This inspection took place on 4 and 5 June 2018 and was unannounced.

Northcott House Residential Care and Nursing Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Northcott House provides nursing and personal care. It provides support for up to 55 older people, some of whom live with dementia. At the time of our inspection there were 41 people living at the home. Accommodation is in a very large building with long corridors and over two floors.

At our last inspection in September and October 2017 we found multiple breaches of the legal requirements. People did not receive safe care and treatment and the management of medicines was unsafe. This was a breach of Regulation 12. The deployment of staff was not appropriate to meet the needs of people and staff had not received appropriate support and training in order to deliver their role effectively. This was a breach of Regulation 18. Care was not always planned or delivered in a person centred way and this was a breach of regulation 9. People’s consent was not always sought and where it was needed the Mental Capacity Act 2005 had not been applied. This was a breach of Regulation 11. Whilst the provider had systems in place to monitor and assess the safety of the service, these had been ineffective in identifying concerns and driving improvement. This was a breach of Regulation 17. The service was rated as inadequate in each key question and overall. It was placed into Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Since our last inspection a new manager had been appointed and had applied to become registered 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. Since this inspection visit they had become the registered manager. Throughout the report we have referred to them as the manager.

Whilst improvements had been made to the assessment and management of risks to people’s safety, further work was needed to ensure this approach was consistently applied.

Medicines were now managed safely. Staffing levels had improved and were now appropriate to meet the needs of people. Staff training had been enhanced and competency assessments were taking place regularly. Staff felt supported and were receiving supervisions to support them in their roles.

Care planning and delivery was improving and we observed staff mostly responded promptly to changes in people’s needs, although this was work that needed further embedding into the service to ensure consistency. Where applicable, mental capacity assessments had been undertaken and we consistently saw and were told that people’s permission was sought before staff provided care.

People were protected against abuse because staff had received training and understood their responsibility to safeguard people. Concerns were reported and investigated. The provider’s recruitment process ensured appropriate checks were undertaken to ensure staff suitability to work in the home. People and their relatives felt the home was always clean and well maintained. Equipment was managed in a way that supported people to stay safe and people were supported to maintain good health and had access to appropriate

This unannounced inspection took place on 25, 26 September and 2 October 2017. The inspection was bought forward due to information of concern we had received about the safety and management of the home, and the care provided to people.

Northcott House Residential Care and Nursing Home is a care home that provides nursing care. It provides support for up to 55 older people, some of whom live with dementia. At the time of our inspection there were 47 people living at the home. Accommodation is in a very large building with long corridors and over two floors.

At the time of our inspection visit 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.

The last inspection of the service was March 2016 and we rated this as overall “Good”.

At this inspection we found serious concerns about the safety of the service. People were placed at risk of harm because appropriate measures had not been implemented to identify and assess risks. In addition, measures had not been taken to ensure that risks for people were minimised and medicines were not always safely managed. Staff lacked knowledge of those at risk of choking and measures were not in place to minimise this risk. Skin integrity was poorly managed placing people at risk of injures. Clinical observations which could indicate health concerns were not understood and acted upon. We could not be confident people always received their medicines as prescribed.

Staffing levels varied throughout the inspection and there was no system to ensure these levels met people’s needs. Call bell response times were poor and people’s comments indicated staffing levels may not be appropriate to meet their needs.

Timely referrals to other healthcare professionals were not made and recommendations from other professionals were not acted upon when concerns for people were identified. People were not always satisfied with the food. The support to eat and drink was disorganised and staff lacked the knowledge required to ensure people received the support they needed. Monitoring of people’s food and fluid intake was poor. Person centred care did not take place. Care plans lacked personalised information about how people’s needs and preference could be met and as people’s needs changed, staff did not respond to these. Staff were not supported through effective supervision and competency assessment to deliver safe and appropriate care.

Although people said their privacy was respected and their independence encouraged, staff approach to support was task orientated and people at times felt uncared for and forgotten. The manager and provider had not ensured the service was safe which demonstrated a lack of a caring approach.

There was a lack of leadership in the service and the registered manager was not visible. Some staff felt the registered manager was unapproachable. Audits to assess the quality of service provision were not completed regularly and were ineffective in identifying improvements needed. The registered manager and provider had no oversight of these. Action plans were not developed to ensure improvements were made. A complaints procedure was in place and records kept of how these were investigated. However, when staff raised concerns these were not acknowledged or appropriately investigated. Notifications required by CQC were not submitted.

Although staff demonstrated an understanding of the Mental Capacity Act 2005 they could not evidence how they had applied this. Staff did have knowledge of those people subject to Deprivation of Liberty Safeguards and understood what this was for. Staff understood their responsibility in relation to safeguarding people. Recruitment pra

The inspection took place on 23 and 29 March 2016 and was unannounced.

Northcott House Residential Care and Nursing Home is registered to provide accommodation, nursing and personal care services for up to 55 older people, and people who may be living with dementia, a physical disability or sensory impairment. At the time of our inspection there were 49 people living at the home. Of those, 25 had a residential service and 24 had nursing needs which varied from people who were relatively independent to people with complex care needs. People were accommodated in single rooms with a number of shared areas which included a lounge, a dining area, a conservatory and a smaller sensory lounge.

There was a registered manager in place. 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. The registered manager was on leave during our inspection. We mainly spoke with the deputy manager.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. Arrangements were in place to store medicines safely.

Staff received appropriate training and supervision to maintain their skills and knowledge. They were aware of the need to gain people’s consent to their care and support, and of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff complied with the principles of the Act where people did not have capacity to make certain decisions.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs and preferences. People were supported to access healthcare services, such as GPs and older people’s mental health teams.

People told us they had caring relationships with their care workers. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy, and dignity.

Care and support were based on plans which took into account people’s needs, conditions, and preferences. Care plans were updated as people’s needs changed, and were reviewed regularly. People were able to take part in individual leisure activities which reflected their interests. Shared activities were available if people wished to take part.

The home had an open, friendly atmosphere in which people felt able to make their views and opinions known. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided.

We carried out this inspection as part of our routine inspection programme to answer our five questions. Is the service safe, is it effective, is it caring, is it responsive and is it well led? The inspection was carried out by a single inspector over two days. At the time of our inspection there were 52 people using the service. We spoke with eight of them in order to understand the service from their point of view. We observed the care and support people received in the shared areas of the home. We looked at records and files. We spoke with the registered provider, the registered manager and eight members of staff.

This is a summary of what people told us and what we found.

Is the service safe?

People told us they felt safe and comfortable in the home. They said care and treatment were only given with their consent, and if they had a problem they were confident it would be dealt with appropriately.

We found the service had systems in place to ensure people were protected from the risk of abuse. They carried out the necessary checks before staff started work and there was a robust recruitment process in place.

People’s individual care plans contained measures to maintain the safety of people’s living environment. Appropriate risk assessments were in place to ensure people’s safety and welfare. Arrangements were in place for foreseeable emergencies to keep people safe and comfortable.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The manager at Northcott House had a good understanding of the Mental Capacity Act 2005, DoLS and their responsibilities. Where people lacked capacity they were protected because the provider followed the appropriate guidance and code of practice. There were no DoLS in use at the time of our inspection. The service had applied for DoLS in the past and followed the correct procedure.

Is the service effective?

People told us that they were satisfied with the care and support they received. One person said staff “do their best for you”. Another person said, “It’s all fine. I have no complaints.”

People were cared for in an environment that had been suitably adapted, with a variety of areas, both inside and outside, where they could spend time according to their choice.

We found people’s care and support were based on thorough assessments and detailed and personalised support plans. Systems were in place to ensure care was delivered according to people’s plans. We found the provider acted in accordance with legal requirements where people did not have capacity to make decisions about their care and treatment.

Is the service caring?

People using the service told us they got on well with their care workers and other staff and had a good relationship with them. One said, “They are nice girls.” Another told us, “The carers are very good.”

Staff we spoke with were motivated to provide good care. They knew about people’s needs and how they preferred to have their care delivered. One member of staff said, “It’s like a second family.”

We observed positive, friendly interactions between staff and people who used the service. Staff took time to make sure people understood, spoke clearly and made eye contact with the person they were talking to.

Is the service responsive?

People told us they had been involved in their assessments and care planning, and that their views and preferences were taken into account. They told us staff listened to them. People’s care plans were individualised and person-centred.

We found the service had systems in place to ensure the care provided was appropriate to peoples’ changing needs. If routine checks and screening procedures identified a possible concern, the service responded appropriately. People were supported by other healthcare providers as appropriate.

Is the service well-led?

Staff told us they were supported to deliver quality care and they received training in the basic subjects for adult social care, such as consent and the safeguarding of vulnerable adults. They said they were confident if they raised concerns with the manager or senior staff, they would be dealt with properly.

Systems were in place to regularly assess and monitor the quality of service provided. Risks were assessed and appropriate action plans were in place. There were processes in place to review and learn from incidents, accidents and complaints.