We carried out a review of the data available to us about Northam Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Northam Lodge, you can give feedback on this service.
Rating at last inspection
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
Why the service is rated Good
Staff had the right skills, training and support to provide personalised care which met people’s complex needs. Care and support was well planned with people being at the heart of this to ensure their preferred routines and wishes were met. The introduction of active support planning will enhance this further. This will ensure people have clear goals and ambitions to develop their independent living skills, enjoy activities of their choice and remain healthy and well.
People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were skilled at interpreting people’s complex ways of communicating their needs, including the use of visual cues and other non-verbal ways of communicating.
People were offered a choice and range of meals to help them maintain a healthy diet. Where people required support to eat and drink, this was done in a sensitive and relaxed manner. People who were at risk of choking, had detailed plans in place to inform staff about how best to support them. Other risks were also being well managed, with clear instructions for staff to mitigate and manage these risks. For example managing a person’s epilepsy.
The home was required by the Care Quality Commission to have a registered manager. 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, senior team and new chief executive of the service were working hard to ensure their approach was open, inclusive and forward thinking.
They had introduced a suggestion box, more leadership and team meetings and incentives to enhance staff morale. This included gift tokens for commitment to service and the introduction of employee of the month. The management team were also actively consulting with people and their families about the future direction of the service. New initiatives included the introduction of eye gaze technology. This would enable some people to be able to communicate their needs in a way that had not previously been possible. This system allows people to use their eyes to indicate their answers to questions. They were also introducing electronic care records to better assist care staff in record keeping and care planning.
Further information is in the detailed findings below.
This unannounced comprehensive inspection took place on 19 and 25 November 2015. Northam Lodge is registered to provide care and support for up to 25 people, most of whom have a learning disability and/or a physical disability. Accommodation is divided into three separate houses which are located within the same site. Each house has its own staff team. At the time of the inspection there were 24 people living at the service.
There was a registered manager in post. 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 brought forward this planned comprehensive inspection as there had been two safeguarding alerts relating to people’s safety. We wanted to be assured that the actions the provider said they had implemented following these safeguarding incidents, were effective. Staff confirmed the actions of training and new systems had been implemented to minimise the risk of further incidents occurring.
People living at the service said they liked living there. Relatives were very positive about how people were being cared for. Comments included, ‘‘This is a home for life. Staff are very caring which is very important.’’ One healthcare professional said ‘‘It is clear from what staff say that they have a very good understanding of the individual needs of clients at Northam Lodge, and genuinely care about their wellbeing. They always speak with genuine fondness for clients.’’
Staff were experienced and knowledgeable about how to meet people’s individual needs. Care and support was being delivered in a caring and sensitive way. People were being offered choice throughout the day about when they wished to be supported to get up, how they spent their day and what meals and drinks they wished to have. One staff member said ‘‘This is what we are good at; giving people choice in all aspects of their lives.’’
People’s health care needs were well met. Relatives confirmed they were kept informed about any changes in people’s health or general well-being.
Staff ensured people were eating and drinking sufficient quantities to maintain good health.
Staff had training, support and supervision to help them understand their role and provide care in a safe way. Staff felt their views were listened to and understood the ethos of the home. This was to provide a safe, homely environment for people to enjoy and to offer people choice in everyday life. Where possible, people were supported and encouraged to be independent. This included having the right equipment for people to eat independently.
Most people lacked capacity, and this had been fully considered in light of the 2014 supreme court ruling, covering mental capacity and the need to consider Deprivation of Liberty Safeguards (DoLS). The registered manager was not aware she needed to inform CQC about DoLS in place for people, but had applied on behalf of most people and had three which had been assessed.
People were protected by the service having clear recruitment processes, which ensured only staff suitable to work with vulnerable people were employed. Medicines were being well managed which also helped to protect people.
There were a range of audits to ensure the environment was safe, clean and homely. Complaints were responded to in a timely way. Relatives confirmed they had confidence in the registered manager and staff team to be able to respond to their concerns and suggestions.
We looked at how incident and accident forms were collated. We saw that each lodge now had an incident form folder. The folder contained important information for staff to follow should an incident or accident occur. For example, on completing a form it was now to be passed to a senior on duty, instead of putting it in a senior staff member's tray. This ensured that any actions required were done in a timely way.
We saw the 'accident/incident monitoring and handover form' which logged all incidents and accidents. This enabled staff to see where themes were occurring. We saw that where incident themes were occurring that additional actions were put in place. For example, we saw that a protocol and risk assessment was in place for staff to follow due to changes in a person's behaviour. This demonstrated that every effort was taken to ensure the wellbeing of the person and that of others.
We saw that people were supported to have their personal and health care needs met in accordance with their individual care plans. Staff knew people well, understood how they expressed themselves and treated them with consideration and respect. Living arrangements and activities were provided in a way that gave people some quality in their life. Indoors, people's comfort was well managed and they were provided with lights and music to suit them. Outdoor activities were provided in the service's day centre and elsewhere.
We found that medication was managed safely and reliably to maintain people's health and well-being. Sufficient staff were employed to provide care in a safe way. Staff observed people and listened to their relatives to provide a sensitive and responsive service. They had not kept a record of concerns brought to their attention which would enable them to recognise any weak points in the service and take action. Good care records were kept but they were not always managed and communicated to all staff in a reliable way.
People who used the service at Northam Lodge had a learning disability and none of these people were able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.
We saw that staff treated people with consideration and respect. For example, we saw that staff quickly responded to people's care needs to ensure that they were kept comfortable and informed about what was happening, such as when lunch would be ready, when activities were due to start and when family members were due to visit.
Staff had knowledge of privacy, dignity, independence and human rights. For example, how to maintain privacy and dignity when assisting with personal care. They showed an understanding of the need to encourage people to be involved in their care. For example, staff recognised the need to promote positive experiences for people to aid their wellbeing through offering a range of activities to choose to partake in or spending one-to-one time with them.
Care plans that we saw reflected people's health and social care needs and demonstrated that other health and social care professionals were involved.
We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have. Staff we spoke with felt confident about responding to changing needs and knew what signs of abuse to look out for during their daily practice.
Staff told us they received health and social care needs specific training which they believed helped to equip them to do their job. Staff said they received supervision and appraisals and that the management team provided close supervision, advice and support.