Background to this inspection
Updated
27 May 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 7 and 11 April 2016 and was unannounced. It was carried out by one adult social care inspector and a specialist advisor. A specialist advisor is a person employed by the Care Quality Commission to support inspectors during an inspection and have specialist knowledge in a certain area. The specialist advisor during this inspection was a registered nurse with experience of working with older people.
We displayed a poster to inform people that we were inspecting the service that day and invited them to share their views.
We spoke with eight people who lived at the service and two relatives during our inspection. We spoke with local authority contracts and safeguarding officers. They told us that they were not aware of any current concerns about the service and there were no ongoing safeguarding investigations.
We spoke with a community matron and a nurse from the challenging behaviour team who visited the service regularly.
We spoke with the registered manager, deputy manager (also a registered nurse), activity assistant and four care workers on the day of our inspection. We also spoke with kitchen and domestic staff.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk to us.
We looked at the care records of eight people using the service, and four staff recruitment files. We also reviewed safety and maintenance records and records relating to the management of the service.
Prior to the inspection we reviewed all of the information we held about Northlands including any statutory notifications that the provider had sent us and any complaints we had received. Notifications are made by providers in line with their obligations under the Care Quality Commission (Registration) Regulations 2009. They are records of incidents that have occurred within the service or other matters that the provider is legally obliged to inform us of. We took this information into account when planning our inspection.
We did not ask the provider to complete a Provider Information Return (PIR) before this inspection. This is a form that asks the provider to give some key information about the service, ‘what the service does well and improvements they plan to make’
Updated
27 May 2016
Northlands is situated in a residential area close to the centre of Morpeth. The service provides accommodation and personal care, including nursing for up to 35 people some of whom are living with dementia. On the day of the inspection there were 29 people using the service.
The inspection took place on 7 and 11 April 2016 and was unannounced. At the last inspection on 22 and 24 October and 3 November 2014, we found two breaches in regulations we inspected at that time, Regulation 13 medicines, and Regulation 20 record keeping. We asked the provider to take action to make improvements. At this inspection we found that appropriate action had been taken in relation to both breaches.
A registered manager was in post. 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 told us they felt safe and there were policies and procedures in place relating to the safeguarding of vulnerable adults. Staff were clear about the action they would take if abuse or neglect was suspected.
Medicines were managed safely. The service was changing pharmacy provider due to some quality issues which they felt compromised their ability to respond quickly when medicines were added to a prescription.
Safe recruitment procedures were in place. Checks had been carried out by the Disclosure and Barring Service. DBS checks ensure staff working at the home have not been subject to any actions that would bar them from working with elderly or vulnerable people.
Suitable numbers of staff were on duty during the inspection. Staff told us they found their work easier due to a slightly reduced number of people living at the service at that time, and a reduction in the dependency levels of people. The registered manager told us that staffing would be adjusted in response to any increase in numbers and complexity of people's needs.
Risk assessments in relation to the physical and psychological needs of people were in place. Some risk assessments lacked detail in relation to particular conditions and the nurse said they would amend these to provide more specific instructions to staff. There were audits relating to clinical safety including wound and catheter care audits and the safety of equipment was also checked.
Accidents and incidents were recorded and analysed for any trends or concerns by the registered manager. Serious accidents had been notified to the Care Quality Commission (CQC) in line with legal requirements.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The registered manager had submitted DoLS applications to the local authority for authorisation. A list was available of applications that had been authorised, those awaiting authorisation and those due to be resubmitted upon expiry. Consent to treatment policy was available and where people lacked capacity, best interest’s decisions were appropriately recorded.
People were supported with eating and drinking and told us they enjoyed the meals. Assessments were carried out to identify any dietary problems and care plans were in place to address these.
Staff told us they felt well supported and records confirmed they received regular training, supervision and appraisals. This meant their development and support needs were met.
People had access to a range of healthcare professionals. Nursing care was provided and advice sought from appropriate specialists where necessary.
We observed that staff were caring. We saw that staff spoke kindly to people and were respectful and courteous. People and relatives told us that staff were caring. Privacy and dignity were promoted and confidentiality of information was maintained.
Person centred care plans were in place which took into account people's personality, behaviour, likes, dislikes and previous experiences when planning care.
A complaints procedure was in place and we saw that records of these had been kept including copies of responses by the registered manager and actions taken to prevent reoccurrence.
The quality of the service was monitored and the views of people, relatives and staff were sought through regular meetings and customer satisfaction surveys and audits. Staff and relatives told us they thought the service was well led.