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Inspection carried out on 8 March 2018

During a routine inspection

This was an unannounced inspection that took place on 8 March 2018.

Norfolk Road is situated in Denton Holme and is near to all the amenities of the city of Carlisle. It is operated by Community Integrated Care who run similar services nationally.

Norfolk Road 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. When we last inspected this service in September 2016 we rated it as 'requires improvement' and we made recommendations.

The home accommodates six people in a large adapted period property. At the time of our visit there were five people living there.

The home had a suitably qualified and experienced registered manager. 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.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and could talk to us about how they would identify any issues and how they would report them appropriately. Risk assessments and risk management plans supported people well. Arrangements were in place to ensure that new members of staff had been suitably checked before commencing employment. Any accidents or incidents had been reported to the Care Quality Commission and suitable action taken to lessen the risk of further issues.

The registered manager ensured that there were sufficient staff to support people. Our findings corroborated this. Staff were suitably inducted, trained and developed to give the best support possible. We met experienced and confident team members who understood people's needs as well as new staff who were keen to learn.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary.

We saw that good assessment of need was in place and that the staff team analysed the outcomes of care for effectiveness. People appeared happy with the food provided and we saw well prepared healthy meals that staff supported and encouraged people to eat.

The house itself was warm, clean and comfortable on the day we visited. Suitable equipment was in place to support people with their mobility.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. 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.

We observed kind, patient and suitable support being provided. Staff knew people and their families very well. They made sure that confidentiality, privacy and dignity were maintained. People were encouraged to be as independent as possible. No one was receiving end of life care when we visited but there were plans in place and training available should the need arise.

Risk assessments and support plans provided detailed and relevant guidance for staff in the home. People in the service were involved in the writing of support plans and were able to influence the content. The management team had ensured the plans reflected the person centred care that was being delivered.

Staff took people out locally and encouraged people to follow their own interests and hobbies. The service was establishing links in the community.

The registered manager demonstrated good vision and values. Staff were able to discuss good practice, issues around equality and diversity and people's rights.

The service had a comprehensive quality monitoring system in place

Inspection carried out on 1 September 2016

During a routine inspection

This unannounced inspection took place on 1 September 2016. We last inspected this service in June 2014 under the regulations that were in force at that time.

Norfolk Road provides support for up to six people with a learning disability and/or mental health problems. It is a large period property set in its own grounds and is a short walk from local shops and amenities.

At the time of our inspection the service was intending to register a new manager. 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.

Care plans were person centred and showed that individual preferences were taken into account. Care plans were subject to regular review to ensure they met people’s changing needs. This meant people received personalised care. They were easy to read and based on assessment and reflected the needs of people. Risk assessments were carried out and plans were put in place to reduce risks to people’ safety and welfare.

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed to protect their rights. Staff were aware of how to identify and report abuse. There were also policies in place that outlined what to do if staff had concerns about the practice of a colleague.

The staff were trained to an appropriate standard and received regular supervision and appraisal. As part of their recruitment process the service carried out background checks on new staff. The provider had identified what they thought to be safe staffing levels within the service. They had not always been able to maintain these levels. They acted quickly to rectify this following our inspection. We have made a recommendation relating to monitoring staffing levels.

The service managed medicines appropriately. They were correctly stored, monitored and administered in accordance with the prescription. People were supported to maintain their health and to access health services if needed. People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed.

Staff had developed good relationships with people and communicated in a warm and caring manner. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with.

Though the manager and the interim service lead had a good oversight of the service and were aware of areas of practice that needed to be improved this was not always acted upon in a timely manner by the provider. We have made a recommendation around the oversight and leadership of the service.

Inspection carried out on 30 June 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

� Is the service caring?

� Is the service responsive?

� Is the service safe?

� Is the service effective?

� Is the service well led?

This is a summary of what we found:

Is the service safe?

We found that people were protected from unsafe and inappropriate care because medicines were well managed and accurate records for all aspects of the service were kept. Staff underwent thorough checks and a robust recruitment system before they were able to work with vulnerable people.

Is the service effective?

People were looked after by staff who understood their care and support needs. Relatives were satisfied with the service provided.

Is the service caring?

We observed that people were cared for by warm and friendly staff who were knowledgeable about the people they cared for.

Support plans were well written, detailed and based on a thorough assessment of people's needs.

Is the service responsive?

Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. Staff were clear about their roles and responsibilities. The manager provided leadership and was aware of areas that required improvement.

Inspection carried out on 21 November 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service, because people had complex needs which meant they were not able to tell us their experiences. Although some people found verbal communication difficult they were able to make their wishes known.

We found that people were well looked after in a warm and friendly atmosphere that promoted dignity and choice. Staff were well trained in the safeguarding of vulnerable adults and were aware of what to do if they were concerned about abuse. We saw that the home worked closely with other health and social care providers in order to ensure that the people who used the service were cared for in a safe and appropriate manner. The home had enough staff to met people's needs and systems in place to check the quality of service they provided.

Inspection carried out on 13 August 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. Although some people found verbal communication a problem they were able to make their wishes known.

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