Archived: Norman Lodge

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

¿ The designated setting is a separate self-contained unit within the home with nine single bedrooms, its own communal areas, outdoor space and toilet and bathroom facilities. It has recently been refurbished to a high standard and is ready for use.

¿ Refurbishment is ongoing in other parts of the home. The provider has given assurance that the designated setting will not be used until the refurbishment programme is completed.

¿ The home is currently closed to non-essential visitors due to local lockdown restrictions. People are supported to keep in touch with family and friends through regular telephone and video calls.

Further information is in the detailed findings below.

Norman Lodge provides accommodation and personal care for up to 35 people. Accommodation is provided in four units at ground floor level and each unit has a lounge, dining and kitchen area. Norman Lodge offers a mixture of placements which includes permanent places, rehabilitation, assessment and respite care. There were 29 people using the service when we visited.

People’s experience of using this service:

People told us staff were caring, helpful, and attentive. We saw people were treated with dignity, respect and compassion. 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 healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. Menus we saw showed people had a good choice of meals and we saw people enjoying their meal. There were plenty of drinks and snacks available for people in between meals.

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome by staff.

We found the home was clean and tidy. Refurbishment was taking place in one of the units.

Staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate identified risks. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

There was a complaints procedure and people and families spoken with told us they knew how to complain.

Everyone spoke highly of the registered manager and acting manager who they said were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified, they acted to make improvements.

Rating at last inspection:

At the last inspection we found the service required improvement (report published April 2018)

Why we inspected:

This was a planned inspection by the CQC to find out if the service had improved. At our last inspection on 31 January and 7 February 2018, we found the service required improvement in effective, responsive and well-led domains. This was in breach of Regulation 17 good governance.

At this inspection we found improvements had been made and we now rate the service overall as good.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Norman Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Norman Lodge provides accommodation and personal care for up to 35 people. Accommodation is provided in four units at ground floor level and each unit has a lounge, dining and kitchen area. Norman Lodge offers a mixture of placements which includes permanent places, rehabilitation, assessment and respite care. There were 29 people using the service when we visited.

There was a registered manager in post. However, they were on secondment to another role and an interim manager was in day to day control of the home. 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 2008 and associated regulations about how the service is run.

Systems were in place to promote people's safety and to check with them if they felt safe. We found the home was well maintained.

We saw accidents; including near misses and other incidents had been appropriately managed and reviewed to help improve safety. Staff understood how to identify and report any potential abuse. Medicines were managed safely and people received their medicines when they needed them. We saw a system was in place to log and investigate safeguarding concerns and where appropriate, ensure action was taken to improve the safety of the service and the person. Staff understood safeguarding procedures and how to report concerns. Staff were also confident that management would act on any concerns yet also felt supported to follow whistleblowing procedures if necessary.

Staff were recruited safely as we found the necessary checks were carried out in line with the provider's policy. Staff were on duty in sufficient numbers to provide timely care and support; including ensuring people could maintain their independence as much and as safely as possible.

Staff told us training was good and provided them with the required skills to offer safe and effective support. Staff received skills support in the form of an induction programme, on-going training, supervision and appraisals.

The service was working in line with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which helped to make sure people’s rights were protected and promoted. People’s rights to choose and make decisions were supported in accordance with good practice and legislation. Staff asked people’s consent before any care or support was given. However, we found documentation did not always clearly indicate whether conditions were attached to DoLS authorisations. It was not always evident whether conditions had been complied with.

People were able to choose how and where they spent their time, and lifestyle choices were respected. People had access to appropriate recreational and social activities and equipment was available for people living with dementia to occupy their time.

People were treated with kindness and compassion. There was a clear emphasis on people’s individuality, dignity and independence. There was a lively and homely atmosphere and we saw people and staff knew each other well.

Staff supported people to access healthcare services and support was delivered to meet their needs and preferences. There were systems in place to ensure complaints were managed appropriately, and people told us their concerns were dealt with well.

People told us they enjoyed the food and had various options available. The cook had good knowledge of people's nutritional needs. However, food and fluid charts needed to be more robustly completed.

We saw staff and people who used the service knew each other well, and we saw examples of caring practice during our inspection. Equality and diversity principles were also well embedded within the culture of the home.

The management acknowledged more work was required to ensure care records were kept up to date and accurately reflected peoples changing needs. We also found end of life care plans were not always available for people.

The home was clean and the environment was well maintained. Gloves and aprons were readily available and were seen to be used by staff when providing personal care.

Staff and people who used the service felt it was well-led, and we saw management had a visible presence in the home and clearly knew people well.

Systems were in place for people to voice their opinions and we saw the provider shared results of surveys and plans for development with people involved in the home. We saw examples of actions taken to improve the service as a result of feedback.

We did not find good governance systems in place. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

At the last inspection in April 2014 we found the provider was meeting the regulations we assessed.

Norman Lodge provides accommodation and personal care for up to 35 people. Accommodation is provided in four units at ground floor level and each unit has a lounge, dining and kitchen area. Norman Lodge offers a mixture of placements which includes permanent places, rehabilitation, assessment and respite care. There were 29 people using the service when we visited. This included nine people who lived there permanently, two people receiving respite care, 15 people in for assessment and three people for rehabilitation.

The home has a registered manager who registered with the Commission in May 2010. 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 found the systems in place to manage medicines were not always safe, which meant people did not always receive their medicines as prescribed.

People told us they felt safe. Safeguarding incidents were recognised and action was taken to keep people safe. Incidents were reported appropriately to the Local Authority safeguarding team and notified to the Care Quality Commission.

Risks to people were generally managed well although this was not always reflected in people’s care records which could lead to inconsistencies in staff practices.

People gave mixed feedback about staffing levels as some felt there were not enough staff while others said there were. During the inspection we found there were sufficient staff to meet people’s needs. Safe recruitment procedures were followed which made sure checks had been completed before new staff started work.

The environment was clean and well maintained. The décor was bright, cheerful and comfortable following extensive refurbishment throughout the home.

People and relatives praised the staff and the care they received. There was a relaxed and friendly atmosphere in the home and we saw staff took every opportunity to engage with people. People told us they were treated with respect and this was confirmed in our observations.

People told us they enjoyed the food. We saw mealtimes were a pleasant and sociable occasion with people being offered a choice of meals and drinks. Staff provided people with assistance where needed.

A wide range of activities were available although the provision of these varied on each unit. Some people said they felt this was an area that could be improved.

Staff told us they received the training they required, however the training matrix showed significant gaps where some staff had not received regular updates. Systems were in place to ensure staff received regular supervision and appraisals.

The home was not meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA). Restrictions in place suggested some people who lacked capacity may be being deprived of their liberty, yet no assessment had been carried out or applications made for DoLS authorisations.

People were aware of how to make a complaint and we saw complaints received had been dealt with appropriately.

People received the care they needed however the care records did not reflect people’s need accurately. We saw people had access to healthcare professionals such as GPs and district nurses.

We found the home was well organised and the registered manager was open and transparent. However, the effectiveness of some of the quality assurance systems needed to improve which is evident from the breaches we found at this inspection.

We identified four breaches in regulations – regulation 18 (staffing), regulation 12 (safe care and treatment), regulation 11 (consent) and regulation 17 (good governance). You can see what action we told the provider to take at the back of the full version of the report.

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, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff we spoke with understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support. People's health and care needs were assessed with them, and they were involved in writing their plans of care.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'It's lovely here, and it's lovely having a bath everyday if you want.' Another said, 'It's beautiful in here, I wouldn't go anywhere else, the staff look after me well, they're all good'.

A relative said, 'They visited regularly without notice and they were happy their relative was well cared for in the home'.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

We found improvements had been made. The number of staff working at night had increased from two to three, and people told us that staff always responded if they needed help at night.

Systems had been put in place which ensured the medication and care records were completed correctly.

We talked to nine people during lunchtime; all made extremely positive comments about the home.

We saw the results of a survey by the provider in March 2013. We saw 40 people who used the service had completed the questionnaire. All had responded that staff had answered all of their questions to their satisfaction whilst staying at the home. All stated that their needs had been met during their stay at the home and stated they were treated with respect and dignity.

We spoke with five people who used the service, and two people's relatives. All were satisfied with the staff's approach. One said 'we couldn't ask for better people to look after us'. A relative also told us they were 'so relieved mum has settled and can leave her here knowing that she is happy'.

We found although there were systems in place which made sure people had received the correct medication. Further work needed to be carried out to ensure the medication records were maintained sufficiently to ensure people received the correct medication.

We saw evidence people's wishes and choices had been included in the planning of their care. A person who used the service told us 'We are always given a choice in what we do; they always ask us what we would like to do.' Another person who used the service said 'they always ask me before helping out'.

We found staff understood the process for acting on people's concerns. One staff member told us 'if I came to my manager with an allegation, I am confident it would be dealt with. We found people had been provided with information on how to raise a concern or complaint.

However, we found people were not protected against the risks associated with medicines because the provider did not have robust arrangements in place to record the administration of medicines and check the expiry dates of opened medicines.