Northwood Nursing & Residential Care

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• 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

For this key question we assessed 6 quality statements relating to; learning culture, safeguarding, safe environments, safe and effective staffing, infection prevention and control, and medicines optimisation. We found the provider was in breach of the regulation; safe care and treatment. People were not always safe because they did not receive safe care in relation to the storage and recording of medicines. Records related to the storage of medicines, the administration of ‘as and when required’ medicines, the use of thickener in drinks and information related to people’s allergies and PEG feeding did not reflect best practice, people’s guidelines or was missing. People were protected from the risk of infection by staff, the home was clean and maintained hygienically. The provider had a food hygiene rating of 5. This meant the hygiene standards were very good. The registered manager assessed risks to ensure people were safe. The registered manager and staff promoted positive risk taking to help people gain skills and live an independent life as possible. There were effective safeguarding processes in place, to support people’s safety.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their loved ones told us that staff were kind, there were always enough staff each day and that they had the right training and skills to support people safely.

Staff told us the management team supported them and encouraged their professional development. One staff member commented, “[Registered manager], he’s nice, he’s approachable and he is good with the residents.” Staff told us about the training and support that provided them with the skills they needed to support people safely. A staff member commented, “They [management] are on top of all the training.”

Systems and processes were in place to support continued learning. These included supervisions, training, investigations of concerns and the completion of logs for incidents, accidents, potential safeguarding events and complaints.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were appropriately supported so they felt safe. They said they understood what it meant to feel safe and could say how they would raise any concerns. People told us they felt confident the registered manager and provider would act on any concerns raised. One person commented, “Yes of course I feel safe. If I didn’t feel safe I would tell [provider] or the nurse.” Feedback we received from relatives did not raise any concerns about people’s safety. One relative told us, " Staff are lovely with [family member]. She is safe."

Staff were effectively deployed to keep people safe. Staff had received training to recognise if people were at risk of abuse and what actions to take to keep people safe. One staff member said, " People are very safe."

People told us they felt safe and knew who to speak with if they had concerns. We observed staff deliver care safely. People were appropriately supported by skilled staff, so people did not feel unsafe or neglected. Staff had time to meet people’s needs and gave people the time to share their thoughts and feelings. Staff supported people to move safely. Staff were observed to respond to people’s requests and provide them with the support they needed.

The provider had a system in place for the management of safeguarding concerns. This meant people were protected from the risk of harm or abuse. Staff had received training to recognise abuse and knew what action to take to keep people safe, including reporting any allegations to the appropriate person or authority. The manager had systems to record, report and analyse any allegations of abuse. The provider had a process to learn and make improvements when something went wrong. Staff recorded accidents and incidents, which management reviewed on a regular basis to identify any trends, themes and areas for improvement. The management team carried out audits and checked the standards and quality of the service people received. This included monitoring people's health and weight regularly. The manager sought legal authorisation where people were subject to any restrictions for their safety. Where deprivation of liberty safeguards (DoLS) authorisations were granted, we saw the service ensured any conditions were met.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

People said they were cared for in a safe environment that was designed to meet their needs. One person told us, “I think the home is very clean and well decorated.”

The provider had systems and processes in place to detect and control potential risks in the care environment. This made sure that the equipment, facilities and technology supported the delivery of safe care. Essential servicing and maintenance of the gas, electric, fire alarm system, emergency lights, moving and handling equipment had taken place.

We had a walk around the home to make sure it was homely, suitable and safe. Feedback from people, staff and relatives was positive on the support delivered. We observed equipment and technology such as air flow mattresses were suitably maintained and operated correctly. Hazardous materials were securely stored.

The management team used a variety of method to assess, monitor and improve the quality of the service provided. They used audits, along with feedback from people and staff to identify areas for improvement and make positive changes to the service people received. Northwood Nursing and Care had smoke alarms, fire extinguishers and fire doors which complied with British standards and were regularly checked and serviced. Each person had a personal emergency evacuation plan [PEEP]. A PEEP is a plan for a person who may need help, for instance, to evacuate a building or reach a place of safety in the event of an emergency. Staff had received fire evacuation training. The manager sought legal authorisation where people were subject to any restrictions for their safety. Where DoLS authorisations were granted, we saw the service ensured any conditions were met.

People and their loved ones told us that staff were kind, there were always enough staff each day and that they had the right training and skills to support people safely.

Staff told us the management team supported them and encouraged their professional development. One staff member commented, “[Registered manager], he’s nice, he’s approachable and he is good with the residents.” Staff told us about the training and support that provided them with the skills they needed to support people safely. A staff member commented, “They [management] are on top of all the training.”

Staff were effectively deployed to keep people safe. Management had considered how environments can keep people safe from psychological harm in relation to their sensory needs. There were motion sensor lighting in all communal areas to lessen the risk of people falling.

Staff were deployed effectively to meet people’s needs. One staff member told us, “We have allocated people to look after, so people are supported and safe.” We did not review any staff recruitment records because there had been no new staff recruited since we last inspected the service in September 2023. Staff told us when they had been recruited and a range of checks including references, disclosure and barring checks (DBS) had been requested and obtained prior to starting work in the service. The information helps employers make safer recruitment decisions.

People told us the home environment was clean and well maintained. One person said, “Yes. The home is cleaned daily. A cleaner comes at 7am morning. The home is well maintained. Carpets are cleaned once a month.” Relatives we spoke with did not raise any specific concerns about the cleanliness of the home. Feedback was positive on the environment.

Staff told us they were able to follow the cleaning schedules. The provider had a food hygiene rating of 5. This meant the hygiene standards were very good.

We took a tour of the home, carried out observations and spoke with staff and relatives. We were assured there were effective processes related to the cleanliness of the environment, equipment and waste management.

The provider had oversight of the service and lead on improvements to the environment. The provider had regular audits to ensure an effective approach to assessing and managing the risk of infection, which is in line with current relevant national guidance.

People managed their own medicines after a risk assessment had been completed to make sure they were supported to do this safely. For one person there was a detailed care plan for the management of their epilepsy, however for others we found a lack of detail in care plans. After the inspection these were reviewed by the service, and they told us that these were updated. Homely remedies were available to support people for the treatment of minor ailments however we found that two of the items were past their expiry date. For another we found that stock records did not match that held by the service. Instructions for medicines that were given when required were not always available. After the inspection these were reviewed by the service, and they told us that these were being put into place.

Staff responsible for the management of medicines received training. The induction for agency staff included medicines handling. Although employed staff had competency checks completed these had not been reviewed annually as stated by the home’s medicines policy. Staff told us that residents had access to a GP and pharmacist who attended onsite weekly to review medicines if needed. Although audits were being completed by the service, they had not picked up on all the issues found during the inspection.

Storage areas for medicines were not always monitored to ensure their temperature stayed within the recommended ranges. When temperatures had gone outside of the recommended range there was no evidence that staff had taken any action. After the inspection, the service told us that air conditioning units were being fitted in these areas. Balances on medicines administration records (MAR) charts did not always follow in a way that ensured that doses of medicines had been administered. Blood monitoring records were not always completed for people with diabetes. Records for the application of creams were not always completed in a way that ensures that creams were applied as prescribed.