CQC report explained · a nursing home
What the CQC found at Northwood Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough suitably trained staff, robust recruitment checks, regular risk assessments, safe medicines management and good infection control.
- Effective?
- Good
- Staff had suitable training and support. People received appropriate food, drink and access to health professionals, and the report says consent and mental capacity processes had improved.
- Caring?
- Good
- People were treated with dignity and respect. Staff knew people well, involved them in decisions and supported their privacy and independence.
- Responsive?
- Good
- Care was personalised and care plans included people's needs and life histories. People were offered activities, community access and ways to raise concerns.
- Well-led?
- Good
- Inspectors found clearer leadership, regular staff supervision and training, and stronger quality checks. The report says this was a major improvement since the previous inspection.
What inspectors found, February 2019
Northwood Nursing Home was rated Good overall; inspectors found safe, kind and personalised care, with some care plan improvements still underway.
This was an unannounced inspection on 19 and 24 December 2018. Inspectors observed care, spoke with people, relatives, staff and professionals, and checked care records, recruitment files, training and quality checks.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines practice, suitable training, respectful care, personalised support and activities.
The report says the home had improved substantially since July 2017. At that inspection, people's liberty had been restricted unlawfully and management systems were not strong enough. These problems were not found at this inspection.
Some care plans and parts of the environment still needed further development. The manager had identified these points and actions were underway.
Enough staff
Inspectors found enough staff with the right skills and experience. Staff had time to provide personal care and spend time talking with people.
“There were sufficient staff with the right skills and experience to meet people`s needs at all times.” from the report
Safe medicines
Medicines were administered by trained staff whose competence had been checked. Inspectors found no medicine or recording errors.
“No medicine or recording errors were found.” from the report
Respectful care
People's privacy and dignity were protected. Staff involved people in choices about when to get up, go to bed, eat and spend their time.
“People were treated with dignity and respect and their privacy was maintained.” from the report
Personalised activities
People could choose from group and individual activities, including music, games, arts and crafts, and trips into the local community.
“People were encouraged to live their lives in the way they wanted and were involved in meaningful activities.” from the report
Improved leadership
The report says leadership, staff supervision, training and quality monitoring had all improved since the previous inspection.
“At this inspection we found that improvements had been made by the newly appointed registered manager and the service was now well led.” from the report
Rights and liberty
The unlawful restrictions identified at the previous inspection were addressed. Mental capacity assessments and checks about liberty safeguards had been reviewed.
“At this inspection we found that the registered manager had worked extremely hard to improve this aspect of the service and to ensure people's rights and liberties were protected at all times.” from the report
Care plans and environment
needs fixingSome care plans still needed more information about people's care and support needs. Further environmental improvements were also in progress.
“Areas for improvement had been noted by the manager and actions were underway to address these.” from the report
- 01What further information was added to care plans, and how do you make sure they stay up to date?
- 02What environmental improvements were still outstanding after the inspection, and have they now been completed?
- 03How do you assess and review any restrictions on a person's freedom, especially for someone living with dementia?
- 04How would you support my relative's particular dietary, cultural, religious, health or end of life needs?
- 05How do families give feedback or make a complaint, and how is the response recorded?
This was an unannounced comprehensive inspection covering all five rating areas, including the premises and the care provided. This explanation was written from the published report of 9 February 2019 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, September 2017
Rated Requires Improvement; inspectors found kind, responsive care but unsafe medicines, unlawful restrictions and weak oversight.
Inspectors visited without warning on 30 June and 7 July 2017. They spoke with people, relatives, staff and health professionals. They reviewed care plans, staff files, medicines, complaints and monitoring records.
The home had improved since the previous inspection. Care plans were more personal, staff knew people well, and people were treated kindly. Staffing, recruitment, activities and support with food and health needs had also improved.
Important problems remained. Medicines were not always managed safely. Some risks were not properly assessed or acted on. Some people's liberty was restricted unlawfully. The home’s checks did not reliably find these problems, so the overall rating was Requires Improvement.
Kind and respectful care
Staff treated people with kindness, dignity and compassion. They knew people's histories, needs and preferences.
“People were supported in a kind and compassionate way by staff who knew them well, were knowledgeable about their care needs and who had taken time to develop positive and caring relationships with them.” from the report
More personal care plans
Care plans had improved and included personal histories, preferences and information about how each person should be supported.
“Care plans had been improved and were now more personalised and contained detailed information about people's support needs.” from the report
Enough suitable staff
Inspectors found enough staff to meet people's needs. Recruitment checks, induction and staff support had also improved.
“The provider had flexible working arrangements which ensured there were enough suitably experienced and skilled staff available to meet people's agreed care and support needs safely, effectively and in a calm and patient way.” from the report
Improved activities and environment
The activity programme included more trips out and other activities. The home had also made changes to decoration, shared areas and bedroom signs to help people living with dementia.
“We saw that the weekly timetable for activities had been further developed to include a range of new activities which included more regular trips out” from the report
Medicines were not always safe
seriousSome covert medicines were not given according to pharmacy advice. As-required medicine instructions lacked enough detail, and some anti-psychotic and hypnotic medicines had not been reviewed properly.
“However, we also found that where people were prescribed medicines covertly, staff did not follow the appropriate pharmacy guidance.” from the report
Risks were not consistently managed
seriousAfter injuries, falls and a person going missing, risk assessments were not always updated. There was also no suitable behaviour plan for a person with challenging behaviour.
“Potential risks to people's health and well-being were not always identified and actioned effectively.” from the report
Liberty was unlawfully restricted
seriousSome people who could safely leave the home without an escort had not been given the door code. Conditions attached to a Deprivation of Liberty authorisation were also not always followed.
“Due to people's liberty and choices being restricted we found that this was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Training did not cover all needs
needs fixingTraining covered key subjects but did not include some specific mental health needs relevant to people living at the home, such as schizophrenia, bipolar disorder and aggression.
“It did not cover additional areas for example in specific mental health needs, or substance misuse.” from the report
Checks did not find problems
needs fixingThe home's audits had not identified the medicine and risk problems found by inspectors. Records relating to capacity, liberty and some other care information also needed improvement.
“The concerns found as part of this inspection had not been previously identified by the registered manager.” from the report
- 01How are medicines given covertly now, and how do you make sure staff follow pharmacy guidance?
- 02How are as-required medicines reviewed and recorded, including clear instructions about when to give them?
- 03What changes have been made to risk assessments after falls, injuries, missing incidents or challenging behaviour?
- 04How do you make sure people who can leave safely are able to do so without unnecessary restrictions?
- 05What extra training do staff now receive for mental health needs, dementia and behaviour that may challenge?
This was an unannounced comprehensive inspection covering all five CQC questions, with visits on 30 June and 7 July 2017. This explanation was written from the published report of 22 September 2017 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 Northwood Nursing Home
4 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- February 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2016Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- February 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- June 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 14 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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