living in the home when we visited. Accommodation is based on three floors with a range of communal rooms for peoples use.

At our previous inspection, on the 09 and 10 December 2015, we found two breaches of regulations. The service was not meeting the regulations relating to keeping people safe from risk of harm, by ensuring that all medicines were stored correctly and peoples care plans were not being followed. At this inspection we found improvements had been made and the identified concerns had been addressed.

There was a registered manager 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.

We found people’s safety was compromised in some areas. People gave us mixed feedback about staffing levels. People told us they sometimes had to wait a long time for the bell to be answered. There weren’t enough pagers available that were linked to the call bells at the time of our inspection which meant that staff may be nearby but be unaware that someone was waiting to receive support. The registered manager informed us that all staff should have pagers and that new pagers were on order which should see an improvement in response times.

People felt safe living at Northlands House Nursing and Residential Home. The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

Safe recruitment practices were followed and appropriate checks were undertaken, which helped make sure only suitable staff were employed to care for people. Staff received training in safeguarding adults and knew how to report concerns.

Staff were trained and assessed as competent to support people with medicines. Medicine administration records (MAR) confirmed people had received their medicines as prescribed.

Staff received regular one to one sessions of supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an appropriate induction programme.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu choice of the day.

People felt they were treated with kindness and said their privacy and dignity was respected. Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully.

People had a choice and access to a wide range of activities and were able to access healthcare services.

‘Residents meetings’ and surveys allowed people to provide feedback, which was used to improve the service. People felt listened to and a complaints procedure was in place.

Staff were responsive to people’s needs which were detailed in people’s care plans. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

Regular audits of the service were carried out to asses and monitor the quality of the service. Staff felt supported by the registered manager. There were appropriate management arrangements in place.

During this inspection, we looked at the outcomes relating to the care and welfare of people, nutritional support, safeguarding adult's process, medicines management, staffing, the process for assessing and monitoring the quality of service and records.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with 17 people who use the service, relatives and visitors to the service, the manager and 11 staff. We reviewed six care plans and associated records, and documents relating to the management of the service.

We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found :

Is the service safe?

The service was safe because the provider had reviewed the staffing and arrangements were in place to ensure there were adequate staff with the right skills to meet people's needs. An assessment of risks had been completed and measures put in place to manage those risks as appropriate. People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received appropriate training in safeguarding vulnerable adults and we found the manager had responded appropriately to incidents of potential abuse.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to MCA and DoLS. There were two people who were subject of a DoLS authorisation and they were receiving appropriate monitoring and support.

Is the service effective?

The service was effective, care plans including risk assessments were completed to demonstrate how people's assessed needs would be met. People we spoke with were complimentary about the care and support they received. Support plans showed people's needs were assessed and clear information was provided for the staff. This included appropriate support regarding food and fluids required to meet people's nutritional needs. Equipment was in place to support people's mobility and to maintain their independence. Effective arrangements were in place for the management of people's medicines.

Is the service caring?

We noted people were supported in a caring and compassionate way. Staff and people using the service had developed good relationships and people were treated with respect. One person told us the staff were "really good" and another said "I have everything I need". People told us they were able to exercise their choices and staff listened to them. Comments included' they treat you very well' and 'the staff are very nice and they do a good job'.

Is the service responsive?

The service was responsive because people told us told us the staff responded to their care needs. A person told us 'they get the doctor in if you need one'. We saw people were supported to access external healthcare facilities as needed. The staff carried out regular reviews of people's care plans and action was taken to address any changes in their needs. However, not all people were fully satisfied with the activities which were available to them.

Is the service well-led?

Systems were in place to regularly assess and monitor the quality of service provided. Risks were assessed and appropriate action plans were in place. There were processes in place to review and learn from incidents and accidents. People's views were sought through satisfaction surveys and service users' meetings; action plans were developed to address any issues as needed. There was a complaints process and information was available to people. The manager had submitted an application to register with us.

We received mixed comments about the care and support people were receiving. People told us 'some staff come and talk and are very helpful and always knock on the door before entering'. Another person said 'I am very grateful to staff for putting up with me'. Another comment was 'staff treat me okay and knock on the door'. Some of the negative comments were about staffing. A senior staff member told us there had been a lot of staff changes recently and this was echoed by health care professionals. Comments from a person who use the service was 'some staff don't want to be here, it's a last chance saloon for some of them and some managers are promoted beyond their capabilities'. Another person commented 'staff do not have time to talk to you but I am treated with respect'.

We looked at care plans; records of care provided and management records. The care plans contained the relevant information; however these were not reviewed and updated at regular intervals as needed. This may pose risks of changing care needs not being identified and appropriate action taken. People were supported with their food and fluids. However the food records were not reflective of people's needs. People received their medicines as prescribed; however, the management of topical creams was inadequate and not always managed safely.

There was a procedure in place for ensuring people were safeguarded against the risk of harm. There was some auditing to assess the quality of the service provision, however this was not robust and effective. The provider had recognised this and was taking action to address this. There was a process in place to deal with any concerns and complaints. The records maintained in the home were inadequate because care, treatment and support given were not clearly and accurately recorded.