Northfields is registered to provide accommodation and non-nursing care for up to seven people. At the time of this inspection there were seven people living in the home who had a learning disability. Each person had their own bedroom in the house. There were two communal kitchens, and lounges for people and their visitors to use.

This unannounced inspection took place on 12 October 2016 and was carried out by one inspector.

At the time of the inspection there was a registered manager in place. 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 Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

People felt safe and relatives said that they had no concerns about the arrangements that were in place to keep people safe. Although risk assessments were in place these did not always include information for staff about how the risk could be minimised. Staff had an understanding of how to protect people from harm and knew what action they should take if they had any concerns.

Staffing levels ensured that people received the support they required at the times they needed it. The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the home. People were involved in the recruitment procedures, with only the most appropriate staff being selected for a job.

Staff were kind and compassionate when working with people. They knew people well and were aware of their preferences, likes and dislikes. People’s privacy and dignity were upheld.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt and reliable access to healthcare services when needed. People were provided with a choice of food and drink that they enjoyed.

Support plans were in place detailing how people wished to be supported and these had been produced in conjunction with people using the service. People had agreed what care and support they needed and were fully involved in making decisions about their support. People participated in activities within the home or in the community and received the support they needed to help them to do this. People were able to choose how they spent their time and what activities they participated with.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the registered manager if they needed to. The complaints procedure was available in different formats so that it was accessible by everyone.

People had confidence in the registered manager and the way the home was run. The registered manager ensured the staff team were well supported and there were opportunities for people and staff to provide feedback about any improvements that could be made, and these were listened to and acted on.

This inspection was carried out by an inspector for adult social care services. We spoke with two members of staff, observed how people were supported and spoke with people living at Northfields. At our last inspection in June 2014, we asked five questions about the service: Is it safe? Is it caring? Is it effective? Is it responsive? Is it well led?

At our last inspection we found that we were not able to conclude that the service was as safe as it should be. Although staff understood how to meet people's needs we found that records were not kept up to date to reflect people's current needs. This included care records where the manager had identified an update was needed. This meant people were at risk of receiving unsafe or inappropriate care. We also found that people's personal records were left accessible in communal areas of the home. This meant that people's confidentiality was not properly protected. We asked the provider to tell us how they were going to make improvements in order to comply with the law about record keeping.

Is the service safe?

This inspection was carried out to check that record keeping practices had improved. This was so that we could be sure that this element of concern for the safety of the service had been addressed properly.

Although we spoke with four people living in the home, their feedback did not relate to the way their records were kept. Three people were enjoying watching the tennis together. One person was looking at magazines. Staff spoke with them respectfully and offered people choices of drink during the afternoon. They also offered people choice for their evening meal.

We reviewed the care records for four people living at Northfields and spoke with staff about people's needs. We found that records were held in locked cabinets, so that people's confidential information was properly protected.

We found that all of these people's plans of care and the assessments of risk to which they were exposed, had been updated. Where a person's needs had changed quickly this was clearly reflected in their file. The advice that had been given to the service by other professionals was included in the records. Staff were able to tell us about these changes and the outcomes of recent appointments. The information they gave us was consistent with what was in their plans.

We concluded that improvements had been made in respect of records, to ensure the service people received was safe.

We spoke with five of the people living in the home. We observed what was going on and how staff were supporting people and reviewed the information the manager sent to us. This 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.

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

Is the service safe?

People were treated with respect and dignity by staff. People told us that they liked the staff who worked with them.

Medicines were managed in a way that ensured they were safely recorded and administered.

We found that, since our last two inspections, improvements had been made to the way the safety of the service was monitored. Regular checks were now being made to ensure fire detection systems worked properly and that staff knew what to do in an emergency if a fire broke out.

Systems were in place to ensure that the safety of the service was monitored. This reduced the risk to people and helped the service to continually improve.

Although staff understood how to meet people's needs we found that records were not always up to date, even though some of them had been identified as needing an update to reflect people's current needs.

The home had procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We were given an example of how the manager had taken advice to see whether an application was needed regarding deprivation of liberty for someone living at the home. This meant people would be safeguarded as required. We provided information to the manager about a recent legal decision regarding DoLS so that further advice could be taken if required.

Is the service effective?

People's health and care were discussed with them. Specialist advice regarding mental health, behaviour, dietary needs, communication and swallowing difficulties had been sought where this was appropriate. It was clear from our observations and speaking with staff that they understood people's care and support needs. We asked people if they felt staff did their jobs properly and supported them well. They told us that they did. People said they were involved in discussions about their care and one person had helped to write part of their plan of care.

Is the service caring?

We saw that people were supported by attentive staff. There was a lot of laughing and good humour. People told us they felt well treated by staff. One person told staff, "You're lovely old people." Another person said, "Staff are alright. They treat me right." One relative had commented on their survey that the person they visited '...is so well cared for I cannot fault the staff.' They went on to write, 'Northfields is brilliant.'

We observed that staff respected people's privacy and knocked on bedroom doors before entry. We also observed that staff had the skills to distract someone who was becoming agitated and to calm the person. Our discussions showed that staff understood the impact of dementia for people living in the home.

Is the service responsive?

People were able to engage in activities inside and outside their home, with staff support as needed. People were also able to discuss how the home was being run at 'service user meetings'. Staff were able to give us examples of where people's needs had changed and how they were arranging for further advice in relation to their care. They were also able to tell us how people's concentration and ability fluctuated during the day and how they would explain and discuss things at the times when the person was most alert.

One person was supported to manage their own medicines because they wished to do so. They also told us, "We have meetings so we can talk about things."

Is the service well led?

The service had a quality assurance system so that shortfalls were identified and addressed promptly. This meant that the quality of the service could be improved where necessary.

We found that, despite identifying in January 2013, improvements were needed to the storage of records this had not been properly addressed. Confidential records were not held securely.

Staff spoken with were clear about their roles and responsibilities.

We found that there were appropriate processes in place at Northfields to obtain people's consent to their care, treatment and support.

We found that the service kept detailed support plans and risk assessments for people, which were updated regularly to ensure they reflected people's current needs. We spoke with two people using the service, and one person told us, "I go to work in a charity shop on Tuesdays". This means that the staff at Northfields are enabling people and supporting people to be independent and find meaningful occupation.

In March 2013, we told Northfields they needed to make improvements to the decor of the home and with carrying out checks on the fire alarm systems. We found that they had made improvements to the decor and that people had involvement in this. However, they had failed to ensure that checks on the fire alarm system were being carried out weekly as required. This meant they could not always guarantee the fire alarm system was operational.

We found that the service undertook the appropriate pre-employment checks to ensure that staff had the right skills, background and qualifications to provide care to people.

We found that there was an effective complaints procedure in place at Northfields. At the time of visit, Northfields had not received any complaints about the service.

We spoke to three people living at Northfields. One person told us "We get on well with staff - it's a good relationship." Another said "I do like living here." Relatives were also satisfied with the care their relations received. Staff kept them well informed about their family members where necessary and they were invited to meetings on a regular basis.

We found that records kept regarding people's care and treatment were extensive but a few gaps were noted. People's care and support was developed with them and reflected their needs and preferences.

We saw that people with specific requirements relating to nutrition and hydration were catered for appropriately and professional support and guidance on nutrition was adhered to.

The premises were secure and generally in good order. However, as the fire alarm had not been tested on a regular basis there was a risk that should a fire break out that the alarm was not operational which would jeopardise people's safety.

Staffing arrangements were in place to ensure that sufficient numbers of qualified and experienced staff were available at all times. The home had recently recruited three more staff which meant that recent reliance on bank or agency staff would be reduced. This would result in better continuity of care for people living at Northfields.

The provider had a complaints procedure in the event of any grievances arising.

People told us they like living at this home. They said they were involved in decision making because the service has regular house and key meetings at which they can voice their views. People told us they could spend their day doing as they wished. They could get up and go to bed when they pleased and they chose the food that was on the weekly menu.

One person told us they enjoyed watching films and liked to spend the afternoon either watching a film on the television or from their DVD and video collection. Another person said they enjoyed sport and they were enjoying watching snooker on the television.

People told us they liked the staff and said they could speak to them if anything bothered them. They said staff were always about although sometimes they had to wait to go out until staff were available, but this didn’t happen very often.