Northlands House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People received a safe service. There was a desire to learn from incidents and concerns in order to make the required improvements. Processes were in place to ensure relevant information was shared when people moved to and from other services. Staff worked with people to identify risks to them and to discuss how they wanted them to be managed. People were provided with the equipment they required for their safety. However, there was a lack of continuity in the information recorded across some people’s care records. Leaders were aware of this issue and the required work had been started but further time was needed for it to be completed. People spoken with did not all feel their call bells were always responded to promptly. Staff and leaders said there were sufficient staffing levels and demonstrated how staffing needs were assessed and monitored. Action had been taken to increase staffing at the times in the day when people’s needs were higher. We saw there were sufficient numbers of staff to provide people’s care without their care being rushed. Staff vacancies had been filled and the number of hours of staff were deployed was higher than the assessed level required for the home. Nurses had not all had the opportunity to set their annual objectives or to update their clinical skills this year. The new clinical deputy manager was working with them to address this need.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People said if they had experienced an incident, staff ensured their safety first and then informed their relatives. People told us of the actions staff had taken following incidents to reduce the risk of reoccurrence. These included providing people with additional equipment or staff support.

Staff said they were encouraged to report any safety issues, they knew how and to whom to report any concerns. Staff told us incidents were then investigated before outcomes and learning were shared with the staff team. Leaders informed us of an incident, which following investigation had resulted in both local actions, and the creation of a working group across the provider’s local homes in order to review processes and share learning.

There was a positive culture of safety and learning. The provider had processes to support both people and staff to raise any concerns, such as their complaints and speak up policies. Staff viewed incidents as an opportunity to put things right, to learn and to make any required improvements. Processes were in place to enable the cause of incidents to be identified. Leaders reviewed incident reports, there were also monthly and quarterly reviews of incidents to identify and address any emerging trends.

People and relatives confirmed when people had to be referred to external services, or were admitted to hospital, relevant information about their care was shared.

Staff told us they used an early warning system to identify and monitor people whose health was at risk of deteriorating. They demonstrated their understanding of how and when to use the system. This enabled staff to identify those at risk and respond promptly. Leaders told us there were daily staff shift handovers and heads of department meetings to share information about the needs of new people prior to their admission and updates when people returned from hospital and their needs had changed.

Professionals told us staff identified promptly if people needed to be referred to them and said staff followed guidance provided. A health care professional confirmed staff worked with them to address any issues.

When people had to be admitted to hospital by ambulance. Staff used the electronic care planning system to produce a “Hospital Pack.” This provided a summary of the person’s needs and information about how best to support them, ready to be sent with them. We saw a person needed to be admitted during the site visit and staff followed this process effectively. Processes were in place to ensure staff referred people to external professionals if required. We saw staff had access to professionals' pre-admission reports where relevant for people. This ensured staff were informed of key information, to enable them to plan the person’s care.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People felt safe and supported by staff to understand and manage risks to them. A person said, “They [staff] know what they’re doing. They’re well-rehearsed. I always feel safe. They know me well.” People said when risks to them were identified appropriate action was taken. A person said, “They [staff] make sure when I’m walking I have two carers with me.”

Staff told us they learnt about risks to people, from their care plans and meetings. They could also access relevant information via their handsets, which they used to record the delivery of people’s care. Staff knew people well and had a good understanding of risks to them. Staff said if people declined their care, they would respect their choice and try again later. Leaders told us when people arrived from hospital, they were often used to bed rails to manage the risk of them falling. Staff were working on reducing bed rail use by exploring with people during their pre-admission assessment if they needed them and by re-assessing people to identify whether bed rails were the least restrictive option for them or if the person preferred to use them.

We saw staff supported people safely and ensured they had the equipment they required to keep them safe. For example, people who were at risk of falling from their bed either had equipment in place to prevent them from falling, to limit the impact of a fall, or to alert staff if they fell. People who could mobilise independently or with the use of equipment did so. People who could feed themselves did so, which promoted their independence. Staff ensured people who required support to eat their meal were safely positioned and were provided with any equipment they needed before they assisted them. People were seen to have access to drinks. Staff discussed the management of risks to people such as from wounds at the heads of department meeting. This ensured potential risks to people were escalated to leaders and their management was discussed.

People’s records showed whilst a range of risks to them had been identified and assessed, there was a lack of consistency across the various parts of some people’s records. For example, a person’s records said they needed staff supervision to drink safely and then it said they could drink independently, which was contradictory. Another person’s records contained conflicting information both in relation to their Body Mass Index score and whether or not they had experienced recent weight loss. Their pressure ulcer risk assessment said they had not experienced weight loss, when their weight records showed they had. The information staff had used to assess risks to people was not always recorded consistently. However, leaders and staff were aware of this issue and work had recently started to review the entire content of each person’s care plan and risk assessments with them, to ensure the consistency and accuracy of records. It will take a further period of time to complete and embed this work.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Thirteen of the 25 people and relatives we spoke with provided negative feedback about staffing levels, 7 were positive and 5 did not express a view. People said their call bells were not always responded to quickly enough. People’s comments included, “We have one of these [call bell] and we press them. They [staff] don’t always come quickly” and, “They’re [staff] always seeing to someone else. There’s always someone in front and other people waiting.” People told us they had to wait for assistance to use the toilet and for drinks. However, the provider’s recent resident survey which included 62 responses, showed 97% of people had rated staff positively in terms of being available to them when they needed them. Overall people felt staff were competent in their role.

Leaders told us staffing levels were kept under constant review and were determined by on-going assessments of people’s care needs and their feedback. Leaders said following feedback earlier this year, a whole home staffing study had been completed. Following which additional staff had been deployed at specific times of the day when demand was higher, and changes had been made to the staffing skill mix. Leaders told us the home was staffed at a level higher than required by staffing assessments, which records confirmed. Staff said there were sufficient numbers of staff to provide people’s care. Staff did not feel people were left waiting for their care. Leaders said they were now fully staffed for nurses and only used agency carers to ensure they had a ‘buffer’ to enable them to cover staff sickness and holidays. We saw data which demonstrated the provider’s staff retention rates were high, which provided people with consistency of staff. Staff said they had supervisions, but these were not always regular. Staff still felt fully supported in their role and said they could speak to the manager at any time. Staff who required any additional support with their training needs said they were well supported. We saw new staff attending their induction programme and staff told us about the support they had received through their probation. The recent staff survey showed 80% of staff felt they had access to good career opportunities and 79% felt they received the feedback they needed to grow. The manager told us how staff in all roles were supported, from newly qualified nurses to staff who were completing apprenticeships or professional qualifications. Staff told us they had applied for and been selected to undertake nursing associate training with the provider, which is a pathway to becoming a professional nurse.

People’s call bells were in reach so they could alert staff. We saw staff were constantly going in and out of people's bedrooms. We could see there were enough staff on the floors, but they were not always visible, as often they were supporting people in their bedrooms. We observed staff to be busy in their work, but they did not rush people. Staff were seen to support people kindly and gently. There were sufficient staff to support people. At lunchtime, staff from all departments came and assisted people with their meals, either in the dining room or by taking trays to their rooms. Staff chatted to people as they supported them. At the daily meeting, heads of departments coordinated both information and people’s care across the whole home. There was discussion of how the maintenance team needed to work with staff to ensure people had the correct bed in place for their needs, in readiness for their admission. This showed how staff worked together effectively to ensure people’s needs were met.

Records showed not all nurses had completed their annual objective setting meeting or had a supervision in 2024. Not all nurses were up to date with their clinical skills training, to support them in their role and ensure their skills were updated. However, following the recent appointment of a new clinical deputy manager, actions were in hand to ensure this was addressed, but it will take further time to complete. The clinical lead was spending time on the floor working alongside the nurses to ensure they understood how they worked in order to support them effectively. Staff in other roles were up to date with their training and supervision requirements. Staff were recruited safely to their role. Leaders completed a weekly analysis of the longest call bell response times, in order to understand their cause and any impact upon the person. The analysis showed most call bells were responded to in a timely manner. Some bells had rung longer during 1 week, when some had got ‘stuck’ and could not be turned off, however, people had still been supported in a timely manner. Staff had then arranged for these to be reviewed by the system manufacturer. Leaders also made night checks, to ensure people's care was provided as planned and regularly reminded staff of the call bell policies.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.