We carried out a comprehensive, unannounced inspection on 22 March 2018. The previous comprehensive was undertaken in September 2017. At this inspection the provider had breached six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. These breaches related to staffing, safe care, consent, dignity and respect, person centred care and good governance. The service was rated as 'Inadequate'. At the present inspection we found the provider had made some improvements against breaches. However, we found further improvements were required to ensure the provider was able to consistently deliver good care for people. You can read the report from our last comprehensive inspection and our focused inspection, by selecting the 'all reports' link for Normanton Village View Nursing Home on our website at www.cqc.org.uk.Following the last inspection in September 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well-led to at least good.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this time frame. At this inspection the service demonstrated to us that some improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Normanton Village View Nursing home is a 'care home' with nursing and is registered to provide accommodation to people who require personal or nursing care for up to 72 people. 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 service is provided across two floors which are split into four separate units. At the time of our inspection there were 38 people living in the service, many of whom were living with dementia.
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.
Risks to people had been assessed and staff demonstrated they understood how to support people safely. However, we found inconsistencies in people's care records. Some records lacked clarity in providing guidance for staff on the measures they needed to take to keep people safe. People's care records did not always reflect people received care to meet their assessed needs and keep them safe. Records lacked the detail and guidance staff needed to intervene when people became distressed or anxious in order to keep them safe.
People did not always receive medicines administered covertly (disguised in food and drink) as prescribed. Other aspects of medicines were, in the main, managed safely.
The provider had made improvements to systems and processes to monitor the quality of the care provided. However, these systems were not always effective in bringing about improvements that were embedded into staff working practices to ensure people received consistently good care.
People did not always receive the support they needed to eat their meals. Further improvements were needed to ensure people experienced a positive dining experience.
Staff did not always demonstrate the awareness they needed to ensure people's right to be treated in a dignified manner was protected.
Staff had completed training to enable them to recognise the signs and symptoms of abuse and felt confident in how to report concerns.
People were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures. There were enough staff available to meet people's needs as assessed in their care plans.
Systems were in place to support staff to follow safe infection control procedures and staff were observed adhering to these in practice.
There were arrangements in place for staff to make sure that action was taken and lessons learned when accidents or incidents occurred, to improve safety across the service.
Staff completed an induction process when they first stated working in the service. They received on-going development training and supervision for their role. The registered manager reviewed and evaluated training to ensure it was effective.
People were supported to access a range of health professionals to maintain their health and well-being. The service worked collaboratively with other agencies to ensure people had the care and treatment they needed in line with best practice guidance.
The provider was in the process of upgrading the décor of the premises. This included appropriate directional signage to enable people to move around the premises safely and independently.
People's needs were assessed before they began to use the service. People were supported to make decisions and choices about their care. Staff understood the principles of the Mental Capacity Act 2005 and sought consent before providing care and respected people's right to decline care and support.
Staff had developed caring relationships with staff and people and relatives were positive about the staff who provided care and support. Staff understood the importance of maintaining people's independence where possible.
Staff supported people to express their views and be involved in decisions about their care as far as possible. This included consulting relatives and providing access to independent advocates if necessary.
People and their relatives were involved in planning their care and were able to make changes to how their care was provided. The registered manager was in the process of reviewing and updating all care records to ensure they reflected people's current needs.
People had access to a varied activities programme, either individually or as small groups. People maintained contact with those important to them and were therefore not isolated from those people closest to them.
People's concerns and complaints were listened to and responded to. The registered manager had an open approach to listening and responding to people's concerns and taking action to bring about improvements.
People, those important to them and staff were able to share their views about the service and the quality of care they received. These were used to critically review the service and drive improvements to develop the service.
People, relatives and staff spoke positively about the registered manager. The registered manager was promoting a positive culture in the service that was focussed upon achieving good outcomes for people. They had identified where improvements were required and had taken steps to make changes and develop the service.
You can see what action we told the provider to take at the back of the full report.