This unannounced inspection took place on 19 & 24 December 2018. Northwood Nursing Home is registered to provide accommodation and support for up to 35 people with health conditions, age related frailty and people living with dementia. It also provides nursing care. At the time of our inspection there were 30 people living in the home.

Northwood Nursing home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection in July 2017 we found that people’s liberty was being restricted unlawfully and the governance systems in place were not robust.

At this inspection we found that the service had worked hard to improve the safety, liberty and welfare of people at the home and now demonstrated good outcomes for people.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People felt safe and staff knew how to mitigate risks to people’s health and wellbeing. Medicines were managed safely and infection control practice adhered to. Safety checks and fire drills were completed appropriately.

People’s individual risk assessments in care records had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded when needed.

Staff demonstrated a good understanding of safeguarding procedures and signs of possible abuse. They told us they reported any concerns to senior staff on duty or their manager and they were aware of the whistleblowing procedures if they needed to elevate any concerns externally to local safeguarding authorities.

Staff were knowledgeable about people and were able to promptly identify changes in people’s needs.

Staff and people who lived at the home were knowledgeable in safety protocols and were provided with the opportunity of attending both fire safety and health and safety training to help ensure they were confident and able to maintain their own safety in case of an emergency.

People were looked after by enough staff, who were trained and supported to help meet peoples` individual needs.

Staff were recruited through robust procedures which ensured that staff working at the home were of good character and were suitable to work with the people they would be supporting.

People were supported to take their medicines safely by staff who had received training and had their competencies checked.

People`s consent to the care and support they received was obtained and staff worked within the principles of the Mental Capacity Act 2005 for people who lacked capacity to make certain decisions to ensure that the care and support they received was in their best interest.

People told us, and we observed, that the service provided a healthy and varied diet and in sufficient amounts to maintain people`s health and well-being.

The environment has been improved with some areas being redecorated and updated since the last inspection took place. The home was maintained to a safe standard.

Staff told us they received regular training and updates to ensure their skills and knowledge remained current in relation to their job responsibilities. Staff were well supported through a range of methods including work based observations, team meetings and individual supervisions.

People told us that staff were flexible and responsive to their needs and preferences. People told us and we observed that the care and support they received met their needs and was personalised to

The inspection took place on 30 June and 7 July 2017. There were 30 people being supported by the service at the time of our inspection.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

Northwood Nursing Home is registered to provide accommodation and support for up to 35 people with health conditions, age related frailty and people living with dementia. It also provides nursing care. At the time of our inspection there were 30 people living in the home.

When we last inspected the service on 23 and 30 September 2016 we found breaches of regulations 9, 11, 12, 14, 17 & 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was insufficient care planning in place to ensure people’s individual needs and choices were being met, people’s choices and preferences were not being upheld and their nutritional needs not being met.

There were ineffective systems in place to keep people safe, people’s dignity was not always respected or maintained. We found that people’s liberty was being restricted unlawfully and people were not always recruited with the necessary communication skills to provide safe care and treatment to people.

The provider’s governance systems were not robust and had failed to identify concerns we found as part of the inspection. We took action using our regulatory powers and imposed a condition on the provider’s registration to provide the Care Quality Commission with monthly action plans to ensure people were kept safe and their health and welfare was maintained. We also placed the service in Special Measures and kept the service under review along with referring our findings to the local authorities safeguarding and commissioning teams.

Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements.

At this inspection we found that the service had improved. People told us they received care and support that met their individual needs. People were involved in the development, planning and review of their care.

Staff knew people well and treated them with dignity and respect. Care plans had been improved and were now more personalised and contained detailed information about people’s support needs.

We found although record keeping had improved, some records were still inaccurate.

Staff knew how to recognise and respond to any allegations of abuse. However we found that people’s medicines were not always being managed or monitored safely and individual risks to people were not always reported or managed effectively.

People were supported by sufficient numbers of staff who were recruited through a robust process which helped ensure staff were suited for the roles they performed. Staff were inducted and received on-going training and support. Staff had individual supervisions and, team meetings in order to share good practice and discuss any concerns.

Although people were supported to make their own decisions, and to retain where possible, their everyday living skills, we found situations where people’s liberty was being restricted.

We found that people views were obtained through resident meetings with the registered manager. Although the service demonstrated they had improved the systems and processes in place to monitor the service in order to continue to improve the standard of care and support for everyone who used the service, this was still an area that required improvement.

We carried out this inspection on 23 and 30 September 2016. The inspection was conducted in response to concerning information received by the Care Quality Commission. We last carried out an inspection at the service on 29 September 2015. We found that the service required improvement in both safe and responsive. These issues related to insufficient hours allocated to people in order to pursue their interests and hobbies and inadequate safety measures with regard to the fire evacuation plan and inadequate individual risk assessments in place for people. At this inspection we found people remained at risk of inadequate safety measures and inconsistency of care and support provided to people.

Northwood Nursing Home is registered to provide accommodation and support for up to 35 people with health conditions, age related frailty and people living with dementia. It also provides nursing care. At the time of our inspection there were 30 people living in the home.

Although there was a manager in post they are not yet registered with the Care Quality Commission to manage the service. We were informed that they had submitted an application to become the manager in July 2016. 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 appeared unkempt and the support provided for their personal hygiene needs was not of a consistently good standard. People were placed at risk from pressure relieving equipment which was not being monitored effectively.

Recruitment processes were not always consistent in ensuring staff employed at the service were suitable to carry out their responsibilities and meet people`s needs. For some of whom English was not their first language we found they did not always understand the questions we asked them or what we were saying to them. The majority of the people who lived at the home had limited communication and therefore it was difficult to fully assess how this impacted on their health and welfare. We also noted that people were not required to complete a numeracy and literacy test in all cases prior to them commencing employment at the home.

The majority of staff understood how to promote and protect people’s rights and maintain their privacy and dignity. However, we observed several instances where members of staff failed to respect people’s privacy or dignity.

Engagement with activities and hobbies was limited. Loud music was playing in conjunction with a television within the main communal lounge area. We observed people were uninterested in either option and staff made no attempt to engage with people or offer people alternative choices of activities.

People’s care plans lacked detail or accurate information relating to people’s care and were not subject to regular review. Care plans were not person centred, and did not always contain sufficient detail to ensure they reflected people’s current needs and choices.

People were supported to take their medicines by appropriately trained staff. However, we found the process for the administration of medicines was not consistently safe.

Staff received support through induction and a training schedule with a mixture of E learning and face to face training. However training was not consistently effective in providing staff with the appropriate skills to help them meet the needs of the people who lived at the service. Staff told us that some of the training was completed at home and we could not be assured that staff were competent following completion of the training, especially for people whom English is their second language.

The service was not consistently well led and had not identified many of the issues we found during the course of our inspection. Where areas of concern had been identified appropriate actions had not been put in place to address these. Records were not completed in a timely way. Some of the staff were po

This inspection took place on 29 September 2015 and was unannounced. Northwood Nursing Home provides accommodation and personal care for up to 35 older people, some of whom may have dementia or physical disabilities. On the day of the inspection, there were 30 people living in the home.

The service has 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.

The experiences of people who lived at the care home were positive. They felt protected from the risks of possible harm or abuse. Information about the safeguarding procedures and how to report any allegations of abuse outside the service was available.

There were sufficient numbers of experienced and skilled staff to care for people safely and regular staff meetings were held to discuss issues relating to people’s general wellbeing and the day to day running of the home. We found that the recruitment system was effective and that staff had all the required checks carried out before and offer of employment was made. Medicines were managed safely and people received their medicines as prescribed.

People were treated with respect. Their privacy, dignity and independence was promoted. Their human rights were protected, and risks to individuals’ had been assessed and managed appropriately.

Staff had received training in Mental Capacity Act (2005. All staff we spoke with were aware of how to support people who lack mental capacity.

People and their relatives had been involved in the decisions about their [relative’s] care and support. Their care needs were assessed, reviewed and delivered in a person centred way. People’s nutritional and health care needs were met.

There are insufficient resources allocated for people to pursue their social interests and hobbies and to participate in activities provided at the care home.

There was a complaints procedure and complaints had been dealt with in accordance with the procedure.

There was an ‘open’ door culture where people said that the registered manager was visible and they were able to raise any concerns they had with them. The views of people were sought in various ways included, regular ‘residents’ meetings and yearly questionnaire surveys. Meetings with staff were held to discuss issues relating to people’s general wellbeing and the running of the home.

The inspection team was made up of one inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

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

Is the service safe?

People we spoke with all confirmed that they felt safe living at the home. One person told us “I feel very safe here”. We reviewed six care plans and were able to see that care plans were person centred and were regularly reviewed. We saw evidence that people and/or their relatives were involved in the care planning process. Risk assessments were regularly reviewed and provided information and guidance to staff on how to minimise potential risk to people.

Staff we spoke with knew where the policy was kept and knew how to make a referral should they have suspicions that a person using the service was being abused. We saw evidence that staff had received training in safeguarding vulnerable adults.

Health and safety checks were regularly undertaken by the manager and the provider to ensure that the home was safe for people to reside in.

Is the service effective?

We looked at the risk assessments and the care records of two people who lived at the home. We found these provided details of what people were able to do for themselves as well as what support they needed.

We saw evidence that people who used the service had a capacity assessment, which held details on people’s ability to make decisions. Where the provider had made applications to the local authority in respect of Deprivation of Liberty safeguards (DoLS), we saw this was recorded, monitored, reviewed and closed once the risk to the person cease to exist. On the day of our inspection the provider did not have any DoLS applications opened.

Is the service caring?

A relative we spoke with said “staff are kind and considerate”. During our inspection we observed staff members assisting people with task in a kind and patience manner. We heard staff asking people for their consent before providing support or undertaking any task. People and relatives we spoke with all said that staff were caring and polite.

Is the service responsive?

During our inspection we observed that staff responded in a timely manner when people asked for help. People were supported by staff to access services in the local community.

Is the service well-led?

A relative we spoke with said the home was “very well organised”. We saw that the service had a quality assurance system in place, which sought the views of people who used the service. We saw that audits had been undertaken in a number of areas by the provider.

People we spoke with said that they were happy with the service they had received. A GP we spoke with told us that people were well cared for and that the manager had made appropriate referrals to medical professionals.

During our tour of the home we saw that several people’s bedroom doors had been left open, we noted that people‘s care plan did not show that people were given a choice as to whether or not they liked their bedroom door left open. We saw evidence that the provider had sought consent from people in relation to care and support.

We observed that a section of the ceiling in the lounge was in disrepair and was leaking, there was a bowl situated under the leak however the carpet was extremely wet. There were no warning signs informing people that the area was hazardous and the area had not been cornered off. This meant that the provider had not taken appropriate action to ensure that people were kept safe.

Staff had received training in how to safeguard people from abuse, however staff were not always clear as to how they could report allegations of abuse outside the home. We saw that there was enough staff on duty to meet the needs of the people who used the service; however some staff had not received regular supervision and an annual appraisal.

The provider has systems in place to assess and monitored the quality of the service and the home had a complaints policy and procedure in place.

People we spoke with were generally complimentary about the service and the care provided. A person said, "Staff are very nice and pleasant." Another person said that the staff were 'very good and caring' and that they had 'no complaints' about the care provided.

People said that they were given choices for their meals, and there was also a choice of activities in which they could participate. A few people commented that the food did not always taste good, but most people found it satisfactory. We noted that the menu planning had reflected the diverse needs of people, and had accommodated their requests and preferences.

The lunch included a choice of hot meals, a selection of fresh fruit as well as a hot pudding for dessert. Soft drinks, tea and coffee were provided. We observed that staff were supportive with people who needed assistance during the meal, which was unhurried.

Several people we spoke with said that staff showed them respect, and took

account of their likes and dislikes. A person commented, "Staff take me to the shops. I buy what I like to eat. The staff are reliable and very pleasant."

We were able to speak with five of the people currently living at Northwood nursing Home when we visited the home on 20 March 2012. People living at Northwood Nursing Home told us that they were happy living there.

People told us that they liked living at Northwood Nursing Home because they were “well looked after”. The people who we spoke with told us that they received a good quality of care in the home. People told us that the staff were kind to them, and treated them well.

People told us that they liked getting their nails done and that a hairdresser came to the home to do their hair when requested.

People said that they liked the garden and they were able to sit outside in the patio area when the weather was good. People told us that they liked the conservatory and that they could eat lunch in there if they wanted to.

People told us that they liked the choice of food and they were able to choose what they ate and drank. People told us they had access to drinks all day and could have drinks in their room if they asked for them.

Some of the people who live at Northwood nursing Home told us that there were rules in place which restricted what they could do sometimes, such as going out to visit places.