Norton Street

Updated 17 December 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector

Service and service type

Norton Street is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Norton Street is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service about the care and support provided at Norton Street. We also spoke with 5 members of staff including the registered manager, team leader and care staff.

We reviewed a range of records, including 2 people’s care and medication records. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including quality assurance, complaints and safeguarding were reviewed.

After the inspection

We spoke with the provider’s compliance manager by telephone. We continued to seek clarification from the provider to validate evidence found. We looked at additional quality assurance records.

Updated 17 December 2022

About the service

Norton Street is a residential care home registered to provide personal care for up to 31 people. The service consisted of 8 separate terraced houses on residential streets close to the registered office address. The provider had opened additional houses as part of this location since the last inspection; The Care Quality Commission (CQC) had accepted the provider’s application to increase the maximum number of people they could provide support to from 25 to 31 people. There were 25 people using the service at the time of our inspection, whose primary support needs related to their mental health.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided. 2 people were receiving support with personal care at the time of our inspection.

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

Risk assessments and associated guidance were not clear about people’s current needs. They contained conflicting, old and repetitive information. This had been identified through local authority audits and a CQC monitoring call in August 2022, but action to improve the risk assessments and guidance was still at the information gathering stage.

There were enough staff on duty to meet people’s needs and they had been safely recruited. Staff had the training to carry out their role. Staff were supported through staff meetings and supervisions. However, some felt there was sometimes a blame culture when issues had been identified. Staff wore the appropriate personal protective equipment. Staff worked in partnership with other professionals. People received their medicines as prescribed. Equipment was checked and serviced as per current guidance.

A quality assurance system was in place and action plans produced from these. However, audits continued to state care plans were complete, up to date, reviewed and checked, despite actions plans identifying they needed reviewing. Incidents and accidents were recorded and investigated to identify actions to reduce the risk of a re-occurrence.

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.

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 25 July 2019).

At our last inspection we recommended that the provider reviewed their processes for checking the required pre-employment information is received prior to appointing members of staff. At this inspection we found improvements had been made and all pre-employment checks were in place.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of medicines. This inspection examined those risks and we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Norton Street on our website at www.cqc.org.uk.

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.

We have identified breaches in relation to risk assessments and associated guidance not reflecting current needs and the governance and quality assurance system at this inspection.

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

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.