This was an unannounced inspection which took place over two days on 6 and 7 April 2016. The service was last inspected in August 2014 and was meeting the regulations in force at the time.Northbourne is a care home which provides personal care for up to 33 people. Care is primarily provided for older people, including people who have dementia related conditions. There were 33 people living there at the time of inspection.
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.’
The home was warm, clean and had comfortable communal areas. The home was undergoing refurbishment and had been adapted to meet the needs of people with a dementia related condition. There were sufficient staff, with different skills to meet the needs of the people living there.
People told us they felt safe, being cared for by staff who knew them well. Staff told us they knew how to raise concerns and had confidence action would be taken if they had any issues. Relatives told us they felt their families were safe at Northbourne and the home was welcoming and had a happy atmosphere.
Risks to people, such as for malnutrition and skin integrity, were assessed and care plans were in place to protect people from harm. Where people’s needs changed, referrals were made to health care services and advice from external professionals was integrated quickly into the care plans and acted upon.
Staff were trained so that they could work with different people and were deployed so there was sufficient staffing. Staff were effectively deployed throughout the day to meet the needs of people. For example, ensuring there was support for people at mealtimes.
People’s medicines were managed safely; stock control and ordering were managed by trained staff with checks to ensure that the risk of errors were minimised. Audits were carried out regularly to ensure that staff were competent and that any errors would be quickly identified and action taken to reduce their reoccurrence.
Care was effective and people received care based on best practice and the latest advice from external professionals. Care plans were detailed and personalised. This had not been consistent over time, but this had been identified and action taken to update all peoples’ care plans. People’s consent was sought, where this was possible. Where people could not consent, their care was delivered in their best interests after consultation with family and external professionals.
There were a number of people subject to Deprivation of Liberty Safeguards (DoLS) and these had been managed by the service, with referrals for local authority authorisation being made appropriately. The service had a system in place to ensure that renewals were requested promptly.
Staff were recruited robustly and received training based on the needs of people using the service including dementia awareness. Staff had undergone an induction period and their mandatory training was up to date.
People were supported to eat and drink and maintain a balanced diet. Staff supported people at mealtimes in a dignified way. We observed a calm and relaxed mealtime experience. The service monitored people’s weights and took further action if needed. Visiting health care professionals told us the care and support offered was effective.
Care interactions observed were positive and there were good relationships between people and staff. All staff we spoke with knew people’s needs well and spoke about them in a positive manner. People and their families were encouraged to express their views and be actively involved in making decisions about their care and support. There was evidence of people’s involvement in their initial admission assessments, reviews of care, as well as at meetings and surveys.
People’s’ choices and rights were respected. Staff knocked on doors before entering; they offered people choices throughout the day and responded to requests. People were encouraged to be part of their community and continue relationships and activities that had been important to them. The service had a reminiscence room that had period furniture and activities.
Where people or relatives had complained or raised queries about the service, the registered manager responded positively and the outcomes led to positive changes in the service.
Throughout our visit we observed staff and people responded to each other in a positive way. People were engaged in meaningful activity with support and staff took time to talk to people as they were carrying out their duties. We saw smiles and heard laughter as staff and people interacted. The activities coordinator offered a range of in house, one to one and external activities including outside entertainment.
The registered manager had taken steps to ensure the service was run effectively. There were regular meetings between staff within the home for the sharing of information. Regular quality audits were conducted and action was taken where incidents occurred or improvements could be made.