Northfield Manor is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. During our inspection 38 people were living at the service. The home has two areas, one of which provides more specialist support for those people living with a dementia or that may have cognitive impairment. The home has gardens with a greenhouse, vegetable allotments and chickens. Parking is available on site. The home is located on the outskirts of Driffield in East Yorkshire.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good with outstanding in the key question Responsive. There was no evidence or information from our inspection and on-going 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.

This inspection took place on the 16, 19 and 20 July 2018 and was unannounced.

Staff had exceptional skills and expertise which empowered people and their families to be involved in the care planning and review process. Management supported staff by offering specialist training in dementia care. This supported them to achieve person centred care that was responsive in meeting effective outcomes for people.

Relatives and records showed that staff were active in their approach and worked above and beyond to ensure people had the right support in place. Staff had a deeper level of understanding when supporting people with a dementia. Advice and guidance was sought from health professionals and best practice tools were utilised to support innovative working with individuals.

Relatives told us that words could not describe the patience and kindness of the management and staff team at this service. People were supported to freely express themselves and staff supported people and their relatives to have a voice. Relationships had been built on trust and excellent levels of communication to maintain relationships for people.

Staff took time speaking with people and their relatives to capture detailed information about what was important to them. This was used to support people to maintain their life skills and achieve their ambitions. People talked passionately about the intergenerational working with the local school and told us about the positive impact this had on their lives.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Risk assessments had measures in place to mitigate risks such as, choking or falls. Records were in place to monitor those that had identified risks and these were analysed regularly by the management team. Best practice guidance was available for staff if needed.

The provider had various quality assurance processes in place to maintain good practice and improve quality standards within the home.

People were protected from avoidable harm and abuse. Staff had received regular training and were knowledgeable about how to report any incidents. Systems and processes supported staff should they need to report a safeguarding incident.

Staff responsible for administration of medicines received regular training and competency checks. We found some areas of concern around the storage and recording of medicines. These were addressed by the registered manager as part of this inspection.

The provider monitored safe staffing levels and had robust recruitment checks in place. Staff felt supported in their role and received regular supervisions and annual appraisals. Opportunities were available to develop their skills further through additional training courses that were offered to them.

Staff

The inspection of Northfield Manor took place on 30 and 31 March 2016 and was unannounced. At the last inspection on 18 June 2014 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were superseded on 1 April 2015 by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Northfield Manor was registered to provide care and accommodation for up to 45 older people, but we were told that it operated with a maximum of 39. At the time of our inspection there were 36 people using the service. The home was situated in a residential development on the outskirts of the market town of Driffield. It was divided into two separate units; the main house where the majority of people resided and the Rose Garden unit where people living with dementia resided. Bedrooms were mainly single occupancy but there were four shared bedrooms. There were extensive and well maintained gardens where plenty of gardening activity took place in greenhouses and flower beds in the spring and summer months. There was a large decking area off one of the lounges where people sat and enjoyed the weather. The large dining room also provided a focal area for activity and socialising. The service had a separate unit for people living with dementia, where they had their own secure garden and single occupancy bedrooms. The service held the ‘Positive about Disabled People Symbol’, which was evidence of its commitment to equality of opportunity. Its values were ‘warmth, security, dignity, respect and choice’.

The registered provider was required to have a registered manager in post. At the time of our inspection there was a manager that had been registered and in post for the last two years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and group basis so that people avoided injury of harm wherever possible.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet people’s needs and we saw that rosters accurately reflected the people that were on duty. Discussion was held with the registered manager and registered provider to assess night time staffing levels and to look at some one-to-one hours. The registered provider carefully followed recruitment policies, procedures and practices to ensure staff were suitable to care for and support vulnerable people. We found that the management of medication was safe.

People were cared for and supported by qualified and competent staff that were regularly supervised and had their performance checked as part of an appraisal system. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People received adequate nutrition and hydration to maintain their health and wellbeing. The premises were suitable for providing care to older people and particularly to those people living with dementia, as the environment was planned, decorated and furnished so as to be conducive to their needs.

We assessed that people received compassionate care from kind and considerate staff and that staff knew about people’s needs and preferences. People wer

Our inspector visited the service and the information they collected helped answer our five questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records.

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

Is the service safe?

People received the care they required as recorded in their care plans. They said, "The staff do a lot for us as we both have our ailments. I am alright, but need a lot of support" and "I love it here. It is much better than being on my own." We saw from our observations and the care files that people received safe care and support.

Care and support was provided in a safe way by staff taking into consideration safe working practices and following current guidance on dementia and nursing care.

People told us they thought the service protected them from harm. They said, "I feel very safe living here" and "I feel very comfortable with the staff who are a nice bunch of people." We found that staff demonstrated that they understood their responsibilities when it came to safeguarding people and they had received training in safeguarding adults from abuse and therefore had the knowledge to recognise abuse and report it promptly so that people could be protected from harm.

We found that the premises were well maintained and service certificates were up to date. The service had good results from their last Environmental Health inspections and the laundry was organised and well managed. People lived in a safe environment. We found that people were supported safely because equipment used to aid their mobility was well maintained.

There were sufficient nursing and care staff on duty to ensure people were safely cared for when it came to providing people with the support of two staff, where people were assessed as needing it and required this.

Is the service effective?

We saw that staff assisted people in an effective and professional way and provided them with support when they asked for it. Staff offered people support when they thought people needed it.

Staff used moving and handling equipment effectively to ensure people received support with mobility, because staff had been trained in its use. Staff had received training in other areas, for example dementia care, end of life care and nutrition and hydration to enable them to provide effective care to people that used the service.

Is the service caring?

We found that staff were friendly and one visitor told us the staff did a fantastic job of caring for people. We saw that staff were patient and kind when responding to peoples' calls for assistance. One person said, "I am well looked after."

Is the service responsive?

We found that staff responded appropriately when meeting peoples' needs. Staff understood how to respond to individuals and worked hard at this to ensure people received the right message about how and when people would be supported when it couldn't be straight away, because staff were caring for someone else.

Is the service well led?

We saw that staff had good instructions within care plans on how to support people, and staff told us they felt the manager had implemented improved documentation to enable this. Staff stated that their roles were very busy as some peoples' dependencies were high, but they acknowledged that in the main they met peoples' needs in a timely and patient manner. They expressed that they now worked well in teams and believed they met peoples' needs well.

There was a quality assurance system in place that the manager was developing in order to identify areas for improvement and there was evidence that the manager guided staff on how best to care for and support people in order to meet their needs.

We visited Northfield Manor to assess the service's progress with achieving compliance with maintaining accurate and suitable records and to check there were no safety concerns in relation to pets brought into the home.

Overall we found that people received favourable outcomes in their daily lives and they were satisfied with the care and support they were given. There were no serious safety risks to people from the introduction of the new manager's dog. Risk assessments on allowing the dog into the home were introduced shortly after our visit.

We found that records pertaining to medication management had improved, so that medicines and creams were handled more prescriptively and recorded more accurately. This meant there was less risk of people not receiving their medication, creams and lotions according to the prescribed instructions when they needed them.

We visited Northfield Manor on 18 November 2013 as part of a responsive follow up inspection. At our previous visit of 13 September 2013 we had raised concerns that improvements the provider had said they would make regarding the management of medicines and quality assurance processes had not been done. We issued warning notice stating the provider was required to make necessary improvements by 27 October 2013. The purpose of the visit was to check that these improvements had been made.

We spoke with one person who said that they got the medicines that they needed and was glad that staff helped them manage them.

Following our visit on 13 September 2013 we had asked the provider to send us regular information regarding their quality audits. At this visit we considered the information that had been sent to us, alongside additional quality checks that had been completed. We found that improvements had been made to quality assurance processes.

We found that although improvements had been made regarding the management of medicines records were not always completed adequately. We also saw that where audits of care plans had been completed that recorded risk assessments had been updated, this was not always the case. This meant that risk assessments had not always been reviewed to make sure they still reflected people’s needs.

We visited Northfield Manor on 13 September 2013 as part of a responsive follow up inspection. The purpose of the visit was to check that improvements the provider said they would make following our inspection in April 2013 had been made.

Changes had been made to staff deployment to ensure people received adequate support at meal times. One person who used the service told us “It is nice home cooked food.”

We found the provider had made improvements with regard to cleanliness and infection control.

We found discrepancies in the stocks of medicines that suggested people had not received their medicines when nurses had recorded that they had been administered. The provider had not completed any medication audits so these errors had not been identified. This meant that people were at continued risk from the unsafe use and management of medicines.

Although the provider had developed a quality assurance calendar, audits had not been completed as planned for the management of medicines. Some staff had not had supervision so had not had opportunity to evidence learning from previous incidents and inspections.

Although this was a scheduled inspection the date of the inspection was brought forward due to information of concern that had been shared with us by the local safeguarding authority. The planning for this inspection was based on the concerns that had been shared.

We saw that there had been a lot of work undertaken by the provider to update the care plans of people who used the service. We found that people had been involved in decisions about their care and had consented to their care and treatment. Where people did not have capacity to consent we saw that staff were working to the principles of the Mental Capacity Act

People who used the service who we spoke with told us that staff were "All very good". People told us that they were satisfied with their care at the home. We observed a medication round and found that appropriate arrangements were not in place for the safe management and administration of medicines.

One person told us that there were times that they had to wait for support as staff were very busy. During our visit we observed times that staff were very busy and saw that this had an impact on the support people received over the lunchtime period.

One relative of a person who used the service told us that they were "Very impressed with the quality" and when speaking of the staff stated "I cannot sing their praises enough".

During our visit we found areas of the home that were not always clean. Some action was taken by the manager during our visit.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us they were happy in the home and would raise any concerns with the staff. The majority of people told us they liked the food provided in the home. Everyone felt that staff respected them.

People who were able to speak with us told us they could make choices about aspects of their lives and were encouraged to be independent. One person said, “It feels like home to me”. People also said they could make suggestions, but they were not sure if these had been followed up.

People told us they saw a range of health care professionals and staff respected their privacy, “They knock on the door to the bedroom and toilet before coming in”. A relative spoken with was very happy with the care provided.

People said that staff answered call bells quickly most of the time, but they also said they were very busy and they understood if they had to wait awhile. One person said, “The staff are very good”.