Norwood House Nursing Home

Norwood House Nursing Home is a residential care home providing accommodation and personal care to up to 31 people. The home provides support to older people and people living with dementia. At the time of our inspection there were 29 people using the service.

People’s experience of using this service and what we found

Risks to people’s health, safety and welfare were not always assessed and monitored safely. People were not always supported to have maximum choice and control of their lives and records did not reflect they were supported in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where people lacked capacity robust best interest assessments were not in place. Accidents and incidents were not always recorded consistently. These shortfalls had not been identified through the provider’s quality assurance systems.

People and relatives praised the standard of care and said staff were kind, caring and attentive. Medicines were managed safely. There were close links with health professionals and other agencies to ensure people's health needs were met and changes responded to promptly. Systems were in place to ensure people were safeguarded from abuse and poor care. The service followed safe infection prevention and control practises.

People’s needs were robustly assessed before they moved into the home. People’s nutritional needs were met. The home and grounds were attractive and well maintained and there had been consideration to ensure the environment supported people living with dementia.

There was a consistent and experienced staff team in place. Recruitment was managed safely and staff received good induction, training, and supervision.

The registered manager and manager provided staff with leadership and promoted an inclusive and supportive team culture. The provider fostered partnership working and being genuinely engaged in the local community. There was an inclusive, warm, and welcoming atmosphere throughout the inspection and a strong emphasis on people receiving person-centred care and having varied positive opportunities.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 October 2018).

Why we inspected

We inspected due to the length of time since the last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Norwood House Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of risk, consent to care and good governance arrangements.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Norwood House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 31 older people and older people living with dementia in one adapted building. Accommodation is provided over two floors.

At the time of our inspection there were 26 people using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a manager in post but they had not yet started the registration process with CQC. 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.

People using the service and their relatives were positive about the care and support provided at Norwood House. They said staff treated people respectfully and in a kind and caring manner.

People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

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.

Individual care and support needs were fully assessed, documented and reviewed at regular intervals.

People were assisted as required by suitable numbers of staff who were trained and supported in their job roles. Staff members had been safely recruited and had received an induction to the service.

People’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. People told us there was a choice of meals and said the food was good. There were plenty of drinks and snacks available for people in between meals.

Some activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome and could have a meal at the home if they wished.

People and their relatives or friends felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues.

The provider had systems in place to monitor the quality of care provided and where issues were identified they acted to make improvements. There were some areas, however, where further development was required

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Norwood House Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 31 people in one adapted building. Accommodation is provided over two floors.

The last inspection was carried out in June 2017 and the overall rating for the service was ‘requires improvement.’ The provider was in breach of three regulations. These related to ‘need for consent’ (Regulation 11), ‘safe care and treatment’ (Regulation 12) and ‘good governance’ (Regulation 17). We took enforcement action and issued a warning notice in relation to the breach of regulation 17 (good governance). We issued requirement notices in relation to the breaches of ‘the need for consent’ and ‘safe care and treatment’ regulations. We met with the provider to discuss their plans for making the required improvements to the service. We asked the provider for an action plan which they provided telling us how they were going to make the necessary improvements.

During this inspection we found improvements had been made.

A registered manager was in place. 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 saw staff was kind and caring and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where they could discuss their on-going 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 any risks which had been identified. We saw appropriate referrals were being made to the safeguarding team when this had been necessary.

People’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. There was a choice of meals and people said the food was good. We also saw there were plenty of drinks and snacks available for people in between meals.

We found the service was working within the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards and that staff had a good understanding of how these principals applied to their role and the care they provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Activities were on offer to keep people occupied both on a group and individual basis.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The registered manager provided staff with leadership and direction and was described as being very approachable.

We saw systems had been introduced to monitor the quality of the service. We saw these had identified areas for improvement and action had been taken to address any shortfalls. People using the service and relatives were consulted about the way the service was managed and their views were being acted upon. We saw that the audit systems were helping to drive improvements in the service. It was clear the service had made significant improvements which now needed to be continued to show the quality of care is sustained. It was too early for the provider to be able to demonstrate that the quality processes were fully embedded and that these improvements could be sustained over time.

At the time of the inspection there were 31 people using the service.

There was a registered manager in post. 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.

When we inspected the service in August/September 2016 we identified one breach of regulation in relation to good governance. On this inspection we identified a continued breach of this regulation and two additional breaches in relation to safe care and treatment and need for consent.

Staff were recruited safely and staffing levels were being maintained. The service was utilising agency nurses and carers but were making sure these staff were consistent and knew the people using the service. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs.

The registered manager had recruited an activities co-ordinator, but this person had not started working at the time of our visit. We saw staff sitting with people and there were some activities being offered, however, we concluded more needed to be offered to keep people occupied.

People who used the service told us they felt safe at Norwood House Nursing Home and we found staff understood the safeguarding process.

People’s healthcare needs were mostly being met, however, there were some concerns about the management of people’s nutrition and hydration needs. Medicines were being managed safely.

People using the service and relatives spoke highly of the staff and told us they were caring and loving. They also said there was a nice atmosphere in the home and relatives said they were always made to feel welcome.

There was a lack of understanding by staff about the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards which meant the service was not always working within the principles of the MCA.

There was a complaints procedure in place and people told us the registered manager was very approachable and they would feel able to raise any concerns.

Quality assurance systems were in place, however, they were not always effective in identifying areas which required improvement such as care planning, monitoring of food and fluid intake and analysis of accidents. The lack of good governance systems has led to a continued breach of regulation 17 and two new breaches.

We identified one continued breaches and two further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Norwood House is registered to provide nursing care to older people, people with physical disabilities and people living with dementia. The home can accommodate up to 31 people. At the time of our inspection 29 people were living at the home.

The home had a registered manager. 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.

The provider had breached the regulation relating to good governance. Standard risk assessments were carried out for people. However, we found there were no other bespoke risk assessments in place for people, such as in relation to behaviour that challenged others. Dependency assessments had not been updated to reflect people’s current needs. The provider did not have a comprehensive system to evidence staffing levels were appropriate.

You can see what action we have asked the provider to take at the back of the full version of this report.

People, relatives and care workers told us enough care workers were deployed to meet people’s needs. The provider did not have a comprehensive system to evidence staffing levels were appropriate. We have made a recommendation about this.

People told us they were happy with their care and the care workers providing it. They said they were cared for by a kind and caring staff team who treated them with respect.

People and care workers said the home was a safe place to live.

Care workers showed they had a good understanding of safeguarding adults and whistle blowing. They also knew how to report concerns. All care workers said they would have no hesitation raising concerns to keep people safe.

Medicines records supported the safe administration of medicines. Medicines administration records (MARs) were accurate and medicines were stored securely.

Regular health and safety checks were carried out to help keep the home safe for people to live in, such as checks of fire safety, water, gas and electrical supplies. Procedures were in place to guide care workers on people’s care needs in an emergency.

Incidents and accidents were investigated with action taken to help prevent the incident happening again.

Care workers received good support including regular one to one supervisions and appraisals. The provider had not ensured staff had all the training they needed when it was due, as some essential training had been completed after our inspection visits.

People gave positive feedback about their meals. Care workers supported people to have enough to eat and drink in line with their assessed needs.

The provider acted in accordance with the requirements of the Mental Capacity Act (MCA) 2005. Deprivation of Liberty Safeguards (DoLS) were in place or had been applied for where people were unable to consent to their placement in the home. Care workers supported people to make as many of their own choices and decisions as possible.

Records confirmed people had regular input from external health professionals, such as GPs and specialist community nurses.

People’s needs had been assessed and personalised care plans developed. Care records provided care workers with information about people’s preferences and ‘life history.’

The provider had worked towards and achieved the nationally recognised Gold Standard Framework (GSF) for end of life care.

Activities were provided to keep people occupied, such as bingo, games and sing songs.

People and relatives knew how to complain. They told us they did not have any concerns about their care. Previous complaints had been thoroughly investigated and resolved.

People said the home was well-led and had a good atmosphere. Regular quality assurance checks were carried out. These had been successful in identifying areas for improvement.

Is the service safe?

We observed staff treating people with respect and dignity and found that staff were following advice recorded in people's care plans. The service was secure and there were appropriate numbers of staff present at all times. We saw mental capacity assessments had been completed and where people were deemed not to have capacity, families and other health and social care professional's had been involved. We saw a safeguarding policy and staff were aware of different types of abuse.

Is the service effective?

People told us they felt safe and they had their needs met. We saw end of life care plans. People's likes and dislikes, cultural needs and aspirations were recorded in care plans and staff told us they had a good knowledge of peoples care plans. We saw the service to be clean, safe and hygienic.

Is the service caring?

We looked through three care files and saw evidence that other professional's had been contacted when needed. We spoke with six family members who told us the staff were, 'Great' and, 'Staff are very caring.' We saw a satisfaction survey was carried out on an annual basis and where there were shortfalls, these were addressed. The people we spoke with felt treated with respect.

Is the service responsive?

We spoke with family members who said they knew how to make a complaint and felt it would be taken seriously. Family members told us they have not had to complain but concerns raised were looked into quickly and changes were made.

We found people were supported by kind and attentive staff. We saw staff were quick to react if someone was unhappy and would always be near in case someone using the service required something. The family members we spoke with told us they are regularly invited to review meetings.

Is the service well-led?

On the day of inspection there were 27 people using the service. There were a range of activities completed on a daily basis and a new activities coordinator had recently started. The service used public transport and family and friends to access the community. We saw one person refuse to take part in an activity and their decision was respected. Staff told us they were clear about their job roles.

The people who used the service and their relatives told us they were looked after very well and felt safe with the care and treatment provided. Their comments included: "I would come to live here tomorrow", 'They are like my family' and 'It's like a five star hotel'.

We found that service had appropriate systems in place to ensure consent was gained before staff proceeded with personal care.

We saw that there was an appropriate system in place for listening to and acting on people's comments and concerns.

We spent time observing the three lounges, garden seating area and dining area during the day of our inspection. We looked at how people spent their time and how staff interacted with people.

The interactions we saw between staff and people who used the service and visitors were respectful. We saw some people engaged in activities with members of staff such as watching TV and having their hair cut by the hair dresser.