Northhill 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.

Northhill is registered to provide accommodation and personal care for up to 28 older people. The accommodation is based over three floors, which are accessed by stairs or a lift. The home is situated in a residential area, close to local amenities and transport links.

At the time of this inspection, 27 people were living at Northhill.

At our last inspection, we rated the service Good. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing 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.

At this inspection, we found the service remained Good.

Why the service is rated Good.

People receiving support told us they felt safe. Our observations throughout our inspection showed people’s safety was promoted.

Staff were aware of their responsibilities in keeping people safe.

Policies and procedures for the safe handling of medicines were in place.

The recruitment procedures in operation promoted people’s safety.

Staff were provided with relevant training, supervision and appraisal so they had the skills they needed to undertake their role.

People receiving support and their relatives felt staff had the right skills to do their job. They said staff were respectful and kind in their approach.

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

People’s care plans contained relevant information and had been reviewed to ensure they were up to date.

People were confident in reporting concerns to the registered manager and staff, and felt they would be listened to.

There were quality assurance and audit processes in place to make sure the service was running well.

The service had a full range of policies and procedures available to staff.

Further information is in the detailed findings below.

The inspection took place on 2 February 2016 and was unannounced. The home was previously inspected in May 2014 and the service was meeting the regulations we looked at.

Northhill Care Home is in north Sheffield. The home has an enclosed garden area and is close to a bus stop and some local amenities. Northill Care Home provides accommodation for up to 28 older people. Accommodation is provided over three floors, accessed by a lift. All bedrooms are ensuite. At the time of our inspection there were 27 people using the service.

The service had a registered manager in post at the time of our inspection. 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.

We spoke with staff about safeguarding people from abuse and they were very knowledgeable about this. They told us they attended training and they had learned about the different types of abuse and how to recognise and report it.

We looked at three recruitment files and found the provider had a safe and effective system in place for employing new staff.

We looked at systems in place to manage medicines and found that they were safe. Medicines were stored and administered correctly.

Care plans we looked at identified any risks associated with people’s care. For example risk assessments were in place for falls, choking, pressure area care and nutritional needs.

We spoke with staff who said they received appropriate training which gave them the skills and confidence to carry out their responsibilities. Training included moving and handling, first aid, health and safety, fire prevention, safeguarding, and food hygiene.

Through our observations and from talking with staff and the registered manager we found the service to be meeting the requirements of the DoLS. Staff confirmed they had received training in this subject.

People were offered a choice of food at each meal, and drinks and snacks were provided throughout the day in line with their preferences and dietary requirements.

We looked at people's care plans and found that relevant healthcare professionals were involved in their care when required. For example, district nurse and speech and language therapist.

We observed staff supporting people and found they were respectful and caring in nature. Care plans we saw included information about people’s likes and dislikes.

The service had identified key staff to be champions in areas such as dignity, end of life care, and dementia. These individuals attended meetings and training to promote best practice and implement any changes as required.

We looked at care records belonging to three peoples and found they were informative and reflected the care and support being given. Care records included activities of daily living which explained how best to support the person.

The service employed an activity co-ordinator who was available in this role two days a week. We spoke with this person and they told us that they used this time to take people out or for one to one activities and games. We were told that other people from the surrounding community visited the home frequently to provide a range of activities such as flower arranging, chair exercises and a puppet group.

The provider had a complaints procedure and people felt able to raise concerns if they needed to. The registered manager kept a log of concerns received and addressed them effectively.

People told us the registered manager was supportive and there was a good leadership structure in place. People felt able to approach the registered manager and felt she listened to them and acted on what they told her.

We saw regular audits took place to check the quality of service provision. Action plans were devised to follow up any iss

We spoke with four people who lived at Northill Care Home in order to gain their experience of living at the home.

One of person told us, “I couldn’t wish for a better place to live, everyone is so kind to me.” Another person said, “I love everything about living here.” The same person stated, “the staff care for me well and always treat me very nicely.” Another person told us that staff at Northill, “know all my quirks, what I need help with and exactly how to help me.”

We spoke with people about how staff respected their dignity and privacy. One person told us, “carers always, always knock on the door before they come into my room” and that, “the carers don’t rush me and always encourage me to do as much as I can.”

One person told us that the food at Northill was, “great,” and was, “good home cooking from scratch.” They told us that there were a range of menu choices and also valued the fact that their views were sought about menus within the home.

People were positive about activities offered by the home. A number of people told us about their enjoyment of the regular keep-fit sessions in the home. One person said, “I love keep-fit and definitely know I’ve had a workout afterwards!” People were also positive about the recent trip to the Yorkshire Wildlife Park. One person told us that they were reluctant to go but that staff encouraged them and, “were marvelous and made sure we all had a great day despite the rain.”

We spoke to people about cleanliness within the home. One person who used the service said, “it’s always clean here.”

We spoke with one relative. They told us that they were confident in the way in which their relative was cared for, and that they were informed straight away of any issues about their relative’s care.They also told us that the home and their family member’s room was, “always clean and spotless.”

We used a number of different methods to help us understand the experiences of people living at Northill Care Home. This was because some people were unable to verbally communicate their experiences to us. We spoke with three people and sat and spent time in the dining room and two of the three lounge areas within the home. Our observations and conversations enabled us to see how staff interacted with people and to see how care was provided. We also spoke with four relatives, four members of staff and reviewed the care plans and other related documents of seven people.

The registered manager was on leave at the time of our inspection. We spoke with them on their return to work the following day in order to gather further information for our inspection.

An adult social care inspector carried out this inspection. We considered all the evidence we had gathered against the outcomes we inspected in order to answer our five key 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 describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at-

Is the service safe?

Throughout our observations we noted that people appeared relaxed with the care staff and seemed happy with the way in which staff were meeting their needs.

Each care plan reviewed during our inspection was comprehensive and reflected current good practice guidance about person centred, outcome focussed care. This was demonstrated as each plan included person centred information about people’s individual needs, how they liked to be supported and the outcome to be achieved.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may lack capacity to make key decisions about their care and treatment. We found that the MCA had been followed in relation to decisions about medical treatment. Staff were also aware of the role of Independent Mental Capacity Advocates (IMCA’s) to ensure that people’s needs were recognised and their rights protected.

At the time of our inspection there were two people subject to a DoLS. The safeguards are used if extra restrictions or restraints are needed which may deprive a person of their liberty. The registered manager and each member of staff had a good understanding of the safeguards and when these may be needed.

During our inspection we observed a senior carer administering breakfast and lunchtime medicines to three people. Our observations, conversations with staff and review of records showed us that medicines were stored, dispensed, administered and recorded safely and appropriately.

The staff at Northill Care Home were knowledgeable about the support and equipment people needed to move safely. We found that staff had received training about how to use equipment safely. Regular internal and external checks were undertaken to ensure that equipment was properly maintained and serviced.

We found that Northill Care Home had an effective process in place to ensure that employees were of good character and held the necessary checks, skills and qualifications needed provide safe and effective care to people.

Is the service effective?

People's care records showed that care and treatment had been planned and delivered in

a way that was intended to ensure people's safety and welfare. One person said, “it’s a home from home from home; they look after you alright here.” Another person stated, “everything is very good here; I can’t fault anything.”

We found that Northill Care Home provided a number of social opportunities and day time activities to promote people’s wellbeing. Opportunities provided included a weekly exercise class, a fortnightly flower arranging class and visits from a community gardening group to grow flowers, fruit and vegetables. We also found that the home also considered and provided opportunities and activities for people with dementia. For example, at the time of our inspection, the home was taking part in a dementia art project organised by the University of Sheffield. To stimulate memories and conversations with people with dementia, a large board decorated with baubles of the world had been fixed to one of the walls within the main corridor of the home. Northill Care Home had asked people and their relatives to provide photographs of past holidays and travels to fix onto this board.

Is the service caring?

One person who lived at Northill Care Home said, “it’s a home from home from home; they look after you alright here.” Another person stated, “everything is very good here; I can’t fault anything.” People were also positive about the staff at Northill Care Home. One person described the staff as, “very good.” Another person told us the staff were, “commendable,” and said, “they are nice, caring and talk to you.” Relatives spoken with during our inspection were similarly positive about the staff and the care their family member’s received at Northill Care Home.

Throughout our inspection the atmosphere within the home was calm and supportive. We saw that people were given support when they needed or requested it. People appeared relaxed with the care staff and seemed happy with the way in which staff were meeting their needs. We noted that staff clearly knew people well and frequently heard them use information about people’s hobbies and families to engage and prompt conversations.

Is the service responsive?

Observations on the day of our inspection showed us that Northill Care Home appropriately responded and met people's individual care needs and requests. We saw that staff responded promptly to people's needs.

One relative described the staff as, “on the ball,” and felt that the staff knew, and were skilled in meeting their family member’s needs. They also told us that the home were, “absolutely brilliant at keeping us informed and getting help from the doctor and district nurses when needed.” This showed us that Northill Care Home were responsive and sought advice when necessary in order to ensure safe, effective care to meet people’s individual needs.

Is the service well led?

We found that Northill Care Home had effective systems to assess and monitor the quality of the service they provided. A number of staff at Northill Care Homes were champions for differing areas of the service. These staff attended meetings about these areas and shared information from them in order to continually improve the quality of service. They also undertook audits relating to their areas of responsibility. Audits seen on the day of our inspection included medication audits, equipment audits and infection control audits.

During our inspection we noted that the registered manager had been proactive in responding to an issue raised about confidentiality by a relative. We found that the action taken was thorough and appropriate and evidenced the homes commitment to reduce the risk of reoccurrence and improve practice within the home.

We saw that people, their relatives and staff were able to give their opinion of the service by completing an annual survey. The results of the most recent relatives and resident’s survey were positive. There was also a suggestion box for people, relatives and staff. The notice on this box stated, “please give us your views and ideas and give us solutions as well as problems. We will feedback each month about what we have done in response.” This clearly demonstrated the home’s commitment to listen to suggestions and issues in order to continually improve the service people received at Northill Care Home.