The inspection visit took place on 19 December 2016 and was unannounced.

Northfield House is a residential care home providing accommodation for up to 19 older people who live with dementia and / or physical disability and who require personal or nursing care. Accommodation is on three levels which are connected by a lift and stairs. People have use of two communal lounges and a lounge dining room, and garden. At the time of our inspection 18 people were using the service.

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. At the time of our inspection the registered manager was absent for more than 28 days. The service was being managed by the provider.

People who used the service were safe. They were supported and cared for by staff that had been recruited under recruitment procedures designed to ensure that people suited to work at the service were employed. Staff understood their responsibilities for protecting people from abuse and avoidable harm.

People’s care plans included risk assessments of activities associated with their personal care routines. The risk assessments provided information for care workers that enabled them to support people safely but without restricting their independence.

Enough suitably skilled and knowledgeable staff were deployed to meet the needs of the people using the service. Staffing levels were decided according to the needs of people using the service.

People were supported to receive the medicines by staff that were trained in medicines management. Medicines were stored safely.

Care workers were supported through supervision and training.

The provider understood their responsibilities under the Mental Capacity Act (MCA) 2015. Staff had awareness of the MCA and understood they could provide care and support only if a person consented to it and if the proper safeguards were put in place to protect their rights. There were people at Northfield House who were being cared for under Deprivation of Liberty Safeguards.

Staff understood the importance of people having healthy diets and eating and drinking. They supported people with their meals. They also supported people to access health services when they needed them.

Where they were able to be, people were involved in decisions about their care and support. They and their relatives received the information they needed about the service and about their care and support.

We observed staff treating people with dignity and respect. The provider actively promoted values of compassion and kindness in the service.

People and their relatives contributed to the assessment of their needs and to reviews of their care plans. Their care plans were centred on their individual needs. People knew how to raise concerns if they felt they had to and they were confident they would be taken seriously by the provider.

The service had effective arrangements for monitoring the quality of the service. These arrangements included asking for people’s feedback about the service and a range of checks and audits. The quality assurance procedures were used to identify and implement improvements to people’s experience of the service.

The inspection took place on 16 November 2015 and was unannounced. At our last inspection on 5 June 2014 the service was meeting the regulations.

Northfield House is a care home for older people and is registered to accommodate up to 19 people requiring care because of old age, physical disability or dementia. At the time of our visit there were 19 people using the service.

There is a registered manager at the service. 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.

People felt safe at the service and staff had a good understanding of the various types of abuse and knew how to report any concerns. Incidents and accidents were analysed to identify any patterns and trends. This allowed the service to take actions where necessary.

People were treated with dignity and respect. Staff knew people’s likes, dislikes and preferences. There were sufficient staff to meet people’s needs.

People told us that they received their medicines as they required. Where medicines were prescribed as PRN [as required] there were no protocols in place to ensure that people received them as and when they needed them.

People’s capacity to make decisions relating to their care had been considered within their care records. Where there was a reasonable doubt that a person had capacity to give consent the service worked within the principles of the Mental Capacity Act 2005.

There were activities carried out most afternoons. The majority of activities took place in the lounge area so people who spent the majority of time on their rooms were not involved. The service had responded to people’s requests and arranged an outing at people’s request.

People’s needs were assessed and care plans put in place to ensure that their needs were met. Where there were risks associated with people’s care control measures had been identified to reduce the risks. However it was not always evident that these were being carried out.

Quality assurance audits were carried out and regular meetings held with staff and people that used the service. People knew who the registered manager and provider were and felt able to talk to them about any concerns.

The registered manager was aware of the responsibilities of their role. We had received notifications from the service as required.

During our inspection we spoke with four people who used the service and two members of staff. Below is a summary of what we found. The summary describes what people using the service and the staff told us and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff knew about risk management plans and told us about how they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The provider ensured that staff rotas where planned so that people's care needs were taken into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met. People had their needs assessed before they began using the service.

Staff recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

The provider ensured that routine maintenance and safety checks were carried out on the premises and equipment. We saw that some redecoration was required in the corridors and downstairs toilet. The provider showed us written evidence that this work had been booked to take place 15 June 2014.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant policies and procedures were in place and the registered manager understood when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs were assessed before they moved in. Each person had a care plan in place and this was evaluated at least monthly.

Staff received the training and support they required to do their job and to keep people safe.

Is the service caring?

We spoke with four people who used the service. We asked them for their opinion about the staff that supported them. Feedback from people was positive, for example; “They are so kind to me”. “The staff are very good”.

When speaking with staff it was clear that they genuinely cared for the people they supported. They were positive about their role and said they liked working at Northfield House. Care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People told us they could speak with the staff at any time. ‘Residents meetings' were held so that people who used the service could give their feedback about the service they received.

We saw that staff referred people to appropriate healthcare professionals such as GP’s and community nurses as soon as this was required.

People who used the service told us that staff worked in a flexible way so that individual needs could be accommodated.

Is the service well led?

The provider had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People who used the service praised the registered manager and told us they could speak with them about any issue or concern. One person told us how the registered manager had helped them to maintain as much independence as possible.

During our inspection we spoke with four people using the service and two visiting relatives. We spoke to them about a range of issues regarding their planned care, food and nutrition, how they receive their medicines and if they knew of the complaints process. People were very positive about all of these areas and those that passed comment stated “I am happy with the food, its far better than the sandwiches I used to have at home”. When we spoke to people about the complaints process one person said “I have not had any reason to make a complaint, the staff are lovely”.

We observed staff talking with and assisting people throughout the visit, this was done with the peoples’ privacy and dignity in mind and showed the staffs’ awareness of peoples individual support needs.

We spoke with staff and they demonstrated they were aware how to support and protect people from malnourishment and dehydration. This was reflected in peoples support plans, risk assessments and other supporting paperwork we viewed. We also looked at how the staff were supported to undertake their caring responsibilities. We found that they are the subject of a continual training programme, backed up by individual and group meetings.

One person we spoke with stated that the staff were “nice people” and they were “helpful and friendly.” This person went on to say the “the food was nice” and that their preference was to spend most of her day watching television in her room, as often the televisions in the lounge were quite loud. Another person we spoke with was aware that staff supported her in her wish to be independent, but felt that they “kept and eye out for her.” This person added that much of furniture in the room was their own and this made the room more like home. They also said that they preferred to have their door locked when they left their room.

We spoke with three people who live at the service and one relative. They told us that they are able to talk to staff if they are unhappy about anything and they are consulted about their care and support.

"I am able to have my meals where I want, staff help me when I need help, they are very kind."

"I feel very lucky to have got her in here,it has worked out much better than we could have hoped."