Archived: Northlands Care Home (Northumberland)

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.

We considered all the evidence we gathered under the regulation we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found;

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service safe?

We saw the maintenance issues identified at our last inspection had been addressed and necessary refurbishments made.

We found people living at the home were now protected against the risk of unsafe or unsuitable premises and the provider had taken steps to provide care in an adequately maintained environment.

Is the service effective?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service well led?

We found there was a manager in post, registered with the Commission in line with legal requirements.

The premises were warm and comfortable but were not always clean or appropriately maintained.

At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Staff responded promptly to requests for assistance.

People's personal records were accurate, fit for purpose and held securely. Other records were kept in an appropriate form.

We spoke with two people who used the service. One said 'I know what medicines I take and I always get them regularly'. The other person said 'Staff seem very confident when they handle my medicines, they know what I need'.

People were protected from the risks of inadequate nutrition and dehydration. People we spoke to told us that the food at the home was good. One person told us, 'It's a good menu here. I enjoyed it and ate it all.' Another person said, 'The food is ok. They cater for particular needs if you have them.'

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

There were not enough qualified, skilled and experienced staff to meet people's needs.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

People told us they were happy with the care and treatment. One person said, 'We get well looked after.' We considered that people experienced care, treatment and support that met their needs and protected their rights.

People told us that staff were efficient at administering their medication. One person said, 'I get my tablets given to me, so I don't need to worry.' We found that appropriate arrangements were in place to manage medicines.

People told us that there were enough staff to look after them. Two people told us they sometimes had to wait for attention. We saw staff giving people support throughout the visit. They did this in a calm, unhurried manner and responded to requests for assistance promptly. We concluded there were enough qualified, skilled and experienced staff to meet people's needs.

People told us they felt able to raise any concerns or comments about the service and that they had no complaints to make. We considered that people were made aware of the complaints system.