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Inspection carried out on 30 November 2018

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this home in October 2017 and rated the home Good.

On 29 November 2018 we carried out an unannounced focussed inspection, prompted in part by a notification and a safeguarding concern. The information shared with the CQC indicated potential concerns about the management of risks to people.

Normanton Lodge 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.

Normanton Lodge accommodates up to 26 people in one adapted building. At the time of inspection, there were 25 older people living at the home, some of whom were living with dementia.

The home is situated in Bognor Regis, West Sussex. Accommodation was provided over two floors with a lift for people to use when accessing the upper floor. There were assisted bathrooms on each floor, a dining room and one lounge area on the ground and first floor.

The manager was new in post and registered with the Care Quality Commission in November 2018 and was supported by a deputy manager, who had been the previous registered manager for over 20 years. 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.

At this inspection we found that Normanton Lodge continued to have effective processes and systems in place to keep people safe and the home was well-led.

The home continued to have robust safeguarding systems, policies and procedures to protect people from abuse. Local safeguarding procedures were followed to respond to safeguarding concerns promptly.

Risks to people continued to be assessed to keep people safe. There were sufficient numbers of staff to support people and meet their needs safely. One person told us, “Yes, there are enough staff and I do get help quickly.”

Risks associated with the environment and equipment had been identified and managed well. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Normanton Lodge continued to promote a positive culture that was person-centred, open, inclusive and empowered people to live healthy active lives. One person told us, “They do seem well trained, because they just get on with their jobs. I think it’s just like a family in here and they are very kind to me.”

The registered manager and provider actively involved staff in opportunities to continuously learn and improve the quality of the service, taking on board feedback from people and relatives.

Inspection carried out on 31 October 2017

During a routine inspection

This unannounced comprehensive inspection took place on 31 October 2017. The last inspection took place on 14 and 15 September 2015. The service was meeting the requirements of the regulations at that time. The service was rated Good. At this inspection the service remained Good.

Normanton Lodge is a care home which offers care and support for up to 26 predominantly older people. At the time of this inspection there were 20 people living at the service. Some of these people were living with dementia. Accommodation was on two floors with a lift for people to use when accessing the upper floor.

Comments from people, relatives and healthcare professionals included, “You could not wish for a better place,” “I think they (staff) are all absolutely amazing,” “They (staff) are just wonderful, like a big family, so caring and very thoughtful,” “It's not home but it is the next best thing,” “We have no concerns at all about this place. It is one of the best in the area” and “This is one of the homes that we would consider using for our relatives, and we don’t say that about a lot of services in this area.”

We walked around the service which was comfortable and appeared clear. Bedrooms were personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Systems for the management and administration of medicines were safe. It was clear that people had received their medicine as prescribed. Regular medicines audits were consistently identifying if errors occurred.

Staff were supported by a system of induction training, supervision and appraisals. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided such as dementia care. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs were recorded. People, and where appropriate relatives, were included in the reviews.

People had access to a wide range of meaningful activities. An activity co-ordinator was in post who arranged regular events for people. These included regular singing and quizzes, also events for firework night and Christmas were planned. People were provided the opportunity to take part in domestic tasks if they wished. One to one activity was provided for people who were being cared for in their bedrooms.

The premises were adequately maintained. The service had some pictorial signage to meet the needs of people living with dementia.

There was effective communication throughout the staff. The staff were happy working for the service and told us they were well supported. The registered manager was supported by a deputy manager, senior care staff and a team of motivated carers, catering and domestic staff. The provider visited regularly to provide support for the registered manager and audit the service provided.

Inspection carried out on 14 -15 September 2015

During a routine inspection

The inspection at Normanton Lodge Residential Home took place on 14 and 15 September 2015 and was unannounced.Normanton Lodge provides personal care and accommodation for up 26 older people, some of whom were living with dementia. At the time of our inspection there were 21 people using the service.

Accommodation is on two floors and there is a lift for access between floors. There is a conservatory leading onto the garden which is wheelchair accessible. The garden had a raised flower bed for people in wheelchairs to access, vegetable plot and a choice of sitting areas.

There are separate areas in the home where residents can go for privacy and see visitors.

The home had a registered manager who was available throughout the inspection. 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 who lived at the home told us they felt safe, secure and well cared for.

The home had systems and checks in place that were used with the intention of keeping people safe. Accidents and incidents were dealt with in a timely manner and any actions and lessons learned were recorded and reviewed by the provider to ensure future risks were minimised.

Staff knew what actions to take should they suspect abuse and received appropriate training in keeping people safe.

The provider had arrangements for the safe ordering, administration, storage and disposal of medicines. People were supported to take their medicines at a time when it was needed.

People were supported to maintain good health and had access to health care services when it was needed. People were supported to eat a nutritionally balanced diet and were given choices of meals.

The registered manager and the staff team followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff training records showed staff had attended training in MCA and DoLS.

People received care and assistance from staff who knew their needs well.

Each person at the home had their own care plan and their needs, choices and preferences had been clearly documented and were known to staff.

People were supported to maintain contact with their family and friends and visitors were welcomed to the home.

We found there were sufficient staff to meet people’s needs and call bells and requests for assistance were responded to in a prompt and timely manner.

The provider sought feedback on the care it provided and monitored the home to ensure that care and treatment was provided in a safe and effective way and when necessary changes were implemented.

Any complaints that were received were documented along with the actions taken.

There was an effective system in place to monitor the quality of service provided.

We last inspectioned the home in February 2015 and found it was not meeting nine of the regulations at that time. These were in relation to consent to care and treatment, meeting nutritional needs, safeguarding people who use services from abuse, management of medicines, safety, assessing and monitoring the quality of service provision, safety, availability and suitability of equipment, staffing, supporting staff and records.

Following our last inspection the provider sent us an action plan to tell us the improvements they were going to make.

At this inspection we found the actions we required had been completed and these regulations were now met.

Inspection carried out on 02 and 06 February 2015

During a routine inspection

The inspection was unannounced and took place on 02 and 06 February 2015.

Normanton Lodge is a 26 bedded residential care home that provides care and support to older people with a physical disability, dementia and/or related mental health conditions. At the time of inspection there were 23 people living at the home.

During our inspection the registered manager was present. 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.

Management of the home was reactionary and this translated into a culture of inconsistency in the way people who lived with dementia were cared for and treated. Quality assurance processes and audits completed by the manager had not identified the shortfalls in service provision. Therefore, they were not effective. People’s records and those relating to the management of the home were not always accurate or in place. The registered manager had not ensured her knowledge and management skills were current to ensure the home was well led. Everyone said that the registered manager was approachable and listened to people’s views, opinions and concerns.

People told us that they felt safe in the home. However, staffing levels did not ensure that people received all the support they required at the times they needed. In-house activities only took place in the morning due to low staffing levels in the afternoon. Medicines were not always managed safely. Risks were not always fully considered and assessed in relation to equipment and staff did not always practice safe moving techniques.

The registered manager had not sought people’s consent or acted on advice when she thought people’s freedom was being restricted. She confirmed that best interest meetings had not taken place with external professionals to ensure that decisions were made that protected people’s rights.

The registered manager had not completed mental capacity assessments or made DoLS applications. This meant that people’s rights were not protected.

Staff understood the importance of protecting people from harm and abuse. People felt able to raise concerns and complaints were investigated. However, the registered manager had not notified the local authority safeguarding team when safeguarding issues had arisen at the home. Therefore, people were not protected and we could not monitor that all appropriate action had been taken to safeguard people from harm.

Staff said that they felt supported by the registered manager to undertake their roles. However, they had not been receiving training relevant to the needs of people who lived at Normanton Lodge.

People’s nutritional needs were assessed but not always managed effectively. Despite this, people said that they were happy with the food and meals provided. When recommendations were made by external healthcare professionals these were acted upon to ensure people received the care and support they required to manage their medical conditions. Staff knew the needs of people and treated them with kindness, dignity and respect.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of the report.

Inspection carried out on 11 November 2013

During a routine inspection

We spoke with three people who lived at the home. They were all content with the care and support they received and were happy living at Normanton Lodge. One person told us, "This is the next best thing to home". Another said, "It took a while to settle in but it's like living with family. I feel very safe". We spoke with two relatives during the inspection. One told us, "This is a great home. I would say something if it wasn't". We noted that the home employed an activities co-ordinator and provided a wide variety of social events and educational opportunities. The people we spoke with were happy with the number and types of activities on offer.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from abuse and cared for in a safe and inclusive environment. We noted that there were adequate numbers of skilled and experienced staff to deliver safe and appropriate care. We also found that systems were in place for people and relatives to make a complaint about the service if necessary.

Inspection carried out on 21 December 2012

During a routine inspection

We spoke with four people who live at the home. All were happy with the care and support provided. All the people we spoke with confirmed that they were treated with respect and their privacy and dignity were maintained. They also confirmed that they felt safe from harm whilst living at the home and felt able to raise concerns with staff if they needed. One person said that" Staff always pay attention. They are very caring". All the people we spoke with told us that there was a wide variety of social activities available to choose from. One person said, "I couldn't ask for more".

Inspection carried out on 19 July 2012

During a routine inspection

We did not speak with people on this occasion as the purpose of this visit was to examine the provider's response to previous concerns raised about this outcome.

Inspection carried out on 13 October 2011

During a routine inspection

We spoke to five people during the visit. Each person made very positive comments about the service they receive.

People said that their care needs are met and they are asked about the help they need. Comments included the following:

“It’s very good. Everything is good. They ask me what I want. Everything is done for me to make my life natural.” Another comment was, “I am treated very well. Whatever you want, you ask for and you get.”

People said they are consulted about their care, and are asked what they want, although people were not aware if they had a care plan or if they had agreed to it.

People said that they are able to exercise choice in how they spend their time such as getting up and going to bed, joining in activities and where they eat their meals. Comment was made that there is a choice at meal times and that they like the food. One person said that there are always drinks available. People said they enjoy the activities provided such as quizzes and entertainers who visit the home. One person said how much he/she enjoyed the activities and atmosphere at Christmas time. People said that the home obtains daily newspapers and magazines.

People said that they feel safe at the home.

Staff were said to be kind and helpful. People said that there are enough staff to meet their needs and that staff respond promptly when requests for assistance are made using the call points in bedrooms.

People said that the home is kept clean and that their room is cleaned regularly.

Reports under our old system of regulation (including those from before CQC was created)