Background to this inspection
Updated
30 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out on both days by two inspectors.
Service and service type
Norfolk Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 did not have a registered manager in day to day control of the service. At the time of the inspection there was a manager registered. This manager applied to CQC to deregister on 9 January 2019 and this application was being processed by CQC at the time of the inspection. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided. A new manager had started in April 2019 and was applying to be registered with the Care Quality Commission.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We spoke with the local safeguarding adults’ team and reviewed information that had been sent to us by the provider, including statutory notification forms.
We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service and two relatives. We spoke with the manager, an operations manager, and four care staff. We reviewed a range of records including four people’s care records, medicines records, and a variety of other safety related documents such as fire risk assessments and kitchen safety records. We reviewed the providers’ policies and procedures and staff records related to recruitment and day to day staff management.
After the inspection
We continued to seek clarification from the provider to provide further evidence. We looked at training and staff rota data and requested a safeguarding referral was made.
Updated
30 August 2019
About the service
Norfolk Lodge is a residential care home providing personal care and accommodation for five people with learning disabilities at the time of the inspection. The service can support up to eight people.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. These values were not always seen consistently in practice at the service. For example, some people could live independent lives and were supported to do so. However, other people were not receiving the assistance with communication they needed to be as independent as possible.
Norfolk Lodge is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation. This does not include Norfolk Lodge; the investigation is on-going, and no conclusions have yet been reached .
People’s experience of using this service and what we found
Risks were not consistently being managed safely, such as around people’s health needs, and staff did not fully understand who to report to under safeguarding. People did not always receive their prescribed medicines when they needed them. Lessons were not learned when things went wrong.
People were at risk of not receiving the right amount to drink as fluid charts were not completed correctly. There were some gaps in staff training and competency checks had not happened when they were needed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People’s privacy and dignity was not always upheld; we found personal medical details discussed in a staff communication book. People did not always have their care plans in the format they needed them. Staff treated people with kindness and people told us they liked their staff.
People’ care plans were not personalised, and some had important information missing. Activities were not person centred and they were not tracked to see what people did or if they enjoyed it. People knew how to make a complaint and the service was helping people make decisions around how they wanted to be supported at the end of their lives.
The service was not well led as audits had not been effective in putting right issues we found at the last inspection. We had not been told about all serious incidents and the previous inspection rating was not being displayed in the service. There was a new manager at the service who was registering with CQC and was working to change the culture in the service.
People told us that they liked living at Norfolk Lodge and that they liked their staff.
We saw some examples of kind and considerate support from staff who had a caring approach.
People knew how to complain and were confident they would be listened to.
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 Inadequate (published 17 April 2019) and there were multiple breaches of regulation.
This service has been in Special Measures since April2019
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Enforcement
We have identified breaches in relation to person centred care, dignity, mental capacity, safe care and treatment, safeguarding, governance, displaying ratings and notifying CQC of incidents at this inspection.
We imposed conditions on the provider's registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider's services and actions to improve, and to inform our inspections.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service remains 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-inspect 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.