We inspected Northfield House on 25 September 2018. Northfield House is registered to provide accommodation and personal care to 25 older people and people living with dementia.

We carried out this inspection following anonymous concerns raised regarding the service in July 2018, these concerns were focused on the safety of people. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to /this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Northfield House on our website at www.cqc.org.uk.

At the time of our inspection, 23 people were living at Northfield House, one of these people was in hospital at the time of the inspection. Northfield House is based near the centre of Stroud. Northfield House has accommodation for people over three floors. The home has an enclosed garden which people could enjoy, as well as a lounge diner, and two other communal lounges, one on the first floor and one on the ground floor. This was an unannounced inspection.

We previously inspected the home on 17 August 2017. The service was meeting all the requirements and we rated the service as “Good” overall.

At this inspection in September 2018, we only looked at ‘Is the service safe?’ and ‘Is the service well led?’ questions. We found concerns regarding people’s recorded care assessments and shortfalls in good governance procedures operated by the registered manager and provider. At this inspection the service was rated ‘Requires Improvement’ overall.

There was a registered manager in place at Northfield House. 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 told us they were safe living at Northfield House. However, we identified shortfalls in people’s care records that could place people at risk of unsafe care or treatment. Where staff had identified risks to people’s health and wellbeing there was not always risk assessments or guidance in place on how to assist people to reduce these assessed risks. Staff we spoke with were able to tell us how they assisted people to reduce their risks and prevent them from avoidable harm.

People’s prescribed medicine stocks were managed well, however there was not clear guidance to assist people with their medicines which had been prescribed ‘as required’ such as pain relief or anti-anxiety medicines. Additionally, there were not always clear guidance in relation to how people’s covert medicines should be provided.

There were enough staff deployed to ensure people’s health needs were being met. There was some unexpected staff absence on the day of our inspection however care staff felt this was manageable. The registered manager had informal systems to learn from incidents and accidents and reduce future incidents of preventable harm and share this information with staff.

The registered manager and provider had some systems to monitor the quality of care people received at Northfield House, however these were not always robust or consistent. Audits were not always effective at identifying concerns that we found in relation to staff performance, people’s risk assessments and the management of medicines. There were not always robust and structured systems in place to seek and act on the views of people, their relatives or healthcare professionals.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The inspection took place on 26 April 2017. This was an unannounced inspection. The service was last inspected on 17 and 18 February 2016.

At the time of the last inspection, there was one breach of regulation. At our comprehensive inspection on 26 April 2017 the provider had followed their action plan with regard to meeting the requirements of the regulations.

Northfield House is a care home based in Stroud and provides accommodation and support for up to 25 older people without nursing. People who use the service may have dementia. It is a detached property in a residential area with local amenities nearby. There were 24 people using the service at the time of the inspection.

There was a registered manager in post at Northfield House. 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 service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment to support people. Staff had a good awareness of safeguarding policies and procedures and felt confident to raise any issues of concerns with the management team. The registered manager had carried out the relevant checks to ensure they employed suitable people at Northfield House.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Where required, the service was adhering to the principles of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS). The environment had been adapted to meet the needs of people living at the home. People were supported to personalise their living spaces.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained peoples dignity. Where required, people were receiving end of life support which reflected their needs and preferences.

The service was responsive to people’s needs. Support plans were person centred and contained sufficient detail to provide consistent, high quality care and support. People were supported to engage in a range of activities based on their preferences and interests. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was well-led. There was a registered manager working at the service. Staff and people using the service spoke positively about the registered manager. Quality assurance checks and audits were occurring regularly and where issues had been identified action had been taken to address them. The registered manager and staff were aware of the vision and values of the service and worked hard to provide a person centred service to everyone living at Northfield House.

The inspection took place on 17 and 18 February 2016. This was an unannounced inspection. The service was last inspected in September 2014. There were no breaches of regulations.

Northfield House is a care home based in Stroud and provides accommodation and support for up to 25 older people without nursing. People who use the service may have dementia. It is a detached property in a residential area with local amenities nearby. There were 18 people using the service at the time of the inspection.

There was a registered manager in post at Northfield House. working at the home for 28 years and had been the registered manager since June 2009. 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.’

Risk assessments were implemented but these were not always updated to reflect the current level of risk. This meant there were no clear guidelines for staff to follow to minimise risks to people.

There were suitable arrangements in place for the safe storage, receipt and administration of people’s medicines.

People and their families were provided with opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. This included meetings with staff members and other health and social care professionals.

People were supported to access and attend a range of activities. People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.

People’s needs were regularly assessed and care plans provided guidance to staff on how people were to be supported. The planning of people’s care, treatment and support was personalised to reflect people’s preferences and personalities.

The staff at the home had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLs). These safeguards aim to protect people from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

Where people lacked capacity, best interests meetings had taken place involving other professionals ensuring decisions were made in peoples’ best interests.

The staff recruitment process was robust and ensured the staff employed would have the skills to support people. Staff were knowledgeable about people. They had received suitable training to support people safely enabling them to respond to their care and support needs.

The service maintained daily records of how peoples support needs were met. Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way responding to their needs.

There was a complaints procedure for people, families and friends to use and compliments were recorded. We saw that the service took time to work with and understand people’s individual way of communicating so that the service staff could respond appropriately to the person.

The provider had quality monitoring systems in place which were used to bring about improvements to the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The purpose of this inspection was to find out is the service safe? We completed an inspection in September 2013 and we told the provider to take action. Below is a summary of what we found. The summary is based on our observations during the inspection and looking at further evidence the provider sent to us.

If you want to see the evidence supporting our summary please read the full report.

We used the information we collected during this inspection, to answer one of the five questions which now form the basis of our inspections. Is the service safe?

Is the service safe?

We found some of the unsafe floor covering we identified as being unsafe had been replaced. The remaining areas were scheduled to be replaced the week after this visit on the 9 & 10 September 2014. Following the inspection the provider sent us a pictorial record of the remaining areas that were completed and a record of regular maintenance audits this year where action was identified to improve the environment. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

People told us about what it was like to live at the home and how they felt they were cared for by the staff. One person told us "I am cared for very well by my staff and my family that regularly visit me” and “Unfortunately I am not very independent but the staff work hard and care for me very well, I have no grumbles”.

Staff told us that the home's computers were password protected with people’s information securely stored on the system. We spoke with the registered manager who told us each staff member had their own password with different security settings applied depending on the staff member’s job role within the home.

People confirmed that staff listened to them and acted appropriately to their requests. People told us “I find the staff are approachable and helpful” and “The staff are very busy but always have time to talk to me and reassure me that I am ok”.

We walked around the home and saw that the first floor corridor, second floor landing and the first floor lounge carpets were very worn and had areas of discoloration throughout.

We spoke with four people living in Northfield House and two relatives. All of the people that we spoke with were positive about the support they received at the home. One person told us that they "couldn't be looked after any better". Another person told us about their relative being very ill and that it was the "determination" of staff that helped them to get better. We saw that people were dressed in clean clothes and one of the people that we spoke with was pleased to have had their nails painted.

During our visit we saw that three cleaning staff were on duty and the home was kept clean and well maintained. People that we spoke with confirmed that their rooms were cleaned daily and bed sheets changed regularly. Cleaning staff told us that they had all the equipment they needed to do their jobs.

We saw that people were asked for their consent to various aspects of their care and were included in the care planning process. Care plans that we viewed were reviewed regularly and risk assessments were in place to ensure that people were cared for safely.

We saw that staffing levels were sufficient to meet people's needs on the day of our visit. We did hear that weekend staffing levels could be a problem at times and that recruitment was taking place to try and address this.

We spoke with five people who lived at Northfield House. They told us that the staff asked them about what care and support they needed. They said that staff were respectful and polite and respect their privacy. People said that they could spend time in their rooms or the lounges as they chose. One person said "I like it here." Relatives could visit at any time and people could go out with their relatives when they chose.

People said that their needs were assessed when they moved into the home and they each had a care plan. They said they felt safe in the home and they knew how to raise any concerns. People said that they had the equipment that they needed and this was maintained.

People told us that they had opportunities to comment on their treatment and care and the quality of the service provided. They all said that they had no complaints and they would tell a senior member of staff if they had a complaint.