Archived: Northleach Court Care Home with Nursing

Northleach Court Care Home with Nursing is better known as Northleach and will be referred to as such throughout this report.

Northleach is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Northleach accommodates up to 40 people in one adapted building. There were 32 people at Northleach at the time of the inspection.

There was a registered manager in post at 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous inspection was completed in February 2018. We identified four breaches of regulation at that time in relation to person centred care, the premises, staff training and good governance. At this inspection we found the provider had made improvements and met the requirements of the regulations. However, more time was needed for the planned improvements to the premises to be completed and the provider’s quality assurance systems needed to ensure these works were completed.

The provider told us they were due to retire and Northleach was due to be sold. The provider had informed all people living at the home, their relatives and staff of the proposed plans. Following the previous inspection, we met with the provider and asked the provider to complete an action plan to show what they would do and by when to improve the key question Well-led to at least ‘Good’ As requested the provider had sent us a written report of the action they planned to take to achieve a rating higher than 'Requires Improvement' to support us to monitor the provider's planned improvements. Significant improvements had been made since our last inspection but improvements to the premises were still required.

At this inspection the registered manager showed us the home’s maintenance plan, they informed us they were currently working through this plan. A number of actions to ensure the safety of the service had been carried out such as some external building work. However, some areas of the home needed refurbishment and could place people who mobilise at risk of slips or falls and still needed to be completed.

There were enough staff deployed to ensure the safety of people. Since our last inspection, the registered manager and provider had taken action to implement two separate care units. This meant staff worked on each unit developing familiarity with the people they assisted. The home had a calm atmosphere. However, during the morning, we identified that some staff were busy and not always available to spend time with people and more staff were being deployed during the morning.

Medicines were managed safely and people received their medicines as prescribed.

Health and safety checks were carried out regularly to ensure the service was safe for people living there.

Risks to people’s health and wellbeing had been identified and assessed. These risks included areas such as moving and handling, mobility, agitation, nutrition and hydration. Assessments were completed where appropriate for people at risk.

The service had implemented a robust training matrix which detailed all staff training and dates of expiry. People were supported by staff who had the skills and knowledge to meet their needs.

People and relevant professionals were involved in planning their nutritional needs. People’s health was monitored and healthcare professionals visited when required to provide support to help meet people’s health needs.

We found the service was working within the principles of the MCA and DoLS legislation.

The service was caring. Care records contained the information staff needed about people’s significant relationships including maintaining contact with family. All of the relatives we spoke with told us they were able to visit when they wanted to and were made to feel welcome by the staff that were on duty.

The service had implemented more robust monitoring systems and the registered and quality assurance manager were responsible for completing regular audits of the service. These audits had resulted in significant improvements being made.

Northleach Court Care Home with Nursing is better known as Northleach and will be referred to as such throughout this report.

Northleach is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Northleach accommodates up to 40 people in one adapted building. There were 35 people at Northleach at the time of the inspection.

There was a registered manager in post at 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous inspection was completed in April 2017 and rated Requires Improvement overall. There was one breach of regulation at that time in relation to management of fluid thickening agents. We found the provider had met the requirements of the regulation breached during this inspection. However we found new concerns in relation to staff support, the environment, care planning and quality assurance systems.

Northleach has been inspected four times since it was registered under the Health and Social Care Act in 2010. Three consecutive inspections, including this one, have identified breaches of regulations. We have again rated the service as Required Improvement overall. We have rated the question is the service well-led? as Inadequate as the provider had not demonstrated they were able to consistently meet the requirements of their registration to meet the regulations since November 2014. This had placed people at risk of receiving care that required improvement over a period of time.

We carried out this inspection as concerns had been raised by a health professional in December 2017 in relation to the premises and equipment, care records, medicines and staffing ratios. These had also been shared with the local authority. We therefore reviewed these areas.

Some governance and monitoring systems had been established in the service but these were not effective in identifying and rectifying shortfalls. The service had a quality assurance manager who visited the service every month. Both the quality assurance and registered manager completed various audits however; these had either not identified or ensured prompt action was taken to address concerns in relation to the environment, staff training and care planning.

Staff had not always received training appropriate to their role and the effectiveness of staff training had not been assessed. Staff supervisions were being completed however these were brief and staff appraisals had not been completed to evaluate staff performance.

Improvements were required to ensure people’s care plans and associated documents were person centred and clearly reflected all their needs, wishes and preferences. End of life care planning required reviewing to ensure people’s care plans clearly detailed their individual needs to support staff to inform specialist health professionals of people’s wishes and preferences at the end of their life.

Where identified, risks to the health and safety of people had been managed. Some improvement was needed to ensure risk management strategies were put in place when people accessed the community. We made a recommendation to support the provider to make this improvement.

Areas of the home were in need of decoration and were not always clean.

There was conflicting information about whether there were sufficient numbers of staff working at Northleach. Some improvement was needed to ensure staffing levels would be promptly reviewed when people’s needs changed.

There was a robust recruitment process to ensure suitable staff were recruited. People told us they felt safe.

People we spoke told us they felt more than happy with the care provided whilst others felt improvements could be made. We saw staff treating people with dignity and respect and ensuring people were warm and comfortable.

People were sometimes supported to participate in meaningful activities. People we spoke with told us the staff were caring and kind.

There were positive comments from people, relatives and staff regarding the registered manager.

Medicines were managed safely and people received their medicines as prescribed.

Health and safety checks were carried out regularly to ensure the service was safe for people living there.

People and relevant professionals were involved in planning their nutritional needs. People could choose what they liked to eat and drink. People’s health was monitored and healthcare professionals visited when required to provide support to help meet people’s health needs.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of the report.

Northleach Court Care Home provides accommodation and personal care for up to 40 people. On the day we visited 31 people were living there. The home accommodates people living with dementia and provides nursing care and end of life care. The home is a converted ‘listed’ building and has a passenger lift to reach the two floors where people are accommodated. There was a registered manager. 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.

There were three breaches of legal requirements at the last inspection in August 2016. Following this inspection the provider sent us an action plan detailing how they would address the shortfalls that had been identified. At our comprehensive inspection on 25 and 26 April 2017 the provider had mostly followed their action plan with regard to the risks associated with using incorrect equipment for hoisting, unsafe infection control procedures, unsafe management of medicines, insufficient staff and incomplete care plans.

People’s dietary requirements were met. However people who required food thickened fluids were not adequately provided for to ensure there was no risk to their health. There was a choice of meals and people were assisted with their meals when required. People and one relative told us they liked the meals provided.

Recruitment procedures were not as robust as they could have been when there was missing information to help ensure suitable staff were recruited. We have made a recommendation that the service consider current legislation on the safe recruitment of staff.

There had been improvements in additional staff provided since the previous inspection. People needs were usually met by sufficient staff but further improvements may be required to always ensure staff are available for people. We made a recommendation about always ensuring there are sufficient staff to promote people’s health and wellbeing.

Peoples care plans did not provide sufficient detail. There was insufficient guidance to support people living with dementia. Some care plans had improved since our last visit in August 2016 but guidance for staff regarding people’s individual needs when they were living with dementia was not detailed enough. We have made a recommendation the care plans for people be more personalised.

We checked whether the home was meeting the legal requirements of the Mental Capacity Act 2005. People’s mental capacity was assessed and best interest records were recorded to ensure people were protected when they were unable to make some decisions.

People’s medicines were managed safely to ensure treatment was effective. Medicine administration records we saw were completed accurately with no gaps in recording. Medicines were audited on a monthly basis with findings recorded and action taken.

People were treated with compassion and kindness but more individual engagement with people would improve their wellbeing. People and their relatives told us the staff were kind and caring. People were safeguarded from abuse as staff were trained to recognise potential abuse and to report any abuse. Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. People and their relatives told us they felt the service was safe.

People took part in more activities and the new activity organiser had made some improvements in people’s individual engagement. There was a weekly plan of organised activities people could join in with for example; ball games, playing percussion instruments, quoits, skittles, cookery, visits by the therapy dog, nail pampering and reminiscence.

Regular resident/relative and staff meetings took place and enabled everyone to have their say about how the home was run. Relatives told us the registered manager was approachable and listened to any concerns they had. Complaints raised had been investigated and responded to appropriately. Improvements to the service had been made as a result of the findings of the complaints; these included a bath audit, staff meetings, night visits by management and monitoring of the recording of meals.

Quality assurance procedures could be improved to ensure the shortfalls we found were addressed. The registered manager was approachable with relatives, staff and people.

We found one breach 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.

Northleach Court Care Home provides accommodation and personal care for up to 55 people. On the day we visited 28 people were living there. The home accommodates people living with dementia and provides nursing care and end of life care. The home is a converted ‘listed’ building and has a passenger lift to reach the two floors where people are accommodated. There was a registered manager. 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.

There were one breach of legal requirements at the last inspection in August 2015. After the focused inspection the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach. We checked and the action had been completed.

People were not protected from harm when incorrect equipment was used to hoist them. People did not have individual hoist slings that were the correct size for them. Infection control guidelines were not followed and some areas of the service were not clean. Improvements were needed to the environment to ensure peoples safety and provide a pleasant home that met people’s needs. .

People’s care and support needs were assessed to monitor the staffing levels required but there was insufficient staff. There was no activity person to ensure people had enough activities they liked and individual engagement. Staff completed some activities with people but they were very busy. The provider agreed to employ additional care staff and recruit an activity coordinator.

People’s medicines were not always managed safely to ensure people were receiving medicines correctly. Medicine management was regularly audited but improvements were not always sustained. Peoples care plans did not provide sufficient detail. There was insufficient guidance to support people living with dementia. Care plan reviews were incomplete.

People told us the food was alright and there was a choice of meals. They had home cooked cakes and snacks were always available. People at risk nutritionally were monitored and appropriate meals and drinks were provided.

People were treated with kindness and they told us staff were good when they supported them with their care. Staff knew how people liked to be supported. People told us they felt safe in the home. Staff knew how to keep people safe and were trained to report any concerns. People were supported by staff that were well trained and had access to training to develop their knowledge.

The registered manager and the providers representative monitored the quality of the service with regular checks. People and their relative’s views and concerns were taken seriously. They contributed in regular meetings and were provided with a record of the meetings. Staff meetings were held and staff were able to contribute to the running of the home.

We found 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.

A member of the public contacted us. They told us they had looked around the home with the possibility of a relative moving in. They said they found the home to be untidy with a smell of urine. They said that people were unkempt and saw a person being assisted with their meal inappropriately, with no engagement from the staff member assisting them. This was the reason we brought forward our inspection.

We found that there was information available for people and visitors to the home. Whilst some people looked smart, there were others who looked untidy. We brought this to the attention of the manager. We saw people being supported appropriately with transfers and at lunchtime. Arrangements were in place to monitor people's nutritional intake. The home was clean and tidy and smelt fresh and there were arrangements in place to minimise the risk of infection. There were enough staff on duty to support people with their care needs. A range of activities were provided.

We spoke with the relatives of three people. One of them said they were happy with their mother's care. Another relative said that they felt the home was 'brilliant' and they 'haven't got a bad thing to say about the home'. They said 'nothing is too much trouble' and 'staff had taken the time and learnt how to support their relative'. Other visitors were happy with the care provided. They all knew how to complain and said they would do so if they had cause.

Staff we spoke with were happy in their work. They showed fondness towards the people they cared for and engaged with them at all times. Staff told us they felt supported and praised the manager for their contribution to the running of the home and the support they gave them. Relatives we spoke with said the manager 'is lovely'.

We saw the arrangements in place to enable people to consent to care and treatment. People confirmed that they always gave consent and knew how to complain. Staff told us about the choices offered to people.

People's needs were assessed and care plans were developed that were evaluated and reviewed. The home worked well with other providers when they were involved.

Management of medicines was safe and appropriate.