Archived: Norton Place

We found the following examples of good practice.

The registered manager has followed guidance on infection control procedures to safely support people living at the service during the pandemic.

People and staff have regularly been tested for COVID-19 and where positive results have been returned the registered manager had acted quickly to support people and mitigate risks.

All staff had received training on how to properly use PPE and there were good systems set up in the service to support the donning and doffing of PPE. Staff had been issued with uniforms at the start of the pandemic to wear and changing were facilities in place.

The registered manager held a party when staff were issued with wearing PPE, to try and help people associate a fun activity with the wearing of PPE by staff, to help prevent them being scared or concerned.

Guidance had been implemented to allow where possible, for relatives to continue to visit people safely. Where visits were unable to go ahead, video calls had been used.

People had been supported to continue to access healthcare services. This had included visits from the palliative care team and video support from speech and language therapy. The registered manager told us they had also received support from a community nurse specialising in support for people with a learning disability and had regular calls with the GP.

Further information is in the detailed findings below.

Norton Place is a nursing home, for up to 11 people with learning disabilities and complex health needs. At the time of our inspection there were nine people living at the service, which is close to the seafront in Shoeburyness.

People’s experience of using this service:

People had good outcomes at Norton Place. They lived in a peaceful setting and their needs were met by care staff who knew them well. Feedback from relatives was positive about the service, with one relative saying, “[Person] is in the right place and is happy. It’s the best care they have had over the years.”

The service was effectively managed by a well-established registered manager and deputy manager. They led by example and had a passion for continually driving improvements and placing people at the centre of the service. They promoted a culture which shifted the emphasis away from people’s health needs and focused on them as individuals. The registered manager developed positive links with outside agencies and used feedback to learn from mistakes.

As part of the conditions of their registration the provider had to ensure there was always a qualified nurse on site. The service was very dependent on agency staff due to the difficulty in employing permanent nurses. There were increased risks from a high turnover of agency nursing staff as they did not always know people and the providers processes. The registered manager had effective measures in place to minimise this risk.

People were safe at the service. There were enough safely recruited staff to meet their needs. Staff knew what to do if they had concerns about a person’s safety and the registered manager investigated concerns thoroughly and openly. Staff minimised risks from the spread of infection.

People received their medicines safely. In the past there had been concerns about the administration of medicines. There had been several improvements as a result, which had improved the safety for people in this area. A new room was being converted into a dedicated area for the nursing staff and for storage of medicines. This would improve safety and privacy for people receiving support with their medicines.

Staff had a good understanding of risk for each person. The registered manager ensured measures to minimise assessed risk did not unnecessarily restrict people. There were effective processes to ensure the service met legal requirements where people’s freedom was restricted. Staff offered people choice and when they did not have capacity, made decisions which were in people’s best interest.

Staff were well trained, supported and supervised. Concerns about staff morale and poor practice were managed well. Staff had developed effective skills to meet the complex needs of the people at the service. Staff worked well along with external professionals to maintain people’s physical and emotional wellbeing. People ate and drunk in line with their preferences and dietary needs.

Support was person centred and tailored around individual’s specific needs. Staff reviewed and adjusted support when changes happened. People were supported to take part in pastimes and interests. The provider had invested in new training and a new vehicle to ensure people remained stimulated and able to access the community.

People and their families felt able to raise concerns. There was a formal complaints process, and although there were few complaints, the registered manager encouraged feedback and was pro-active about investigating and resolving informal concerns.

Staff had received training and guidance around supporting people who needed end of life care. Whilst no one at the service was currently receiving palliative care, staff spoke with respect and fondness of people and families who they had been able to support when end of life care was required.

More information is in the detailed findings below.

Rating at last inspection:

Good. The last report was published on 3 September 2016.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to check Norton Place to ensure people receive care which meets their needs. We plan our inspections based on existing ratings and on any new information which we receive about each service.

Norton Place provides accommodation and nursing care for up to 11 people who have a learning disability; some of whom may have dementia related needs. There were 10 people living in the service on the days of our inspection.

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.

There were enough well trained and supported staff who had the knowledge and skills to care for people safely and meet their individual needs and wishes. Staff had been safely recruited to ensure they were fit to work with vulnerable people. Where people were not able to share their views with us verbally they used their individual style of communication which included facial expressions and body language to communicate with us. People indicated that they felt safe and we saw they were comfortable in staffs’ presence. Staff demonstrated a good knowledge and understanding of how to protect people from the risk of harm. They had been trained and had access to information and guidance to support them with the process.

Risks to people’s health and safety had been assessed and well managed. There were support plans together with risk assessments in place to ensure people were cared for safely. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines.

The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications when needed.

People had enough to eat and drink to meet their individual needs and preferences. Their care needs had been fully assessed and their support plans provided staff with the information they needed to meet people’s needs and to care for them safely. People’s healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when needed.

Staff treated people with respect and were kind, caring and compassionate in their approach. They respected people’s privacy and treated them with dignity at all times. People expressed their views and opinions in their own individual style of communication. People were supported to participate in activities that were meaningful to them and they regularly accessed shops and parks in the local community. People’s family and friends were able to visit at any time and were always made to feel welcome. Advocacy services were available when required. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

Relatives had confidence in the service and felt that the registered manager would listen and act on any concerns or complaints. Improvements had been made to the systems used to assess and monitor the quality of the service.

We saw that staff treated people well and took their time when speaking with them. Staff actively listened to people and responded appropriately at a level and pace that was suitable for the individual.

There was a good range of activities on offer which included arts and crafts, painting, ball games, cards, dominoes, puzzles, movement to music and the use of sensory items. People regularly received massage therapy from a visiting professional masseuse.

The support plans and risk assessments had been well written and they provided good information about the individual. The daily notes were detailed and informative.

Safeguarding procedures were in place and people appeared relaxed and happy. Staff had a good knowledge of the safeguarding procedures and had received regular training.

There were good procedures in place for handling medication. Staff had been trained in handling medicines and their competence had been regularly assessed.

People's rooms were personalised and the environment was clean, tidy and fresh.

People's health and personal care needs were assessed and there were detailed care plans for support assistants to follow to ensure that people were supported safely, effectively and in accordance with people's individual wishes. Support assistants spoken with demonstrated a good understanding of people's health and personal care needs and how each person wished to be supported. Our observations showed that support assistants ensure that care and support provided to people who use the service was person led, flexible, consistent and able to meet their changing needs. Evidence showed that staffing levels may not always meet the needs of the people using the service. This referred specifically to people having to wait on occasions to receive personal care, to have their manual handling needs met and to be supported to eat their meals and/or be given a drink. The provider may wish to review these arrangements.

We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place.