Northwood Nursing & Residential Care

Northwood Nursing and Residential Care is a residential care home providing accommodation and nursing care for up to 27 people in one adapted building, with bedrooms over 3 floors. At the time of the inspection there were 22 people using the service.

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

Risks to people’s health and safety were not always identified and medicines were not always managed and administered safely. People spoke highly of the staff but felt there wasn’t always enough of them. People’s mobility care plans and risk assessments were not always reflective of their current needs, and some held conflicting information. Infection control processes were not always followed, and recruitment processes were not always robust, we made a recommendation about this. Staff had received training in safeguarding, and people felt safe living at the service

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; However, the policies and systems in the service did not always support this practice. People’s consent was not always sought, and staff had limited knowledge of DoLS. Staff received induction, training and support to carry out their role. The service had been adapted to meet people’s needs. The provider worked well with other healthcare professionals to provide joined up effective care.

Governance systems were in place but not always effective. There was limited evidence of mitigation of risk when concerns had been found. The service had policies and procedures in place, but they were not always reflective of current practices. People and their families spoke positively of the management team and of the staff. Staff described the management as fair and approachable. People were empowered to maintain their independence.

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 5 October 2022)

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to the management of medicines and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well led sections of this report.

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

Enforcement and Recommendations

We have identified breaches in relation to medicines management, risks to the health and safety of people living at the service, consent, and good governance at this inspection. We made a recommendation in relation to infection control and staffing and recruitment.

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

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.

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

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.

Risks to individuals and staff were identified and well managed. Staff had received training in safeguarding people from abuse. Safe systems of staff recruitment were in place and there were sufficient staff on duty to meet people’s needs. Medicines were managed and administered safely. The system in place for infection control and the management of risks of COVID-19 was suitable and met government guidance in place at the time of the inspection.

People’s needs were assessed, and clear person-centred support plans and risk assessments were in place to guide staff. Staff received the induction, training and support they needed to carry out their roles effectively. People were generally positive about the food and told us the food had improved recently. The home was clean and clutter free. Some areas of the home were in need of updating. There was an ongoing programme of planned refurbishment and redecoration in place.

Staff were observed to be busy, but to have a kind, unrushed and patient approach. The home had a friendly relaxed atmosphere. Staff knew people well and had a clear fondness for the people who lived at the home. People were positive about the staff and the support they received. One person said, “It’s a nice comfortable place. The staff are very good.”

Most people we spoke with were happy with the amount and type of activities. There were 1:1 activities for people who liked to spend time in their rooms or who didn't want to join in group activities. People told us their visitors were made to feel welcome. There was an appropriate system in place to manage complaints. Staff spoke with compassion about providing end of life care.

The service was well organised and managed. Everyone was positive about the provider, registered manager, the recent changes, and how well the home was now run and organised. There was a range of quality monitoring, auditing and oversight. Audits and spot checks were thorough, and records demonstrated any issues identified were addressed. Staff told us they enjoyed working at the home. One said, “It's a brilliant place to work.” People who lived at the home told us they could raise any concerns and were listened to.

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 10 July 2021). We also carried out an inspection which focused on infection prevention and control and was unrated (published 9 February 2022).

Why we inspected

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 inspection was prompted in part due to concerns we received about food, care records, cleanliness, activities, training and staffing. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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

Follow up

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

We found the following examples of good practice.

Staff had received training on infection control and the safe use of personal protective equipment (PPE). The provider had an infection prevention champion in place to provide guidance and support to other members of the staff team, During the inspection we observed staff wearing PPE in accordance with government guidance. The home was clean. The provider had increased the working hours for domestic staff to enable them to undertake cleaning of high touch areas throughout the day. The provider had policies and procedures in place to support staff in safe working practices. The provider was supporting people to maintain contact with their relatives in line with guidance in place at the time of the inspection. They had encouraged families to nominate essential care givers who were able to continue to visit relatives living in the home during any outbreak of COVID-19. The service was meeting the requirement to check and log the fact that visiting professionals were vaccinated against COVID-19. The service participated in the regular COVID-19 testing programme for both staff and people living in the home.

Northwood Nursing & Residential Care is a residential care home providing personal and nursing care to 18 people at the time of the inspection. The service can support up to 27 people. The home is a detached building with accommodation provided over three floors. There is a passenger lift to help people mobilise around the building.

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

People who lived in the home told us they felt safe and that staff cared for them well. One relative had concerns about the care their relative received. We raised these concerns with the registered manager who told us of the action they had taken to help ensure the person concerned received safe care. They told us they had a plan to meet with the relative to further discuss their concerns. The other relatives spoken with gave positive feedback about the care provided in the home.

We were generally assured regarding the measures in place to protect people from the risk of cross infection. However, some areas of the home needed refurbishment and staff did not always wear or dispose of PPE correctly. The registered manager took immediate action to ensure these concerns were addressed. We have made a recommendation about this.

Arrangements were in place to enable people to safely receive visitors. Staff had been safely recruited and there were enough staff on duty to meet people’s needs in a timely manner. Medicines were safely managed and the provider had processes to record and investigate accidents and incidents to ensure lessons were learned.

Staff received the training, supervision and support necessary to provide people with effective care. Systems were in place for staff to monitor people’s nutritional needs. People told us they enjoyed the food provided for them. 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.

Care plans contained information on people’s health and communication needs as well as their family background, religious needs and social interests. Activities were available for people to participate in if they wished. The provider had a system to record and respond to complaints.

The provider had systems to assess and monitor the quality of the service. Although there had been several changes of manager since the last inspection, people spoke positively about the way the service was led and the approachability of the management team.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 August 2019). 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 regulations.

Why we inspected

We previously carried out an inspection of this service on 16 July 2019. A breach of legal requirements was found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

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 rating from the previous comprehensive inspection for the key question not looked at on this occasion was used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

Northwood Nursing and Residential Care is a residential care home and at the time of the inspection was providing personal and nursing care to 20 people aged 60 and over. The service can support up to 27 people.

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. In the area this home was located, these were commonly known as the 'Tier 3 Restrictions'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.

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

The service had robust measures in place around the use of personal protective equipment (PPE). Staff, management and visitors were using PPE correctly.

The provider and manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

People received their medicines as prescribed and aspects of medicines administration and storage were safe. At inspection, we found a delay in the administration of one person's medicines. This was as a result of misadministration by others before the person was admitted to the home. Although staff at the home spotted the issue, there was a lack of proactivity around ensuring the person received their medicines in a timely way.

Details of this can be seen in the 'Safe' section of this report.

Rating at last inspection

The last rating for this service was Requires Improvement (published 31 August 2019).

Why we inspected

We undertook this targeted inspection to check on whether medicines were being administered correctly and whether appropriate infection prevention measures were in place. The overall rating for the service has not changed following this targeted inspection and remains 'Requires Improvement'.

CQC have introduced targeted inspections to follow up on a Warning Notice or other 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.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Northwood Nursing and Residential Care on our website at www.cqc.org.uk.

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.

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

With the exception of one individual, people were very happy with the care and support they received in the home. They told us staff were kind, caring and respectful of them. Relatives also spoke positively about the care their family members received. Comments people made to us included, “‘The staff are wonderful and they appear to be very well trained”, “I am very safe here as I have no worries regarding any staff who look after me” and “I cannot speak highly enough of the staff; I cannot fault them. They will do anything for me to make me comfortable.”

One person told us they did not believe staff had acted promptly enough when they raised some concerns about their care. We did not find evidence to support this view although the manager was keen to identify any areas where care could have been improved.

Systems to ensure the safe handling of medicines were not sufficiently robust. This meant we could not be assured people had always received their medicines as prescribed. Staff had been safely recruited and there were enough staff on duty to meet people’s needs. Improvements had been made to the environment and measures to control the risk of cross infection since the last inspection.

The provider was in the process of moving to a new electronic care planning system. Staff used hand held devices to record the care they had provided to people. However, the records failed to show that people’s nutritional intake had been robustly monitored or that specialist guidance had been followed to reduce the risk of choking for one person. Staff received induction, training and supervision to help them deliver effective care.

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 told us the quality of food was good and they could have alternatives if they did not like what was on the menu.

Staff were observed to be kind, caring and respectful towards people. They demonstrated a commitment to providing high quality care and told us they would be happy for a relative to live in the home. Staff supported people to be as independent as possible.

An activity coordinator had been appointed since the last inspection. They had a programme of activities to reduce the risk of social isolation. People told us they were happy with the range of activities provided. Although people generally told us they received the care they needed, they were unaware of any care plans in place. The provider told us the new care planning system would better record people’s involvement in the care planning process.

Although the provider had systems in place to monitor the quality and safety of the service, these needed further improvement as they had not identified the issues we found regarding the safe handling of medicines. People had opportunities to provide feedback on the care they received. They were positive about the new manager and felt confident they would run the home well. Staff told us morale had improved since the last inspection.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 15 October 2018) at which time there were breaches of four regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had not been made in all areas and the provider was still in breach of one regulation. The service remains rated requires improvement. This is the second consecutive time the service has been rated requires improvement.

Why we inspected

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Northwood Nursing and Residential Care (referred to throughout the report as Northwood) is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. the Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

TOB Care Ltd is registered to provide accommodation at Northwood for up to 27 people who require support with personal care or have nursing needs. At the time of the inspection, there were 24 people accommodated in the home.

The service had a registered manager in place. A registered manager is a person who has registered with CQC 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. However, we were told the registered manager had taken the decision to step down from this role and was intending to de-register with CQC. A new manager had been appointed and had been in post for one month when this inspection was carried out. They told us they intended to apply to register as manager with CQC.

During this inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were not always provided with care which met their individual needs and preferences. The provider did not have effective systems for the safe handling of medicines and for identifying, handling and responding to complaints. The systems in place to monitor the quality and safety of the service were not sufficiently robust.

This was the first inspection for the service and the first time it has been rated as ‘Requires Improvement’. At the time of the inspection, the provider had already identified many of the issues we found and had put an action plan in place to improve the quality and safety of the service. However, this had not yet been embedded in the governance arrangements for the home.

Although there were systems in place to monitor the quality and safety of the service, these had not been effective; this had resulted in many of the shortfalls we identified during the inspection.

We found there was a culture in the home of staff doing things to people rather than checking this was what each individual wanted.

Some areas of the home, particularly the bathroom and toilets, were not clean. We have therefore made a recommendation in relation to infection prevention. Following the inspection the provider sent us evidence to show that sluice rooms had been refurbished.

We were told one person was at risk of wandering at night. Although there was an alarm on their door to alert staff if they left their bedroom, we were concerned this room was located very close to a door which opened directly onto a flight of stairs. We were also concerned that staffing levels at night, as well as the layout of the home, meant there was a risk staff would not be able to respond in a timely manner if the alarm was activated, placing the person at risk of falling down the stairs. Following the inspection we received evidence to show the manager had taken action to reduce the risk of people accessing the stairwell.

Safe systems were in place for recording the administration of oral medicines. However, some improvements were needed in relation to topical medicines and medicines prescribed ‘as required’. At the time of the inspection, storage of medicines needed to be improved to ensure it was safe. Following the inspection, the provider sent us evidence to show medicines had been moved to a larger and more secure room.

The complaints procedure was not sufficiently robust. We noted two concerns raised by people who lived in the home during residents’ meetings had not been recorded as complaints. We could not find any evidence that these concerns had been properly investigated to ensure people received safe and appropriate care.

People told us they did not always feel safe in the home; this was mainly due to the attitude of staff. The manager raised a safeguarding alert with the local authority after we informed them of concerns a person had raised with us about the way they had been treated by staff. Our observations showed staff did not always take the time to interact positively with people who lived in the home.The operations manager told us they were in the process of arranging communication training for all staff to help improve their interactions with people who lived in the home.

People who lived in the home gave us mixed feedback about staffing levels and the amount of time they had to wait for staff to respond to their requests for assistance. Some staff considered it could be difficult to meet all people’s needs in a timely manner due to the level of care many people required. The manager told us they were in the process of recruiting more staff to help ensure staffing numbers were sufficient to cover for leave and sickness.

People told us the quality of food was generally good. The manager told us they had plans to improve the quality of the dining experience for people who lived in Northwood.

Records showed all staff had completed the training courses considered as mandatory by the provider.

There was a lack of meaningful activity for people to maintain or improve their sense of well-being. The manager was in the process of recruiting an activity coordinator to improve the opportunities for people to engage in activities in the home.

Care records included an assessment of people’s needs and a series of care plans to inform staff about how these needs should be met and how any identified risks should be managed. However, care staff were not always able to speak confidently about people’s needs. In addition, people were unaware of their care plans and told us they had not been involved in any reviews of how their care needs were met.

We received mixed feedback from staff about the way the home was run. Some members of care staff told us they did not feel engaged with improvements the manager intended to make. However, we noted a staff meeting had been held to inform all staff of the changes the manager had identified as necessary.

The manager demonstrated a commitment to improving the quality and safety of the service. The provider had ensured the manager was provided with additional support from two area managers and a newly appointed operation's manager to drive forward the necessary improvements.