CQC report explained · a residential care home
What the CQC found at Northfield House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, May 2022
Rated Requires Improvement; inspectors found major improvements, but safety and person-centred care still had legal breaches, and the home had only recently left Special Measures.
This was a focused inspection on 10 and 21 March 2022. Inspectors checked Safe, Effective and Well-led, including infection control and whether the home had acted on its previous improvement plan.
The home had improved since its previous Inadequate rating. Staffing, recruitment, medicines, cleaning, communication and the environment were better. People were supported with activities, food choices, healthcare and communication in ways suited to them.
There were still important problems. Some risk assessments and care records were not up to date or clear. Infection control and visiting arrangements during a COVID-19 outbreak were not always safe. Mental Capacity Act records also needed more work.
The overall rating was Requires Improvement. The home remained in breach of Regulation 9 and Regulation 12, but it was no longer Inadequate or in Special Measures. CQC said it would request an action plan and return to check progress.
Kind and respectful care
Inspectors found that people received kind care and that staff understood their individual needs, privacy and dignity.
“People received kind and compassionate care. Staff protected and respected people's privacy and dignity.” from the report
Improved staffing
The home had enough staff, including support for activities and visits. Recruitment checks and induction arrangements had improved since the previous inspection.
“The service had enough staff, including for one-to-one support for people to take part in activities and visits how and when they wanted.” from the report
Safer medicines systems
Medicines were stored securely and detailed guidance was available. A recording problem found during the inspection was corrected immediately.
“Medicines were stored securely, and procedures were in place to ensure adequate supplies of medicines were maintained.” from the report
More open management
Families, staff and professionals said communication and responsiveness had improved. Managers were described as approachable and willing to act on feedback.
“Staff and people's family members told us that they felt listened to and involved in the changes being made to the service.” from the report
Improved environment
The home was cleaner, better maintained and more suitable for people's sensory needs than at the previous inspection.
“Changes had been made to the design of the home since the last inspection.” from the report
Risk records were not reliable enough
seriousSome care records and risk assessments were out of date or difficult to use. One risk assessment was not updated after an incident that caused harm, leaving the person at further risk.
“A risk assessment and care plan had not been reviewed and updated following an incident that resulted in harm to a person.” from the report
Infection control and visits
seriousThe home did not always follow shielding, distancing and PPE requirements. During a three-week outbreak, visiting restrictions did not include the option of essential care giver visits.
“People had not had the option to receive essential care giver visits during a COVID-19 outbreak.” from the report
Mental capacity records
needs fixingStaff understood some people's decision-making abilities, but this was not always recorded clearly. Best-interest decisions also needed better documentation.
“For people that the service assessed as lacking mental capacity for certain decisions, staff didn't always clearly recorded assessments and any best interest decisions.” from the report
New checks needed more time
needs fixingThe home had introduced audits and new systems, but its checks had not yet shown that these changes were consistently effective.
“Further time was needed to embed these new ways of working and review progress made to ensure their effectiveness.” from the report
Communication technology not yet in place
minorThe manager planned to use more technology to help people communicate their needs and choices, but this improvement had not yet been implemented.
“At the time of the inspection, improvements had not been implemented.” from the report
- 01What has been changed to make sure risk assessments and care plans are updated immediately after an incident or injury?
- 02How will you ensure staff follow PPE, shielding and social distancing rules during any future outbreak?
- 03How will essential care giver visits be arranged if there is another COVID-19 outbreak?
- 04How are mental capacity assessments and best-interest decisions checked for accuracy and completeness?
- 05What evidence can you show that the new audits and management systems are now working effectively?
This was a focused inspection of Safe, Effective and Well-led, so the Caring and Responsive ratings were not covered and the report does not provide ratings for them. This explanation was written from the published report of 27 May 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.
What inspectors found, October 2021
Rated Inadequate and placed in special measures; inspectors found serious problems with safety, staffing, medicines and management.
This was an unannounced focused inspection over three days. Inspectors spoke with one person, relatives, staff and outside professionals. They reviewed care records, medicines records, staff files, training information and management records.
The home was rated Inadequate for Safe, Effective and Well-led. Inspectors found risks were not managed properly, medicines were not handled safely, safeguarding procedures were not followed consistently and there were not always enough trained staff. The building was unclean and poorly maintained, and infection control guidance was not always followed.
Care was not always suited to people's needs or choices. Staff training and supervision were weak, communication with healthcare professionals was poor and management checks did not identify or fix problems quickly. The home had no registered manager at the time of the inspection.
The overall rating fell from Good at the previous inspection, published on 23 May 2019. The home was placed in special measures, with a warning notice issued and a requirement to provide an action plan.
Some meal choices
Inspectors saw people being offered choices at breakfast and lunchtime. Some people's likes and dislikes were recorded.
“Some people's likes and dislikes were documented. We observed people offered a choice at breakfast and lunchtime.” from the report
Actions had started
The management team had identified some of the problems and had begun working with partner agencies to improve care.
“The management team recognised and had identified actions needed to address shortfalls.” from the report
Legal authorisations monitored
The report says that legal authorisations for restrictions were requested or in place and were monitored by management.
“People had DoLS authorisations requested or in place and these were monitored by management.” from the report
Risks and incidents
seriousRisk assessments were missing or out of date, and accidents and incidents were not properly investigated or reviewed. This included inadequate monitoring of a person who had regular seizures.
“People did not receive the level of support and supervision they needed to keep them safe.” from the report
Medicines
seriousMedicines were stored, administered and recorded unsafely. Inspectors found errors, missing records and weak checks.
“Medicines were not managed safely. Responsibilities for medicine administration and documentation was not clear and communication was poor.” from the report
Safeguarding
seriousStaff did not always recognise or report possible abuse and safeguarding concerns. Required procedures were not followed consistently.
“Staff did not always recognise abuse and take action to address concerns where there was a risk to people.” from the report
Staffing and training
seriousThere were not enough suitably trained staff at night to safely evacuate people in a fire. Most staff had not completed important training and supervision was not regular.
“There were insufficient staff on a night to safely evacuate in the event of a fire and the service did not have a plan in place.” from the report
Cleanliness and environment
needs fixingThe home was visibly unclean and needed repairs. Inspectors found mould, worn carpets, broken clinical waste bins and a noisy environment that was not suitable for people's needs.
“The service was poorly maintained, and repairs and redecoration were required throughout the service.” from the report
Weak management checks
seriousAudits and quality checks did not identify important problems with care plans, medicines, incidents and observations. Management did not always act quickly enough on known risks.
“Quality assurance processes were not in place or effective. There were limited audits carried out by the service and those that were in place were inadequate.” from the report
- 01What has changed since the inspection to make medicines safer, and how are medicine errors now checked and reported?
- 02How many waking staff are now on duty overnight, and how would everyone be evacuated safely during a fire?
- 03What training and supervision have current staff completed, particularly for learning disabilities, autism, safeguarding and behaviours that challenge?
- 04How are risks, accidents, incidents and safeguarding concerns now recorded, reviewed and shared with families and outside professionals?
- 05What repairs, cleaning and changes to the environment have been completed, including the mould, worn carpets and noise levels?
This was a focused inspection of Safe, Effective and Well-led, prompted by concerns about medicines, staffing and risk management; Caring and Responsive were not inspected and their previous ratings carried over. This explanation was written from the published report of 9 October 2021 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
4 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- May 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2021Inadequatedown from GoodSafe: InadequateEffective: InadequateWell-led: Inadequate
- May 2019Goodstayed GoodSafe: GoodWell-led: Good
- December 2017GoodSafe: GoodEffective: GoodWell-led: Good
- December 2016
Registered with the Care Quality Commission on 14 December 2016.
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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28 live-in carers within about an hour of North Yorkshire
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 £1,010 to £1,290 a week. 27 can care for a couple. 12 years' experience on average.
“Carla has been a god send with the implementation of bringing mum back home from respite care.”
“She was always 'just present enough': attentive, available, kind and engaging, but without ever over-stepping any boundary”
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.