All inspections: Norbury Court - Care Quality Commission

Date of Assessment: 28 January to 7 February 2025.

Norbury Court is a nursing home providing accommodation and personal care to older people. The service can support up to 60 people. At the time of this assessment, there were 36 people living at Norbury Court.

We carried out this assessment to follow up on actions from the last assessment in July 2024 where we identified breaches of regulation in relation to safe care and treatment and good governance and rated the service inadequate.

Improvements were found at this assessment and the provider was no longer in breach of the regulation relating to safe care and treatment. However, we found a continued breach of the regulation related to good governance. Changes in management meant some systems and processes had not been consistently implemented and still required embedding into practice. The provider was in the process of recruiting a new manager following further changes within the senior team.

This service has been in Special Measures since 25 April 2024. The provider demonstrated improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Norbury Court is a nursing home providing accommodation and personal care to older people. The service can support up to 60 people. At the time of this assessment, there were 43 people living at Norbury Court.

We carried out unannounced assessments of this service on 21 and 23 July 2024. The assessment was prompted in part due to concerns we had received about staff culture and to follow up on action we told the provider to take at our last visit in February 2024. In February 2024 we found concerns about people’s safety and governance. As a result, the service was rated as inadequate and placed in special measures.

Since our last visit there had been changes to the senior team with an interim manager and new regional manager recently appointed. Recruitment was also underway for a new Registered Manager.

At this assessment we looked at 5 quality statements under the safe key question and 2 under well led.

Action had been taken to learn lessons following the last assessment and to implement improvements. However, we found insufficient progress with some concerns from our last visit still in process or not yet actioned. Systems and processes to ensure good governance were improved but not yet robust.

We found continued breaches of Regulation 12 and 17 relating to the management of people’s risk, the management of medicines, infection control, and governance of the service.

The overall rating for this service remains ‘Inadequate’ and the service remains in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a time-frame within which providers must improve the quality of care they provide.

Norbury Court is a nursing home providing accommodation and personal care to older people. The service can support up to 60 people. At the time of this assessment, there were 54 people living at Norbury Court. We rated this service under our previous methodology on 15 June 2022, where it was rated requires improvement overall. We carried out this assessment on 27 and 28 February 2024. We looked at all the quality statements under the key questions, Safe and Well-led. We also looked at the following quality statements, Independence, choice and control and Equity in experiences and outcomes. At this assessment we found the provider had not made enough improvements. We found continued breaches of Regulation 12 and 17 relating to the management of people’s risk, the management of medicines, infection control, and governance of the service. We found concerns relating to staffing and the quality of care provided at the service. This resulted in breaches of Regulation 9 and 18.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-assess within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Norbury Court is a nursing service that provides care for up to 60 people. It is a purpose-built care service and has three floors. At the time of our inspection 50 people were living at the service.

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

At this inspection, we identified concerns with the management of risk, care planning, the delivery of care, the management of medicines and governance.

The provider had a range of audits in place to monitor the quality and safety of the service. These audits had identified similar concerns with medicines and the environment, yet there was little evidence any action had been taken to address these concerns. This resulted in the same concerns being identified at this inspection.

Medicines were not always managed safely across the home, which placed people at risk of harm. We also found people’s medical and health needs were not sufficiently monitored by nursing staff to ensure their health and wellbeing was being maintained or to identify possible early signs of ill-health. This placed people at risk of avoidable harm.

Risks to people's health, safety and wellbeing were not managed safely. People’s care plans did not contain adequate details of their medical conditions and the clinical care they required, to keep them safe and well.

Staff did not always follow infection control procedures and the home was not clean in some areas.

Staff did not always receive on-going support on the job to ensure they carried out their roles as necessary. This included a lack of regular supervision, appraisal and observation on the job. People and staff reported they felt more staff were needed to meet people's wishes and choices. We have made recommendations about this.

Overall, people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We have made a recommendation about the review of MCA and best interest decisions.

Staff we spoke with told us the management team were supportive and team meetings were taking place.

People received support from a range of health and social care professionals including dieticians; mental health teams; speech and language therapy and their local GP.

The registered manager and regional manager were open and honest about the shortfalls at the service. They engaged with the inspection positively and were committed to making any necessary improvements.

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 02 August, 2017).

Why we inspected

We received concerns in relation to the management of medicines and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections, even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Norbury Court is a nursing service that provides care for up to 60 people. It is a purpose-built care service and has three floors; however, at the time of our review the ground level had been closed and people lived on the first and top floors. At the time of our inspection 59 people were living at the service.

We found the following examples of good practice:

At the entrance of the home, information was displayed to inform visitors about any infection control procedures to be followed. Temperature checks were completed, along with a questionnaire to establish if visitors had recently displayed any symptoms of COVID-19.

The home had a robust process in place for facilitating indoor or outdoor visits. All visitors underwent screening checks on arrival and were directed to wear PPE before being able to enter the service. As the ground floor was no longer being used for care and accommodation, rooms were re-purposed so family or professionals could visit people without needing to enter the main living areas of the home. In exceptional circumstances, such as when a person was on end of life care or nursed in bed, the home had processes in place to facilitate visits to people’s room in the safest possible way.

Zoning arrangements were used when people had tested positive for COVID-19 and needed to self-isolate in certain areas of the home, such as bedrooms. COVID-19 testing was in place for staff and people using the service. The majority of people and staff had received their COVID-19 vaccination.

We found Norbury Court to be clean and tidy. A dedicated domestic team, with the assistance of care staff, carried out scheduled infection control tasks throughout the day. Regular infection control audits were undertaken to ensure standards were maintained.

Risk assessments were completed where certain groups were at higher risk of harm if they contracted the virus. Staff had received additional infection control training during the pandemic.

Norbury Court is a nursing service that provides care for up to 60 people. It is a purpose built care service. At the time of our inspection 56 people were living at the service. The service has three floors; the ground floor is primarily used for people living with dementia who do not require nursing care. The service has five lounges, five dining rooms, a library room, a music room, a hairdressing room, an activities/games room and two enclosed garden areas.

The registered manager had been registered with the Care Quality Commission in May 2017. A registered manager is a person who has registered with 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.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

People told us they felt ‘safe’. There was evidence of involvement from other health care professionals where required, and staff made referrals to ensure people’s health needs were met.

Staff had undertaken safeguarding training and were knowledgeable about their roles and responsibilities in keeping people safe from harm.

All the relatives we spoke with made positive comments about the care their family member had received and about the staff working at the service. Some of the relatives we spoke with told us they would recommend the service.

The service had appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.

The recruitment systems were designed to make sure new staff were only employed if they were suitable to work at the service.

Staff received induction and refresher training to maintain and update their skills. Staff were supported to deliver care and treatment safely and to an appropriate standard.

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.

A varied diet was provided, which took into account people’s dietary and cultural needs and preferences. This meant people’s health was promoted and choices could be respected.

The registered provider had appointed an additional activities co-ordinator to increase the level of the activities available at the service. They were due to start working at the service in the near future.

People living at the service, and their relatives said they would speak with staff if they had any worries or concerns and felt they would be listened to.

Relatives we spoke with made positive comments about the way the service was managed.

There were effective systems in place to monitor and improve the quality of the service provided.

Further information is in the detailed findings below.

This inspection took place on 27 October 2014. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. The service was last inspected on 14 October 2013 and was meeting the requirements of the regulations we checked at this time.

Norbury Court is a nursing service that provides care for up to sixty people. It is a purpose built care service. At the time of our inspection fifty eight people were living at the service. The service has three floors; the ground floor is primarily used for people living with dementia who do not require nursing care. The service has five lounges, five dining rooms, a library room, a music room, a hairdressing room, an activities/games room and an enclosed garden.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

There was a calm and friendly atmosphere in the service. The service was clean and had a pleasant aroma. During the inspection we heard people and staff singing along to music. We observed staff encouraging people to get up and dance with them. One person spoken with told us it was always like this at the service.

Our observations during the inspection told us people’s needs were being met in a timely manner by staff. People told us staff responded promptly when they called for assistance. A few people told us they did not use a call buzzer or want one and they preferred to shout for assistance. One person demonstrated how effectively this worked. We observed staff giving care and assistance to people throughout the inspection. They were respectful and treated people in a caring and supportive way.

People told us they felt safe and were treated with dignity and respect. Our discussions with staff told us they were fully aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen.

The service had appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

People had personalised their rooms and they reflected their personalities and interests. There were memory boxes outside some of the rooms. There was good signage in the service to help people navigate around the building. People living with dementia may need such signs every time they move around a building. People spoken with told us they were satisfied with the quality of care they had received and made positive comments about the staff. Relatives spoken with also made positive comments about the care their family members had received and about the staff working at the service.

People had a written care plan in place. People’s records were updated on a daily basis.

Individual risk assessments were completed for people so that identifiable risks were managed effectively. People and/or their representatives were included in the completion of these and they were reviewed regularly and in response to changes. There was evidence of involvement from other professionals such as doctors, optician, tissue viability nurses and speech and language practitioners.

People’s nutritional needs were monitored and actions taken where required. People made positive comments about the food and said their preferences and dietary needs were being met.

Staff told us they enjoyed caring for people living at the service. Staff were able to describe people’s individual needs, hobbies and interests, life history, likes and dislikes and the name people preferred to be called by. Staff completed induction, training and received ongoing support. Staff received specialised training to meet the needs of people they supported.

We saw the service promoted people’s wellbeing by taking account of their needs including daytime activities. There was a range of activities available which included: sing alongs, arts and crafts and games. A group of people had gone on a trip to Cleethorpes earlier in the year. We looked at the service’s newsletter dated 5 August 2014. It gave details of the events the service had held earlier in the year, a sports day and a summer fete. On the morning of the inspection a small group of people were carving pumpkins in the activities room. The service was in the process of recruiting an additional activities worker to enable more people to participate in activities in a group or on a one to one basis.

The provider had a complaint’s process in place. We found the service had responded to people and/or their representative’s concerns, investigated them and had taken action to address their concerns.

Regular residents and relatives meeting were held at the service. A copy of the latest relatives meeting minutes was available for people and visitors to the service to read. In the reception area there was an information board with details of future projects planned for the service. For example, changes to the garden area. This meant people and their relatives or representatives were kept informed about information relevant to them.

Accidents and untoward occurrences were monitored by the registered manager to ensure any trends were identified. There were effective systems in place to monitor and improve the quality of the service provided.

Norbury Court opened in April 2013. This was the home's first inspection.

We were not able to fully communicate with some people living at Norbury Court. However, people told us they were "Happy" and "Alright". People also commented that staff were "Lovely" and "Kind."

Relatives spoken with said that they were satisfied with the care their loved one received. They told us they had no worries or concerns about Norbury Court. Their comments included, "It is marvellous here and I would recommend this home. [My relative] is well looked after" and "It is brilliant here. The staff really care."

We found that people's care and welfare needs were assessed and each person had a written plan of care that set out their identified needs and the actions required of staff to meet these.

During the inspection we were able to observe people's experiences of living in the home. The interactions between people living at the home and staff were positive. We found that care and support was offered appropriately to people.

We found that suitable arrangements were in place to ensure people were safeguarded against the risk of abuse and their rights were upheld.

We found that sufficient numbers of staff were provided to meet people's needs. Staff were provided with relevant training to maintain and update their skills and knowledge.

We found that procedures were in place to audit and monitor systems within the home.

Norbury Court

All Inspections

During an assessment under our new approach

During an assessment under our new approach

During an assessment under our new approach

15 June 2022

During an inspection looking at part of the service

10 March 2021

During an inspection looking at part of the service

14 June 2017

During a routine inspection

28 October 2014

During a routine inspection

14 October 2013

During a routine inspection