Archived: Northwood Nursing & Residential Care

This comprehensive inspection was carried out to check that the provider had met the requirements of the warning notice regarding the management of medicines and to check that all other required regulations were being met.

Northwood is registered to provide accommodation for up to 27 older people who require support with nursing or personal care needs. At the time of our inspection there were 23 people using the service.

The service had a registered manager in place who was also one of the two providers of the service. 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. The registered manager was supported in the day to day running of the service by a care manager and deputy manager.

We found improvements had been made to the way medicines were administered in the service. However, we observed poor medicines administration practice on the first day of the inspection. This was because the nurse on duty administered medicines to several people without checking and completing the medicines records at the time of administration to each person. The nurse told us that this was because it was difficult to get the medicines trolley to the rooms at the top of the home. Following the inspection the registered manager told us they had arranged for individual medicines cabinets to be fitted in the bedrooms which could not be reached by the medicines trolley; this should help reduce the risk of mistakes occurring.

Protocols were in place providing guidance for staff about the use of ‘when required’ medicines but these could be further individualised. However, an epilepsy care plan for one person did not refer to a medicine that may be needed if they had a seizure. The date a medicine administered by the district nurses was next due had not been recorded. This meant nurses at the home would not be able to follow this up if a dose was missed, or for example if that person was admitted to hospital.

The lack of robust systems to ensure the proper and safe management of medicines was a breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We received conflicting information about staffing levels in the service. Our observations on the first day of the inspection showed staff were unable to respond promptly to two people’s requests for assistance. However, we were told this was partly due to our presence in the service. On the second day of the inspection we noted there was an additional member of staff on duty. This meant staff were able to spend time with people and respond to their requests for support in a timely and unhurried manner.

The provider had recently introduced an electronic system to record the care people required. Risk assessments were in place in relation to physical and mental health needs as well as any environmental risks; these helped to protect the health and welfare of people who used the service. Although all risk assessments had been regularly reviewed and updated, we noted that hard copy care records did not always contain the most up to date information. The registered manager told us they would take immediate action to ensure all hard copy care records reflected the most up to date information which was contained on the electronic care records.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. All the staff we spoke with were able to tell us the correct action they should take if they witnessed or suspected abuse.

All areas of the home were clean and we saw that procedures were in place to prevent and control the spread of infection. During the inspection we observed staff used personal protective equipment (PPE) when carrying out care tasks.

We saw that the equipment and services within the home were serviced and maintained in accordance with the manufacturers’ instructions. This helped to ensure the safety and wellbeing of everybody living, working and visiting the home. Systems were also in place to deal with any emergency that could affect the provision of care such as utility failures. Regular checks were in place to ensure staff were aware of the action they should take in the event of a fire at the service.

Staff told us they received the induction, training and supervision they required to be able to carry out their role effectively. We noted the registered manager regularly submitted information regarding the training staff had completed to the NHS commissioning unit. However, there was no central training matrix held within the home. The registered manager told us that they would ensure they maintained a more detailed central record of staff training. Such records are important to highlight when staff refresher training is due.

People told us they were always asked for their agreement before staff provided any care. Comments people made to us included. “I make all my own choices” and “The staff always ask me if I want a shower and give me the help I need.” One staff member told us how they used ‘flash cards’ to gain the consent of a person who had limited verbal communication. The registered manager was aware of their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); to ensure that people’s rights were upheld.

Systems were in place to help ensure people’s health and nutritional needs were met. People made varying comments about the food provided in Northwood. During the inspection we observed meals were well presented and nutritionally balanced. Staff provided individual support to people who required assistance to eat.

Most people who used the service spoke positively about the caring nature of staff. The visitors we spoke with told us they always observed staff to be kind, caring and respectful. The staff we spoke with had a good understanding of the care and support that people required. They demonstrated a commitment to providing high quality, person-centred care.

A programme of activities was in place to help stimulate people and maintain their contacts within the local community.

Records we reviewed showed people had opportunities to comment on the care provided in Northwood. All the people we spoke with told us they would feel confident to raise any concerns with the staff and registered manager.

Staff told us they enjoyed working in the service and received good support from both the registered manager and senior staff. Staff meetings provided staff with an opportunity to comment on the service provided and to suggest any improvements they felt could be made.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided. There were systems in place for receiving, handling and responding appropriately to complaints. Our discussions with the registered manager showed they were committed to driving forward improvements in the service.

We reviewed the care files of six people who lived at Northwood. We found evidence that there were systems in place to record the decisions people were able to make for themselves. Staff told us they understood the need to seek consent from people before providing any care or treatment.

We saw that care plans clearly identified the needs of the person and included information on how they wished their care to be delivered. We found evidence that care plans included guidance for staff about the need to promote independence and choice for people living in Northwood wherever possible.

We found the premises were safe and secure and had been decorated and maintained to a high standard. All the people we spoke with told us they felt safe and comfortable within the home.

We spoke with four members of staff who told us they felt well supported and confident in carrying out their responsibilities. We saw evidence that staff were appropriately qualified and provided with regular training opportunities.

We found that suitable arrangements were in place to manage an effective complaints process for identifying, receiving and handling complaints for people in Northwood.

We found that records were being maintained appropriately. This meant that people were protected from the risks of unsafe or inappropriate care.