About the service:

• Northlands House Care Home is registered to accommodate a maximum of 101 service users. The home is situated in Southampton close to the city centre and provides care mainly to people with general nursing needs or a physical disability. At the time of the inspection there were 83 people living at the home

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

People’s experience of using this service:

• People and their visitors gave us positive feedback about all aspects of the service they received.

• One person told us, “I never thought that I’d live anywhere but my own flat but now I’m here I’m really pleased. It’s so much more peaceful here than the hospital and no mobile phones to bother me.”

• Since our last inspection the provider had made improvements to staffing levels and to their processes for notifying us of certain events.

• People received care and treatment from staff who felt valued. There was a high level of morale among staff.

• We saw caring and compassionate relationships between staff and people they supported.

• People’s care and treatment were based on records that were thorough, detailed and up to date.

• People’s care and treatment met their needs and reflected their preferences.

• There was a wide range of activities and entertainments which reflected people’s interests, choices and previous experiences.

• Management processes were thorough and methodical, including processes to make sure people received care and support in a safe environment. There was a positive, open and empowering culture.

Rating at last inspection:

• At our last inspection (published 3 February 2018) we looked at the safe and well-led key areas and rated them both requires improvement.

Why we inspected:

• This was a planned inspection based on the date of and rating at the last inspection. At the last inspection we found breaches of three regulations. The provider sent us an action plan with dates when they planned to be compliant with those regulations. At this inspection we checked that they had made and sustained those improvements.

Follow up:

• We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

At our last inspection of Northlands House Care Home on 1 and 4 November 2016, we rated the service as Good but the Key Question of Safe was rated as Requires Improvement. This was because people gave us mixed feedback about staffing levels. People told us they sometimes had to wait a long time for their call bell to be answered.

We undertook this unannounced focused inspection on 28 and 29 November 2017. The inspection was in response to a number of concerns which were raised with the Care Quality Commission and by the local authority safeguarding team. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led?

No risks or concerns were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The inspection was conducted by two inspectors and a nurse specialist advisor.

Northlands House Care 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.

Northlands House is registered to accommodate a maximum of 101 service users. The home is situated in Southampton close to the city centre and provides care to people with physical disabilities and those who may have dementia. The home is over three floors with communal areas on each floor. There were 80 people living in Northlands at the time of our inspection plus a further two who were in hospital.

There was not a registered manager at the service 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of the inspection the manager had submitted an application to register to the Care Quality Commission and was registered between the inspection and our report being finalised.

We found there were not enough staff to meet people’s physical care needs. People waited a long time for staff to respond to call bells. People and staff felt there was not any time to talk and chat to people unless they were supporting them with their personal care or eating. Staff said they were stressed and worried about the quality of care they were providing.

The provider did not ensure that all notifiable incidents that affect the health, safety and welfare of people who live at the home were reported to the Commission, which they are required to do by law. When people died at the home, staff completed the relevant notifications but there was a delay in sending them through. It is important for providers to notify the Commission so that we are kept informed and aware of any issues of concern developing.

The provider had policies and procedures in place designed to protect people from abuse. Risk assessments identified when people were at risk from every day activities. Personal protective equipment, such as aprons and gloves were readily available to ensure the risk of cross infection was minimised. People received their medicines as prescribed by staff who were trained and assessed as competent. Lessons were learnt and improvements made when things went wrong.

The provider promoted an open and transparent culture in the home. People and staff were involved in the everyday running of the home and action was taken to address their ideas or concerns.

There was a quality assurance system of audits in place to monitor and assess the quality and safety of the service provided. The mana

This inspection took place on 01 and 04 November 2016 and was unannounced. Northlands House Nursing and Residential Home provides accommodation and care for up to 101 older people, who require nursing care. There were 89 people living in the home when we visited. Accommodation is based on three floors with a range of communal rooms for peoples use.

At our previous inspection, on the 09 and 10 December 2015, we found two breaches of regulations. The service was not meeting the regulations relating to keeping people safe from risk of harm, by ensuring that all medicines were stored correctly and peoples care plans were not being followed. At this inspection we found improvements had been made and the identified concerns had been addressed.

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.

We found people’s safety was compromised in some areas. People gave us mixed feedback about staffing levels. People told us they sometimes had to wait a long time for the bell to be answered. There weren’t enough pagers available that were linked to the call bells at the time of our inspection which meant that staff may be nearby but be unaware that someone was waiting to receive support. The registered manager informed us that all staff should have pagers and that new pagers were on order which should see an improvement in response times.

People felt safe living at Northlands House Nursing and Residential Home. The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

Safe recruitment practices were followed and appropriate checks were undertaken, which helped make sure only suitable staff were employed to care for people. Staff received training in safeguarding adults and knew how to report concerns.

Staff were trained and assessed as competent to support people with medicines. Medicine administration records (MAR) confirmed people had received their medicines as prescribed.

Staff received regular one to one sessions of supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an appropriate induction programme.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu choice of the day.

People felt they were treated with kindness and said their privacy and dignity was respected. Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully.

People had a choice and access to a wide range of activities and were able to access healthcare services.

‘Residents meetings’ and surveys allowed people to provide feedback, which was used to improve the service. People felt listened to and a complaints procedure was in place.

Staff were responsive to people’s needs which were detailed in people’s care plans. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

Regular audits of the service were carried out to asses and monitor the quality of the service. Staff felt supported by the registered manager. There were appropriate management arrangements in place.

We spoke with 21 people, five relatives, twelve staff including the manager and a visiting professional. To help us to understand the experiences of people, we spent time observing what was going on in the home and talking to people. We observed how people spent their time, the support they received from staff including at mealtimes and whether they had positive outcomes.

People told us that they were treated with respect when receiving care. Two people said that the staff were “very good”. Three people confirmed that they were involved in their care and staff offered them choices about the care they received. One person said that they liked to get up around 10 o’clock and we observed staff helping them at half past ten. Another person said “the staff come and ask you if you want to get up” and stated that the staff would come back later if needed. Three people confirmed that choices were offered regarding the times they got up and went to bed.

People commented that they were offered choices and the meals were “very good”. They said that they completed a menu sheet and there was a varied menu to choose from. One person told us that they preferred small portions and the staff were aware of this. We observed that the staff interacted well with people who use the service. People told us that the staff were kind, courteous and supported them as needed. We heard staff talking to people in a calm manner and explaining to them what they needed to do.

Three people told us that the staff were very busy and said that the staff came fairly quickly to assist them. One person said that they sometimes had to wait for a while when they rang their bells. They added that it “probably seems long but it is not as can’t work out how long”. Two relatives also commented that the call bells at times took a while to be answered. We monitored calls throughout the day and found the responses varied and it took longer in the mornings for staff to respond.

One person told us that their relatives came to visit the home prior to them moving in. They said that the staff were very helpful and provided their relatives with information. We were told that they were supported to bring in items of personal belongings such as their favourite armchair and family photos.

Two people and two relatives told us that they knew how to raise any concerns and they were keen to tell us that they did not have any concerns about the care people were receiving. Three other people said they would report concerns to the manager, the staff or to their relatives.

This inspection took place on 9 and 10 December 2015 and was unannounced. The home provides accommodation for up to 101 people, who require nursing care. There were 87 people living at the home when we visited.

The service had 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.

Arrangements to manage medicines safely were not always being followed. This meant medicine administration records were not always accurate and staff could not account for all medicines. In some cases, information about when staff should administer ‘as required’ medicines was not available. Staff left medicines which had not been given, unattended. Meaning they could have been taken by another person and caused harm.

Decisions taken on behalf of people were not always documented in accordance with legislation designed to protect people’s rights. People had not always been consulted in making decisions about their care. Staff were not always following the legislation that protected the liberty of people living at the home as they had not considered someone’s best interest with regards to using a positioning belt when they were using their wheelchair.

Every floor supported people who were older adults, some of whom were living with dementia or had mental health care needs as well as physical health needs. There were registered nurses as well as care staff on every floor. Staffing levels for each of the three floors of the home had been determined by the level of need for that area. This was not always been sufficient during mealtimes.

Staff recruitment had not completed all the required checks to ensure staff’s suitability of working with vulnerable people before they began working in the home as the service had not obtained full employment histories for their staff. Staff knew how to keep people safe; they were knowledgeable about the signs of abuse and how to report their concerns.

People were not involved in assessing, planning and agreeing the care and support they received. Care plans were not personalised to meet people’s individual needs. Risks to people were not always personalised and appropriate actions had not been documented. There were risk assessments in place for pressure injuries, malnutrition, falls and confusion, these were recorded, monitored and managed effectively.

Care plans did not always show people’s current health and support needs were being met. One person who had diabetes was not having their blood sugars monitored as documented. Failure to identify any changes could have resulted in a hospital admission. Reviews of care were conducted regularly and care records showed that people’s needs were met.

There were a variety of activities for those people who were able to attend the activities room. There was a lack of mental and physical stimulation for those who were being cared for in their bedrooms. The provider sought, and acted on, feedback from people, for example in changing the activities they supported people to take part in.

Effective systems were not in place to assess, monitor and improve aspects of the service, such as the management of risks to people, medicines and care planning.

People, staff and professionals felt the home was organised, well-led and praised the registered manager, who they described as “approachable”. Staff understood their roles and worked well as a team. They were motivated and enjoyed working at the home.

Staff were encouraged to gain formal qualifications in health and social care and received appropriate support and supervision in their roles.

People had mixed views about the quality of the meals and were not always supported to eat and drink well. People were supported to attend health care appointments and saw doctors, psychiatrists, nurses and other health professionals when needed.

Appropriate arrangements were in place to deal with foreseeable emergencies, such as a fire. People had individual evacuation plans in place and took part in regular fire drills

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.