Our inspection took place on 31 January and 7 February 2018. The inspection was unannounced on the first day and announced on the second day. At our last inspection in August 2016, we rated the service overall as 'requires improvement' and identified breaches of the regulation relating to the need for consent, safe care and treatment, good governance and staffing. At this inspection we found the provider had made improvements in all of the above areas. However, further improvements were still needed to good governance. 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.