Northfield House

Updated 24 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Northfield House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in their latest provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 13 staff including the registered manager, the provider, deputy manager, 1 senior care staff, 3 care staff, 1 housekeeper, 1 chef, 1 maintenance worker and 3 agency staff. We also spoke with 2 representatives of the provider. We spoke with 9 people living at Northfield House and with 6 people’s relatives or representatives.

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 with us.

We reviewed a range of records. This included 4 people's care records and multiple medication records. We looked at 3 staff files in relation to recruitment and supervision. A variety of records relating to the management of the service, including governance systems, policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the registered manager and provider to validate evidence found. We sought feedback from 2 healthcare professionals.

Updated 24 January 2023

About the service

Northfield House is a residential care home providing care for up to 25 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 22 people using the service. People are accommodated in one adapted building.

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

The registered manager and provider had implemented new monitoring systems to continue to improve the quality of the service people received. While the new governance arrangements had brought about improvements, further improvement and time was needed to allow these systems to bring about and sustain good outcomes for all people.

People’s care records were not always current and reflective of their needs. The management team was aware of this shortfall and was taking action to improve people’s care records.

Whilst improvements had been made to promote people’s person centred care throughout the home, people might not have always received care which promoted their wellbeing and was personalised to their needs. People did not always benefit from fulfilling and stimulating engagement tailored to their needs.

People’s risks had been assessed and clear guidance was available for care and nursing staff to follow. Where people had specific healthcare needs, these were clearly documented.

The registered manager and provider were in the process of recruiting more staff to help drive the person centred culture they were embedding into Northfield House. While recruitment was ongoing the home was supported by consistent agency staff.

Improvements had been made in relation to people’s prescribed medicines. The management team had implemented new systems and had taken action to ensure people received their medicines as prescribed.

Systems were in place to ensure people were protected from the risks associated with their environment.

Staff supported people in the least restrictive way possible and in their best interests. Where people were living under Deprivation of Liberty Safeguards; staff understood the support they required.

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. We were assured the service were working in accordance with government guidance.

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 13 October 2022).

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, however the provider was still in breach of two regulations in relation to person centred care and good governance.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 24 and 25 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment), and a requirement notices in relation to Regulation 9 (Person centred care) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For the key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northfield House on our website at www.cqc.org.uk

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care and good governance in the Effective key question and Well-led key question, at this inspection.

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.