Northfield Nursing Home

Northfield Nursing Home is a care home that provides accommodation and nursing care for adults with a range of care and support needs, including adults who are living with dementia. The home can accommodate up to 63 people in one adapted building. In addition to nursing care, Northfield Nursing Home provided intermediate care and rehabilitative care. Intermediate care is typically short-term reablement support from a range of external professionals to help people recover and increase their independence. At the time of inspection there were 28 long-term placements and 11 intermediate/rehabilitative care placements.

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

Since our last inspection the provider had made improvements in the management of medicines. Medicines were managed safely, and staff involved in the management of medicines had been assessed as competent to support people with their medicines.

People were safeguarded from the risk of abuse. Risks in relation to people's care were identified and risk assessments detailed information about how risks could be mitigated. The home was clean, and people were protected from the risk and spread of infections. There were enough staff available to assist people to meet their needs in a prompt way. Accidents and incidents were recorded and analysed to identify any trends or patterns. This helped to mitigate future risks and ensured lessons were learned. The provider had a safe recruitment process which assisted them in recruiting suitable staff.

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 were happy with the food provided, with choices available at each mealtime, along with snacks in between. The building was adapted to meet people’s individual needs, there had been redecoration and refurbishment of the building since our last inspection. The home was clean and bright throughout.

The management team carried out regular audits to ensure the quality of the service was maintained. The management team took appropriate actions to address any issues. People, their relatives and staff had confidence in the management team and felt they were approachable.

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 good, (published 31 March 2022).

At our last inspection we recommended that minor improvements were needed to ensure people’s medicines were managed safely. At this inspection we found the provider had acted on these recommendations. Medicines were managed safely, and staff involved in the management of medicines had been assessed as competent to support people with their medicines.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 remained good 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 Nursing Home 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.

Northfield Nursing Home is a care home that provides accommodation and nursing care for adults with a range of care and support needs, including adults who are living with dementia. The home can accommodate up to 63 people in one adapted building. In addition to nursing care, Northfield Nursing Home provided intermediate care. Intermediate care is typically short-term reablement support from a range of external professionals to help people recover and increase their independence. At the time of inspection there were 20 long-term placements and 22 intermediate care placements.

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

People told us they felt safe living at the home. People received support from a staff team who were recruited safely and knew how to safeguard people from the risk of abuse. There were enough staff to ensure people’s needs were being met in a timely manner, though some staff said the regular use of agency staff meant providing good continuity of care was often difficult. The manager said recruitment was ongoing and they were looking at creative ways to decrease the service’s use of agency nurses, such as recruiting from overseas. People’s medicines were mostly well-managed, with further minor improvements needed to ensure practices were consistently safe. Despite our findings around medicines, this did not appear to impact people living at the home. Infection prevention and control measures were in place and people told us the service welcomed visits in the home.

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’s healthcare needs were being met. Referrals had been made in a timely manner to professionals when any issues had been noted or concerns raised. Equipment was in place to support people to stay well. People were happy with the food provided, with choices available at each mealtime, along with snacks in between. The building was adapted to meet people’s individual needs, though some parts of the building were beginning to show signs of wear and tear.

The home used a range of systems and processes to monitor the quality and effectiveness of the service provided. Due to our findings around medicines, we asked the manager to review their audit process to ensure it was robust enough to identify the same issues found at inspection. We also asked the manager to consider formalising their improvement plans for the home’s environment in writing, so these actions can be monitored and reviewed at appropriate intervals. The provider regularly sought feedback from people and staff, in order to continuously drive improvement.

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 25 August 2017).

Why we inspected

We received concerns in relation to following current guidance on visits in care homes. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe section of this full report.

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.

We found the following examples of good practice.

The premises were clean and well-maintained. Staff followed cleaning schedules to ensure all areas of the home were regularly cleaned, including high touch areas such as door handles and light switches.

Staff had received training in infection prevention and control, including how to put on and take off their personal protective equipment (PPE) in a safe manner. Staff were also observed completing this to ensure they were competent.

We observed staff changed PPE when appropriate, and staff regularly washed and sanitised their hands.

People’s rooms were individual and they all had en-suite facilities so people could be safely isolated if they became infectious.

Tests for COVID-19 were being carried out in line with good practice guidance, where possible.

The provider had built a visiting pod on the grounds of the home. Visits to the home were restricted at the time of this inspection, in accordance with local infection control guidance. During this time staff were supporting people to stay in contact with their relatives and friends via the telephone.

There was a manager at the service who was registered with Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Our last inspection at Northfield took place on 9 May 2016. We found two breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in regard to Regulation 18: Staffing and Regulation 11: Consent. The registered provider sent an action plan detailing how they were going to make improvements. At this inspection we checked improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of Regulation 18: Staffing, as staff had been provided with an annual appraisal in line with the registered providers policy. We also found sufficient improvements had been made to Regulation 11: Consent, as records were in place to show the registered provider complied with the requirements of the Mental Capacity Act 2005.

This inspection took place on 31 July 2017 and was unannounced. This meant the people who lived at Northfield and the staff who worked there did not know we were coming. On the day of our inspection there were 57 people living at Northfield.

People spoke positively about their experience of living at Northfield. They told us they felt safe and they liked the staff.

Staff were aware of safeguarding procedures and knew what to do if an allegation was made or they suspected abuse.

We found systems were in place to make sure people received their medicines safely so their health was looked after. Some medicines storage required improvement, which was rectified on the day of our inspection.

We found one area of the home presented a possible falling hazard. This area was made safe on the day of our inspection.

We found two plastic bedrail bumpers were torn which could compromise infection control. Staff had identified this and replaced the bumpers during our inspection.

Staff recruitment procedures ensured people’s safety was promoted.

Sufficient numbers of staff were provided to meet people’s needs.

Staff were provided with relevant training, supervision and appraisal so they had the skills they needed to undertake their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

A programme of activities was in place so people were provided with a range of leisure opportunities.

People said they could speak with staff if they had any worries or concerns and they would be listened to.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

There was a registered manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Northfield is a care home providing personal and nursing care. Accommodation is provided for 57 people. The home is situated in the residential area of Crookesmoor in Sheffield. It is close to the main bus route and is a short walk away from the local shopping area. The home is purpose built with accommodation provided on two floors, which are accessed, by a lift. The gardens are landscaped and outside patio areas are easily accessible. There is a small car park.

Within Northfield there was the provision of 33 Intermediate Care beds based on a separate floor. People received rehabilitation and enablement support from Sheffield Teaching Hospitals physiotherapists and occupational therapists. Peoples nursing and personal care needs were met by the nurses and care staff of Northfield. The unit had support from a GP, in relation to people's medical needs. Peoples stay varied from 21-35 days before discharge. In addition, Northfields provided permanent accommodation for up to 24 people. At the time of this inspection 22 people were living at the home on a permanent basis.

We spoke with 10 people who used the service and friends or family members, who were visiting at the time. We spoke with the registered manager and seven members staff .We also met a quality assurance manager and the training manager and spoke with three health professionals who were visiting the home during our inspection. We looked at documentation relating to people who used the service, staff and the management of the service. We looked at four people’s written records, including the plans of their care.

People we spoke with told us staff were very nice and easy to talk to. One person told us, “I am delighted with the home.” A relative told us, “I have no worries about this place” another relative told us “There seems to be the right numbers of staff and they seem to be well trained.”

Assessments had not always been completed regarding a person’s capacity to consent to care and treatment, or records to demonstrate that ‘best interest’ decisions made on a person’s behalf were appropriate. Improvements needed to be made in the way the provider complied with the requirements of the Mental Capacity Act 2005.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people

People had individual personal plans that were centred on their needs and preferences and had a good level of information, which explained how to meet each person’s needs.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action to safeguard people from abuse.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink.

There were limited activities available. Both the people living at Northfields and relatives told us they would like more activities to be available.

We saw that staff were respectful and made sure people’s privacy and dignity was maintained.

People said they felt comfortable to raise any concerns with staff. The service learned from incidents and from people’s feedback and used this as an opportunity for improvement.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Some people living at the home had complex needs and were not able to verbally communicate their views and experiences with us. Due to this we sat in communal areas of the home, observed care practices and saw how staff interacted with people. We saw that there was clear and respectful communication between staff and people. Staff treated people in a kind, considerate and empathic manner.

Records checked showed that before people received any care, support or treatment they and/or their advocates were asked for their consent and the staff acted in accordance with their wishes.

We found that people's needs were identified in care plans. People told us that they had regular access to healthcare professionals.

We found the home had systems and processes in place to ensure the safe administration of medications.

We found there were effective recruitment and retention processes in place.

We found that a complaints policy and procedure was in place. All of the people and their visitors we spoke with said they had no complaints or concerns about the home.