Normandy House

Normandy House is a residential care home providing personal care and support to four adults with a learning disability. The service can support up to six people in one adapted building.

Normandy House is a family sized property in a residential area which looks similar to other houses on the street. It is located in the suburbs so transport is required to access community resources and the town.

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

Improvements were required to ensure care records reflected people's current risks to ensure staff knew how to provide safe care and support. Some medicine recording required strengthening to ensure staff knew when to administer medicines safely and record all relevant information in line with best practice guidance.

Improvements were needed to quality assurance processes to ensure they were completed within the provider's timescales and identified issues which needed action. The registered manager was committed to ensuring people received good quality care in line with the Right support, right care, right culture guidelines and followed up promptly on issues brought to their attention.

People received safe care and were supported by a consistent team of staff. Safe recruitment processes were in place. Processes were in place to ensure lessons were learned when things went wrong.

Infection prevention and control measures were in place including sufficient stocks of personal protective equipment (PPE) to reduce the risk of cross infection.

People living in the service, relatives/next of kin and staff had opportunities to contribute their views. Positive feedback was received about communication between staff and relatives. Relatives knew how to make a complaint if they needed to.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions Safe and Well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• People were supported to have choice and control of their lives. People were starting to be able to do activities they enjoyed again, and meet more often with family and friends, following the lifting of the pandemic restriction.

Right care:

• People were cared for safely. We found some issues with documentation which needed to be strengthened.

Right culture:

• The registered manager and staff promoted a positive and open culture. When issues were brought to the attention of the registered manager they were dealt with appropriately. Relatives knew how to make a complaint and felt any concerns would be taken seriously.

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 13 November 2019). In March 2021 we undertook a targeted inspection which only looked at the area of infection prevention and control. This did not impact upon the last rating.

Why we inspected

We received some concerns in relation to management and staff practices in the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

¿The service was clean and tidy. Thorough cleaning took place regularly, which included touchpoint areas such as door handles.

¿Procedures were in place to facilitate contact between people and their families, when this was allowed.

¿Visitors to the service were required to undergo a temperature check, and wear correct Personal Protective Equipment (PPE) at all times.

¿Suitable arrangements were in place to ensure that if anyone were to move in to the service, they would do so safely. This would include a negative COVID-19 test before moving in, and isolating for a 14-day period within the service.

¿Staff had access to sufficient supplies of PPE including masks, gloves, aprons and hand sanitiser. The manager had been proactive in ensuring stock levels remained good for the staff. We observed staff using PPE correctly throughout the service during our inspection.

¿Staff followed guidelines with the donning and doffing of PPE, and had an area within the service where this could be done safely.

¿Regular testing was completed for staff and people living at the service. This meant prompt action could be taken should anyone test positive for COVID-19 .

¿Regular checks and audits around infection control were completed to ensure the manager had oversight on the service, and could address any issues promptly if found.

¿Sufficient staffing levels were in place to ensure people received the support they required.

Rating at the last inspection

The last rating for this service was Good (published 13 November 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice (IPC) was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place, as well as staffing levels within the service.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Normandy House is a residential care home which provides care and support to older people with learning disability and dementia. It is registered to provide care for up to six people. At the time of our inspection five people were living at the home.

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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were supported by staff that knew how to keep them safe and knew how to raise any concerns regarding people's safety with the provider, the relevant safeguarding body and the Care Quality Commission (CQC).

People's care plans included assessments of risks associated with their care. Staff followed the risk assessments to ensure that people received safe care. Staff knew how to respond to and report any concerns about people's safety and well-being.

Staff were safely recruited, and staffing arrangements met people’s assessed care and support needs. People were supported to take their prescribed medicines safely. Staff followed good practice infection control guidelines to help prevent the spread of infection.

People were supported by staff who had the right skills and knowledge to provide care that met people's assessed needs. Staff were alert and responsive to changes in people's needs. They liaised with relatives and health professionals in a timely manner which helped to support people's health and well-being.

People were supported to stay healthy. Staff encouraged people to live healthier lives, they encouraged healthy eating and supported people to attend medical appointments. Staff enabling people to socialise and develop and maintain relationships.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service very well and had built trusting relationships with them. People and their relatives, or advocates were involved in planning their care and support. People's privacy and dignity was always maintained.

The registered manager and the provider closely monitored the quality of care and support people experienced and acted on people's feedback to drive continual improvements in the service. Policies, procedures and other relevant information was made available to people in formats that met their communication needs, such as easy read picture styles.

Effective quality assurance systems were in place to monitor the quality of the service. Actions were taken, and improvements were made as required. The service worked in partnership with outside agencies.

Rating at last inspection.

The last rating for this service was Good (published 6 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Our inspection took place on 18 April 2017 and was unannounced.

The service had a 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.

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service. People had risk assessments in place to enable them to be as independent as they could be whilst remaining safe. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient numbers of staff who had the right skills and knowledge to meet people’s needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Systems were in place to ensure people’s medicines were managed in a safe way and that they received their medication when they needed it.

Staff received support and training to perform their roles and responsibilities. They were provided with on-going training to update their skills and knowledge. Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were provided with a balanced diet and adequate amounts of food and drinks of their choice. The service had developed positive working relationships with external healthcare professionals to ensure effective arrangements were in place to meet people’s healthcare needs.

People were looked after by staff that were caring, compassionate and promoted their privacy and dignity. We saw that people were given regular opportunities to express their views on the service they received and to be actively involved in making decisions about their care and support.

Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported. There was an effective complaints system in place which was used to drive future improvement within the service.

There were effective systems in place for responding to complaints and people and their relatives were made aware of the complaints processes. Quality assurance systems were in place and were used to obtain feedback, monitor service performance and manage risks.

We carried out this inspection on 21 March 2016, to check that improvements had been made following our focused inspection on 14 July 2015. This inspection was unannounced.

There was no registered manager in post during our inspection; however the service had a new manager who was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Although there were systems in place in respect of the Mental Capacity Act 2005 (MCA) these were not always used appropriately to ensure that decision specific assessments were completed for people.

Care plans were based upon people’s individual needs and preferences. We found that they were reviewed and updated regularly, to ensure they reflected the most up-to-date information regarding people’s care needs. However, records did not show that people or their relatives were full participants within the formal review process, which meant that their input into the care planning process was not always well documented.

Quality monitoring systems and processes were in place but were not always used as effectively as they could have been. The manager required time to embed their proposed changes so as to drive future improvement.

People felt safe in the service. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report potential abuse. Systems in place were not followed to ensure that appropriate action was taken to keep people safe from abuse or neglect. Potential safeguarding incidents were reported to relevant external agencies. Risk assessments ensured that staff understood how to manage risks to promote people’s safety.

Robust recruitment checks took place in order to establish that staff were safe to work with people. There were adequate numbers of staff on duty to support people safely and ensure people had opportunities to take part in activities of their choice. Systems and processes in place ensured that the administration, storage, disposal and handling of medicines were suitable for the people who lived at the service.

Staff were provided with an induction programme when they commenced employment and they also received on-going training, based on the needs of the people who lived at the service. They benefitted from additional support within regular supervision sessions which enabled them to discuss any concerns and training and development needs.

People were able to access snacks and fluids throughout the day. Meals were based upon their preferences and catered for specialist dietary requirements. People had access to health care professionals to make sure they received appropriate care and treatment to meet their individual needs.

Staff were friendly, kind and compassionate towards people. They engaged with them in a friendly manner and assisted them as required, whilst encouraging them to remain as independent as possible. Staff treated people with dignity and respect and understood their specific needs and wishes. Advocacy services were accessed to enable people to have a voice when this was appropriate.

People were supported to undertake activities both inside and outside of the service to keep them engaged. The service also had a complaints procedure in place, to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The service was led by a manager who was new in post, with additional support from the deputy manager. Although the manager was new to the service we found that there was an open and transparent culture, which was used to good effect in supporting people and staff to express their views about the delivery of care.

We found that people's records had been reviewed on a monthly basis, or as needs had changed which meant that people received safe and effective care.

We found the service at Normandy House to be well managed.

As some people at Normandy House were not able to talk to us about their care, we spoke with relatives and family members. One person told us that 'the staff are fantastic'. Another person said that they were pleased with the care that their relative was receiving.

We saw that the provider had a safe and effective system in place for the management of medicines, and that there were sufficient members of staff to provide the care that people needed.

We were concerned that not all records had been kept up to date when people's needs had changed, and that some staff had been provided with informal training but we could not find any records which demonstrated that their competency had been assessed.

We saw that adequate food and drink was provided by staff in the way that best met people's requirements.

People told us that they were happy at Normandy house and that they had no complaints.

Normandy House was very clean, warm and homely.