CQC report explained · a residential care home
What the CQC found at Northfield House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- People received their medicines as prescribed, risks were assessed and staffing levels were suitable. Infection prevention and control arrangements also gave inspectors assurance.
- Effective?
- Requires improvement
- Some people's needs were not fully assessed or reflected in their care plans. Activities and engagement were not always tailored to people's needs and preferences.
- Caring?
- Good
- This key question was not inspected during this visit, so no rating was given in this report.
- Responsive?
- Good
- This key question was not inspected during this visit, so no rating was given in this report.
- Well-led?
- Requires improvement
- New monitoring systems had improved the service, but they had not identified all the problems with care records, falls records and personalised activities.
What inspectors found, January 2023
Requires Improvement; inspectors found safe care and better medicines systems, but person-centred care and quality checks still fell short.
This was an unannounced focused inspection on 06 and 07 December 2022. Inspectors spoke with people, relatives, staff and healthcare professionals. They observed care and checked care records, medicines records, staff files and management systems.
The home was rated Good for Safe. Medicines were now given as prescribed, risks were assessed, staffing levels were suitable and infection control arrangements were satisfactory. Staff also supported people with food, drink, healthcare and decisions about their care.
The home was rated Requires Improvement for Effective and Well-led. Care records were not always complete or up to date. Activities and engagement were not always suited to people's needs. Quality checks had improved but did not find all these problems.
The overall rating stayed at Requires Improvement. This was a focused inspection of Safe, Effective and Well-led. The Caring and Responsive ratings were carried over from the previous inspection because they were not checked during this visit.
Medicines
Inspectors found that medicines were now given as prescribed. New checks, training and guidance had improved medicines management.
“Improvements had been made and people had received their medicines as prescribed.” from the report
Risk management
People's risks were assessed and staff had guidance about how to keep them safe. The environment was also checked for risks such as fire and legionella.
“People's risks were assessed and known by care staff.” from the report
Food and drink
Staff understood people's dietary needs and supported people with meals and drinks. People spoke positively about the food.
“People received the support they needed to eat and drink.” from the report
Staff support
Permanent and agency staff received induction, training and supervision. Staff said they felt supported and had the skills to meet people's needs.
“Staff spoke positively about the training and support they received at Northfield House.” from the report
Incomplete care plans
seriousCare plans were not always accurate, complete or based on people's individual needs and preferences. One person did not have plans covering their mobility and behaviours when inspectors visited.
“People's care plans did not always support person centred care as they were not an accurate reflection of people's needs or preferences.” from the report
Limited activities
needs fixingPeople did not always have activities or engagement suited to their interests. Records also gave limited evidence of activities and engagement.
“People did not always benefit from effective engagement and activities which reflected their needs and preferences.” from the report
Weak quality checks
seriousThe home's monitoring systems had improved but did not find all the shortfalls inspectors identified. This included problems with care assessments, falls records and activities.
“The provider's quality monitoring processes had not been effective in identifying and addressing quality concerns.” from the report
Falls records
needs fixingPost-fall observations were not always recorded as required by the home's own protocol. Managers had reminded staff about the process, but records were still incomplete.
“Where people had an accident there was not always a record of post falls observations as per the providers post fall protocols.” from the report
- 01How have you updated each person's care plan so it accurately reflects their current needs, mobility, behaviours and preferences?
- 02What activities and daily engagement are now available for my relative, and how are they matched to their interests?
- 03How do you check that post-fall observations and other care records are completed correctly every time?
- 04What evidence can you show that your quality monitoring now identifies missing or inaccurate care records?
- 05How is the recruitment of permanent staff progressing, and how are agency staff being supported to provide consistent care?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings were used for the overall rating. This explanation was written from the published report of 24 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2022
Northfield House was rated Requires Improvement; inspectors found medicine, risk assessment and care record problems, although staffing and infection control were reassuring.
This was an unannounced focused inspection on 24 and 25 August 2022. Inspectors looked mainly at Safe, Effective and Well-led because of concerns about falls, blood-thinning medicines and moving and handling. They spoke with people, relatives, staff and a health professional, observed care, and checked care, medicine and management records.
Inspectors found that people did not always receive medicines as prescribed. Risks were not always assessed or reviewed properly. Care plans and records did not always give staff clear, up-to-date instructions. Some people did not receive the support they needed to eat and drink.
There were also positive findings. Staffing levels were enough at the time of the inspection, staff received training, infection control arrangements were satisfactory, and people could access health professionals. The overall rating changed from Good at the previous inspection to Requires Improvement. This means there were important shortfalls and only limited assurance about safety.
Enough staff at the inspection
The provider was using agency staff and permanent staff flexibly. Inspectors found enough staff to meet people's needs at the time of the visit.
“At the time of the inspection there were enough staff to meet people's needs and to support the overall running of the care home.” from the report
Infection control
Inspectors were assured about infection prevention, use of protective equipment and the home's ability to manage an outbreak.
“We were assured that the provider was responding effectively to risks and signs of infection.” from the report
Access to healthcare
People could see a GP and access other health services, including dental, optical and chiropody support when needed.
“People had access to a GP when needed.” from the report
Consent and least restriction
Staff sought consent and decisions for people who lacked capacity were made in their best interests. The report says people were supported with maximum choice and control.
“Staff sought people's consent prior to delivering care.” from the report
Medicines were not always safe
seriousSome medicines were missed, doses were misread and one medicine was stored in the wrong packaging. Errors were not always reported or acted on.
“People had not always received their medicines as prescribed.” from the report
Risks were not fully managed
seriousRisk assessments and care plans were missing or out of date for issues including falls, seizures, poor mobility, blood-thinning medicines and fire evacuation. Wound care was also provided without the right professional assessment and treatment plan.
“People's risks had not always been fully assessed.” from the report
Support with food and drink
seriousSome people were not prompted or supervised to eat, and changes in nutritional needs were not always recorded. Missed meals and refusals were not consistently reported.
“People did not always receive the support they needed to eat and drink.” from the report
Weak monitoring and records
seriousThe provider's checks did not identify the problems found by inspectors. Care plans, risk assessments, wound records and daily records were not consistently complete or accurate.
“The provider's quality monitoring processes had not been effective in identifying the shortfalls we found during this inspection.” from the report
- 01What has changed to make sure every medicine is given as prescribed and all medicine errors are reported and investigated?
- 02How are risk assessments updated after a fall, seizure, change in mobility or other change in health?
- 03How will staff know when a person needs prompting, supervision or help with eating and drinking?
- 04What checks now make sure care plans, wound records, risk assessments and daily records are complete and up to date?
- 05How are agency staff kept familiar with each person's needs, and how much reliance is there still on agency staff?
This was a focused inspection of Safe, Effective and Well-led, with infection prevention and control also checked under Safe; the other key question ratings were carried over from the previous inspection. This explanation was written from the published report of 13 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Northfield House
9 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- January 2023Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2022Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- July 2021Goodup from Requires improvementSafe: GoodWell-led: Good
- November 2020Requires improvementstayed Requires improvementSafe: Inspected but not rated
- October 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- November 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- November 2018Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- July 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 11 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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38 live-in carers within about an hour of Gloucestershire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,030 to £1,360 a week. 31 can care for a couple. 12 years' experience on average.
“She was very caring, kind and patient to all his needs, she built up a wondetful rapport with him, she was dedicated and was there for him through good times as well as through the tough times”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.