Northfield Care Centre

Northfield Care Service is a care home It can accommodate up to 80 people in a purpose-built building. It comprises of five units providing personal and nursing care for older people, including people living with dementia. There were 68 people using the service at the time of the inspection.

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

There was a quality monitoring system in place covering all aspects of the management of the service. Action plans were then developed to help drive improvement. We identified some documentation that could be improved to ensure standards were maintained. The registered manager addressed this following our site visit and sent us the actions taken to improve these areas.

We have made a recommendation that, documentation is consistent and new systems embedded into practice.

People told us they felt safe living at the service. Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Relatives we spoke with told us their family members were kept safe. There were enough staff to support people safely. People received medicines as prescribed. However, we identified some minor documentation errors and lack of consistency between units. This was addressed by the registered manager and evidence of audits and actions taken were provided. Staff administering medicines had received training which was regularly refreshed. Risks to people were managed and assessments contained appropriate guidance for staff to follow. Incidents and accidents were monitored, analysed and reviewed to ensure lessons were learnt. However, documentation could be improved to evidence how risks were mitigated. 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.

Staff followed infection prevention and control procedures. The registered manager and staff understood the importance of infection control. However, we identified some minor issues that required attention, which were addressed.

The management were visible in the service and staff told us they felt supported. People felt listened to and their views were obtained. Feedback we received from people and their relatives was predominantly positive. One relative told us, “The manager is very responsive." Although some relatives were not aware who the new registered manager was, they all said communication was very good. One relative said, “They [Staff] communicate with me every week and let me know of any changes.”

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 22 September 2022)

Why we inspected

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

We undertook this focused inspection and this report only covers our findings in relation to the Key Questions safe and well led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northfield Care Centre 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 Care Service is a care home. The service can accommodate up to 80 people in a purpose-built building across four units and provides personal and nursing care for older people, including people living with dementia. There were 63 people using the service at the time of the inspection.

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

People told us they were happy with the service. Relatives told us they thought their loved ones were safe and well cared for.

Potential risks to people's health and welfare had been assessed and staff were provided with guidance to mitigate the risks. Accidents and incidents were analysed to identify patterns and trends with action taken to prevent them happening again.

The manager worked with the local safeguarding authority when concerns were raised to keep people safe. Care plans contained information about people's choices and preferences, they had been reviewed when people's needs had changed. People's health needs were assessed and reviewed using recognised tools following government guidance.

People received their medicines as prescribed by staff that were trained and competent. People were supported by enough staff who had been recruited safely.

Staff had received training appropriate to their role. Competency checks and supervisions were completed to support staff with their practice and knowledge. The provider had a complaints policy in place, this had been followed when complaints had been received.

Checks and audits had been completed and had been effective in identifying shortfalls. Action had been taken to rectify the shortfalls.

Based on our review of safe and well-led key questions. 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.

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 09 February 2022).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

Northfield Care Service is a care home. The service can accommodate up to 80 people in a purpose-built building across four units and provides personal and nursing care for older people, including people living with dementia. There were 46 people using the service at the time of the inspection.

People’s experience of using this service

People had benefitted from improvements to the quality and safety of the service. Following our last inspection. The registered manager and provider had devised an action plan and continued to make improvements and embed these changes into the running of the service. There were still some improvements required in regard to infection control, medicines management, the meal time experience and the environment. However, these had been identified by the provider quality monitoring system and were being embedded into practice.

We have made a recommendation about improving the meal time experience for people who use the service.

Relatives felt listened to and told us complaints were appropriately dealt with and resolved. People told us their views were obtained to continually drive improvements. Feedback from staff was extremely positive about the improvements to the service, they worked better as a team and were well supported.

Staff ensured peoples safety and people told us they felt safe. Staff understood safeguarding and whistleblowing procedures. There were sufficient staff employed to meet people’s needs and staff respond to people’s needs in a timely way. The provider operated a robust recruitment process and monitored accidents and incidents, which ensured staff learned lessons when things went wrong. Risks to people were identified, assessed and managed. People were protected from the risk of infection. Staff followed safe medicines management systems and people received their medicines as prescribed.

Staff were well-trained and received supervision and support. They were knowledgeable about people needs and provided person-centred and individualised care. 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 had access to health care professionals and staff worked closely with professionals to ensure people's needs were met. Professionals working with the service gave positive feedback about the improvements in the care and support people received.

People told us staff were extremely kind and caring. Relatives were also positive about the care and support provided. They told us they had noticed improvements over the last few months since the new registered manager had been in post. Staff understood people’s needs and respected their dignity.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 9 July 2021) and there were multiple breaches of regulation. 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 and the provider was no longer in breach of regulations.

This service has been in Special Measures since 9 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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

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.

Northfield Care Service is a care home providing personal and nursing care for older people, including people living with dementia. It can accommodate up to 80 people. There were 39 people using the service at the time of the inspection.

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

We found there was insufficient staff and ineffective deployment of staff to ensure people’s needs were met. We observed staff were not present in communal areas. We observed people waiting for assistance and staff not having time to talk with people.

We found systems and processes used to ensure the service was running safely were not effective. They had not identified required improvements. There were systems in place to safeguard people from abuse. However, we referred three safeguarding concerns to the Local Authority, which we identified at inspection.

Risks associated with people’s care were not always identified or managed in a way that kept people safe. Incidents and accidents were not effectively reviewed to ensure lessons were learnt to drive improvements. We identified some shortfalls in the way people’s medicines were managed. We were not fully assured people were protected by the risk and spread of infection.

Staff did not support people appropriately. Their approach was not person-centred and care and support we observed, was task orientated. Staff told us they wanted to spend time with people but were unable to because they were too busy. We observed people left with no support, interaction or stimulation for long periods of time.

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 requires improvement (published 22 September 2020)

Why we inspected

The inspection was prompted due to concerns received from complaints and whistleblowing. These were regarding, inadequate staffing, infection control and risks not being managed. We completed a focused inspection to look at the safe and well led key questions.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person centred care, safe care and treatment, staffing and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Northfield Care Centre is a residential care home providing nursing and personal care for up to 80 people. At the time of the inspection 31 people were using the service.

People’s experience of using this service:

People felt safe and gave us positive feedback about the home. One person’s relative said, “I am happy with everything my relative is getting, he has been happy.” Another person said, “It’s a nice place to be.”

People were supported by staff who were deployed in sufficient numbers to meet their needs. Staff were aware of how to safeguard people from abuse and had good knowledge on how to recognise and respond to concerns. A relative we spoke with confirmed they felt their relative was safe at the home.

Risks to people were assessed and people’s independence was promoted. Staff numbers were assessed according to people’s needs. Medicines were administered safely by trained and competent staff although some improvement is required to the recording of medication. Infection control procedures were in place. Processes were in place to analyse incidents and learn when things went wrong.

The home had improved since the last inspection. The registered manager told us they had worked hard to address the breaches and shortfalls identified at the last inspection. They produced and worked through a comprehensive action plan. There was a clear vision and open culture. A governance framework was in place which covered all aspects of the service and the care delivered. Numerous quality assurance audits were in place however, some could improve. People, relatives and staff were engaged in the home. There was evidence of continuous improvement by considering trends and themes, and by sharing best practice. The home worked in partnership with other professionals, and the community when able to do so.

We saw no evidence people's needs were not met. However, we recommend the provider continues to monitor sufficiency of staffing in line with people's assessed dependency and layout of the building to ensure safe staffing levels are sustained as capacity in the home is increased.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 3 March 2020) and there were three breaches of regulation. 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 and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned focussed inspection based on the rating at the last inspection. As this was a focussed inspection, we reviewed the key questions of safe and well led only. 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.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Northfield Care Centre is a residential care home providing nursing and personal care for up to 80 people. At the time of the inspection 41 people were using the service.

People’s experience of using this service

There were not always enough care and nursing staff available to meet people needs. We found no evidence that people had been harmed however, we identified areas of risks to people’s welfare. The tool used to identify the staffing needs of the people using the service was not fit for purpose and there was a discrepancy between the outcomes described by the tool and people’s and staffs’ lived experience. After the inspection the provider told us there were sufficient staff to meet people’s needs. However, they felt the deployment of staff had been poorly managed.

In the nursing unit and the unit for people living with dementia we saw staff were under pressure to meet people’s needs and, although it was evident they were trying very hard, we saw instances of shortfalls developing in the care provided. This affected the quality of the service people received in all our key questions. For instance, in the first floor units there was little time for staff to engage with people unless providing them with direct care, or to provide person centred care at mealtimes,

There were improvements in the opportunities provided for meaningful activity, which benefitted people in the residential care units, on the ground floor more than those living in the nursing unit and the unit for people living with dementia, on the first floor. The home was clean and overall, staff followed good practice in relation to the prevention and control of infection. However, staff were very busy on the day of the inspection and sometimes failed to pick up on issues.

There had been a change of manager and the effectiveness of the audit checks had been improved considerably. Although, their management time had recently been reduced, and there was a need to ensure the improvements that had been achieved were sustained. Audit checks had been less effective for some, more recent shortfalls. This was consistent with the manager’s view that the recent reduction in staffing hours had a negative impact on their management time and would, in future, have further impact.

Care records had been improved and showed people's needs were being met. Improvement had also been made to ensure risks associated with people's care and treatment were identified and managed safely. There were also improvements in people’s care plans. Although, recent changes in staffing had an impact on the sustainability of this improvement and there remained areas to be addressed.

Improvement had been made to ensure safe arrangements were in place for managing people's medicines and the system in place to safeguard people from abuse remained effective.

The provider had improved systems to make sure staff received the proper training and support to carry out their role. Staff told us they felt supported by the manager.

People's choices for their end of life care had been considered and were recorded. People we spoke with knew how to raise a complaint.

Rating at last inspection and update

The last rating for this service was requires improvement ( published date December 2018). This service has been rated requires improvement for the last two consecutive inspections. You can read the report from previous inspection by selecting the ‘all reports’ link on our website at www.cqc.org.uk

At the last inspection breaches of regulation were identified. The provider was served with a Warning Notice in respect of concerns around the governance of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had been made, but new breaches of regulations were identified in relation to staffing and there remained a breach in respect of the governance of the service. Following the inspection we asked the provider for information and assurance as to how they would address our concerns about staffing and deployment of staff.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will monitor the service closely in respect of the effectiveness of the actions taken by the provider to mitigate the risks we identified at this inspection.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Northfield Care Centre provides accommodation care and nursing care for up to 80 people. The home consists of four separate units, one providing personal care and the other three providing nursing care. Some people receiving support at the home were living with dementia. Accommodation is provided over three floors, with the upper two floors being accessed by passenger lift. On the day of the inspection there were 37 people living in the home and three people who regularly came for care during the day.

This inspection took place on 8 October 2018 and was unannounced. This meant the people who lived at the home and staff did not know we would be visiting. Our last inspection at Northfield Care Centre took place in April 2018 when the service was rated overall as requires improvement. At that inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 12; Safe care and treatment and Regulation 17; Good governance. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Northfield Care Centre’ on our website at www.cqc.org.uk.

During this inspection, we did not see sufficient improvement to warrant a rating of ‘Good’, which is the minimum standard care homes should be aiming to achieve for people who use their service. Due to the failure to improve, we have rated the service as ‘Requires Improvement’ for a second time.

We checked on progress with improvements the registered provider told us they would make in the action plan they sent to us after the last inspection. We found the registered provider had made some improvements. However, there were continued shortfalls and we found a repeated breach of Regulation 12, Safe care and treatment, in relation to people's medicines not being safely managed or consistently administered as prescribed. We also found further breaches in Regulation 12, Safe care and treatment, in relation to shortfalls in people’s assessments and care plans regarding risks associated with their care, as well as in day to day monitoring records kept about people’s care. We found a repeated breach of Regulation 17, Good governance in relation to the range of audits to monitor and assess the quality of the service. The registered provider had not been proactive, identified shortfalls or taken action to address them in a timely way. This had led to some risks associated with people's care not being addressed or managed effectively.

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

There was no registered manager in post at the time of the inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered provider had appointed a manager who was employed at the home and was in the process of registering with the Care Quality Commission.

There were enough staff to support people safely. However, staff were often very busy, having limited time to engage with people. The home was clean and tidy and staff had received training on reducing the risk of the spread of infection. The manager was monitoring accidents and incidents and there was evidence that trends and patterns were being identified, and some actions had been taken to reduce hazards in relation to these.

Staff received ongoing relevant training. However, some staff had not received an adequate induction when first started working in the home, staff performance was inconsistently monitored and some staff said they felt unsupported. Most people told us they liked the food. Meals provided were nutritious and appetising. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, some assessments of people’s capacity to make decisions and records about people’s consent to care were incomplete, or required more detail.

Staff treated people with respect or dignity. We observed caring interactions when staff were supporting people. Although, the time staff spent engaging with people, other than to complete to day-to-day tasks, was limited. Efforts had been made to include people in making decisions about their day to day care, but records did not always reflect their involvement in ongoing reviews. People’s religious and cultural needs were met, their independence was encouraged, People’s confidentiality was respected and their records were handled in accordance with the Data Protection Act 2018.

People’s care plans were not as person centred as they could be. The quality of people’s end of life care planning documentation needed improvement. There were opportunities for people to engage in activities and the home also provided a dementia café and held events with guest speakers, which were open to the public. Most complaints were handled appropriately, although recent records showed some complaints had not been responded to in a timely way.

Although, a range of audits were in place and most of them identified areas of improvement, we found the audits in relation to medicine management and risk management were not effective, as they had not identified the concerns we raised during our inspection. Shortfalls in people’s care plans and written records had not been identified. People, their relatives and staff were asked for their view regarding the service. However, the outcomes were not always fed back to people.

The registered provider’s senior management team had been alerted to concerns about the quality of the service and had responded with increased level of senior management presence in the home. Members of the senior management team were aware of areas for improvement in audit and governance and were introducing new quality assurance systems, to improve in these areas. They were also reviewing the support available to the manager in the home, to ensure this was effective. There was evidence that shortfalls were being more effectively identified and improvements were being made. However, these improvements needed to be embedded into practice.

Further information is in the detailed findings in the full version of the report.

The service provides accommodation, nursing and personal care for up to 80 older people some of whom may be living with dementia and/or have complex nursing needs. People were accommodated over two floors with lift access. At the time of our inspection there were 29 people using the service. The service is situated in Thorne, Doncaster.

The service has a manager who was in the process of registering 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 2008 and associated Regulations about how the service is run.

There were systems and processes to assess and monitor the quality of the service provided. However, we found that audits were not always effective as they had not identified shortfalls in care records and medicines.

Staff were able to recognise signs of abuse should they occur and knew how to report concerns if they suspected a person was at risk of harm. There was a complaints procedure available in the service for people and relatives to raise concerns.

People received effective care from staff who had the skills and knowledge to meet their needs. Staff monitored people's health and well-being. People had access to healthcare professionals according to their needs.

People were cared for by staff who were observant and ensured people were comfortable. People told us, and we saw, that staff were kind and caring.

Staff knew the needs and preferences of the people they cared for and promoted people's rights to privacy, dignity and independence.

The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff spoken with had an understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support.

People's diversity was respected and staff responded to people's social and emotional needs. People told us their needs were met because they were supported and cared for in accordance with their wishes and choices. People and staff were positive about the culture of the service. People felt the staff team were approachable and polite.

People gave positive views about the food they received and pleasant mealtimes. There were activities for people and people were supported to take part in these where they wished.

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 this report.