Northfield House

Updated 27 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

This inspection also looked at whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

One Inspector, a member of the CQC medicines team and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Northfield House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Northfield House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced on the first day and announced on the second day.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with one person who used the service and six relatives about their experience of the care provided. A lot of the people who used the service were unable to talk with us, they used different ways of communicating including using Makaton, pictures, photos, symbols, objects and their body language.

We spoke with seven members of staff including the registered manager, deputy manager, operational manager and support workers.

We reviewed a range of records. This included five people’s care records and eight medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, policies and procedures and quality assurance records. We spoke with seven professionals who regularly visit the service.

Updated 27 May 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Northfield House is a residential care home for up to eight younger adults living with a learning disability and/or autism. At the time of the inspection, eight people were living at the service.

Northfield House is a detached property. Bedrooms are across two floors with en-suite facilities, shared communal spaces and a shared bathroom.

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

The registered manager had made significant improvements at the service since the last inspection. However, there was further work to be done to make sure changes and new systems introduced were effective.

Risk around COVID-19 were not always reduced and staff were not always wearing personal protective equipment (PPE). The registered manager acted quickly to provide training to staff in this area.

Guidance for staff and risk assessments had not been reviewed after an incident which led to harm, this wasn’t identified by the providers systems and checks.

The environment was better maintained, and cleaning had improved since the last inspection. The home was more welcoming, and staff were passionate about how they could further improve the service and lives of people they supported.

Staff, families and professionals all remarked on the improvements made especially around communication, responsiveness and acting on feedback and suggestions.

People took part in activities and their sensory needs were being met. This was a work in progress to ensure activities were more in line with people’s personal choices. People were encouraged to learn new things and plan new goals.

Changes to the layout of the home meant people had space when they needed it and noise levels were more manageable for people who preferred this.

People were involved in meal choices and making meals where they were able. The use of pictures and Makaton to communicate with people was encouraged. The registered manager was exploring the use of technology to empower people to communicate their needs and choices. At the time of the inspection, improvements had not been implemented.

Staff had the relevant training and checks in place to work with vulnerable adults.

We made a recommendation about the continued work needed around application of the mental capacity act and best interest decisions.

One family member told us, “[Person] is happy and I can see the difference in the way things are run. [Person] seems happy to go back, after a visit they asked to go back to the home.”

Another family member told us, “The staff look after [person] like a relative. We now get regular updates. Staff are happy when they visit with them.”

Based on our inspection of the safe, effective and well-led domains; the service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

People were supported by staff to pursue their interests and try out new activities for the first time in their local community. The service gave people care and support in a safe, clean environment that met their sensory and physical needs. More was being done to refurbish bedrooms and improve the sensory experience for people. People had personalised their bedrooms and changes had been made to the layout of the home that worked better for people and their needs. Staff communicated with people in ways that they preferred.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Staff knew people’s individual ways of communicating, using body language, sounds, Makaton (a form of sign language) and pictures. Some staff had the necessary skills to communicate using Makaton and more was being done to ensure all staff had those skills to improve communication.

People could take part in a range of activities and pursue interests that they enjoyed. The service was at the early stages of developing tailored activities for some people and had started to support some people to try new meaningful activities, that enhanced and enriched their lives. Some people were being reintroduced to activities that had not been available to them throughout the pandemic as restrictions were lifted.

Right Culture

Peoples quality of care, support and treatment was improving because staff had received training and were working with specialists to meet their needs and wishes. Staff knew and understood people well and were responsive. More work was needed to engage people in a meaningful way and improve their quality life. The registered manager had improved engagement with people families and staff were taking a proactive approach to develop the service. Staff valued and acted upon people’s views.

People’s quality of life was improving as the service’s culture improved, people’s needs, and quality of life was becoming the focus of the service. The registered manager had plans to increase the use of technology to improve people’s ability to communicate and be more empowered and involved in their 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.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 11 October 2021) and there were five breaches of regulations. 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 however the provider was still in breach of two regulations.

At our last inspection we recommended that the provider reviewed their recruitment processes. At this inspection we found that they made improvements and recruitment checks were now in place.

We also recommended that the provider reviewed their practices around the Mental Capacity Act in line with best practice guidance. We found that work had started to improve in this area, but further work was still needed.

This service has been in Special Measures since October 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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We used this inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We also assessed whether the service is applying the principles of Right support right care right culture.

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.

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

Enforcement and Recommendations

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 safe care and treatment and person-centred care at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.