Archived: Northgate House

Northgate House is a residential care home providing personal care to 31 people at the time of the inspection. The service can support up to 32 older people, some of whom may be living with dementia.

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

People were supported by staff who were caring and attentive. Staff were aware of risks to people’s safety and wellbeing and acted to minimise these. Staff followed appropriate safeguarding procedures to help protect people from harm. A range of infection prevention and control measures had been put in place in response to the coronavirus pandemic to help minimise risks to people, staff and visitors.

People received appropriate support with their nutritional needs and had access to the support of healthcare specialists if needed. People’s privacy and dignity was respected and they received appropriate support with their personal care and bathing needs.

Relatives were able to maintain contact with their loved ones throughout the pandemic, in line with national care home visiting guidance. The provider was exploring ways to expand the range of visiting options available over the winter months, if this could be achieved safely and in line with guidance.

Staff felt supported and relatives told us they had good communication with staff and the management.

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 31 July 2018).

Why we inspected

The inspection was prompted in part by notification of a specific incident where there were concerns about visiting arrangements. Some concerns had also been raised about risk management and support with nutrition and personal care. A decision was made for us to conduct a targeted inspection to examine those risks.

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

We also 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northgate House 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.

At our last inspection we rated the service Good overall, but Requires Improvement in the key question: Is the service effective? The was because the service was not meeting legal requirements in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

At this inspection we found the service had made significant improvement in this area and was now meeting legal requirements. The evidence from the inspection continued to support the rating of Good overall and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This inspection took place on 13 and 20 June 2018 and was unannounced. 29 people were using the service at the time of our inspection.

There was a registered manager in post. People, relatives and staff spoke positively about the management and leadership of the home.

People told us they felt safe living at Northgate House. Risks to people were assessed and managed. There were systems in place to protect people from the risk of harm or abuse. Medicines were stored, administered and recorded safely. The premises were clean and well maintained. The provider took action to address some minor infection control issues we identified on the first day of our inspection.

There were enough staff to respond to people’s needs in a timely manner. Appropriate checks had been undertaken before staff began work to ensure they were suitable to work in a care setting. Staff received an induction, training and supervision to give them the skills and knowledge for their roles.

The provider assessed people's needs in line with best practice. The environment had been planned with consideration of people’s needs. People were supported to receive a varied diet and sufficient to drink. Staff sought advice from healthcare professionals when they had any concerns about people’s health or well-being. This included supporting people to access the GP, community nurses and other specialists, such as the falls team.

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.

Feedback we received from people, relatives and visiting professionals showed us that staff were caring and treated people with dignity and respect. This was corroborated by the observations we made during our inspection. The interactions between staff and people who used the service were warm and friendly.

The provider had introduced a new care planning system and care plans were recorded electronically on this system. Staff also used this system to document the care they provided; this enabled the provider to monitor that the care delivered was in line with people’s needs and preferences. Care plan contained information about people communication needs, but we have made a recommendation about researching and implementing best practice in the provision of accessible information.

Some activities were provided at the home, and the registered manger had plans to increase the range of activities available by working with a local community scheme.

The provider had a complaints policy in place and people told us they would feel comfortable raising any concerns. There was a quality assurance system and audits to identify any issues and drive improvement. Some audits could be developed further to analyse aspects of the service in more detail, such as care records. We also found some policies needed updating and the provider told us they planned to complete a review of all policies and procedures. People, relatives, visiting professionals and staff were asked for their feedback in surveys. Comments in these surveys indicated there was a high level of satisfaction with the service provided.

Further information is in the detailed findings below.

Northgate House is a care home in Market Weighton, which provides care for up to 25 older people who may be living with dementia. At the time of our inspection there were 17 people using the service. Accommodation was on two floors and most of the upper floor was accessed by a chair lift. There was a registered manager for the service, but on the date of our visit the registered manager was on a period of extended leave, and an acting manager was overseeing the home. 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.

Mental capacity assessments and Deprivation of Liberty Safeguards (DoLS) applications had not been submitted to the local authority for everyone who we were told needed them and not all staff had completed training in the Mental Capacity Act (2005). The registered provider had started to complete mental capacity assessments and DoLS applications, but we have made a recommendation that the service acts promptly to complete these to ensure they are meeting all the requirements of the Mental Capacity Act (2005). This was a breach of Regulation 13(5) of the Health and Social Care Act 2008 (Regulated Activities) Regulations.

We found that the provider had robust recruitment processes and completed appropriate checks before staff commenced employment. There were sufficient staff to meet peoples’ needs.

The provider had a safeguarding policy in place and we were told this would be updated. Staff were aware of the signs of abuse and knew how to report this. People who used the service felt safe at the home and were confident that they would not be harmed.

The provider completed assessments to identify potential risks to people using the service and risks to staff. The risk assessments we saw were reviewed monthly and were up to date.

The provider had a system for recording and responding to accidents and incidents. There had been a significant number of falls at the home over the previous year, but we saw the provider had completed comprehensive risk assessments and implemented measures to minimise the risk of falls occurring. Specialist guidance and support had also been sought from the falls prevention team and physiotherapists for individuals where this was required.

We saw evidence that people using the service signed their care plans and staff demonstrated an understanding of the importance of gaining consent before providing care to someone.

The decor in the home was tired and the building was in need of renovation to improve the environment for older people including those with dementia. The registered provider was fully aware of the issues with the decor and layout of the building and told us they had plans for extensive refurbishment and re-design of the premises. We have made a recommendation that the provider commences their planned renovation work at the earliest opportunity, taking steps to improve the design and decoration of the premises in line with the needs of people using the service.

People were supported to maintain good health and to access health care services when they needed them. Visiting healthcare professionals commented positively about the care provided by staff at the home. People were also supported well with their nutritional needs.

People using the service told us that staff were kind and caring, and the interactions we observed were positive, friendly and respectful.

Most people we spoke with felt they had choice and control about their care and that staff respected their wishes. Care files demonstrated the involvement people wished to have in their care planning. Peoples’ privacy and dignity was also respected.

Everyone using the service had a care plan and we saw that these were detailed, person centred and had been reviewed regularly. Staff demonstrated a good knowledge of peoples’ needs.

There were opportunities for people to comment on their experience of the service, as we saw evidence of regular residents’ meetings and satisfaction surveys. There was also a complaints procedure and people knew how to complain.

Staff received an induction, training, supervision and appraisals. Staff meetings were held and staff told us they felt supported by the management.

There were a range of quality assurance audits in place, and regular equipment and environmental checks; most of which were accurately completed.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were safely cared for according to their individual care plans and staff followed safe practices with regard to mobility and providing personal care.

The service was providing a safe standard of infection control within the constraints presented by the building and staff were following some good hygiene standards.

We found that the systems in use enabled suitable and safe recruitment of staff, so that people were only cared for by reliable staff that were considered to be suitable for the caring profession.

Is the service effective?

People were effectively cared for and supported by staff that had received relevant training and achieved appropriate qualifications to do the job. Staff looked competent to do the job.

Is the service caring?

We saw that staff were kind, caring and considerate. Staff spoke with people to explain how they wanted to help and why, but they also ensured peoples' dignity was upheld by maintaining discretion.

People said, "The staff are respectful towards me and look after me in a way that I want them to" and "I've been here four years and the staff are very good to us."

Is the service responsive?

People were assisted with their care and support in a way they wished to be. Staff said, "Before assisting someone with their personal care I always ask what they would like me to do and then I try to do it as well as they expect", "I try to give the care that people want, making sure their choices are followed" and "I offer people their independence in all aspects of their daily lives."

Is the service well led?

We looked at two peoples' care files and saw they were organised into sections, which contained information on individuals' needs and the care and support they required. Care plans included information on how best to support people with those care needs.

People that used the service and their relatives experienced opportunities to make their views about the service known and there were systems in place to check on the service performance, so that improvements could be made.

The service was well led because there were strategies in place to ensure care plans were followed and people could have an input into the way the service developed.