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Normanhurst Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 19 September 2017

This inspection took place on 31July and 01 August 2017 and was unannounced. There were 29 people living at Normanhurst Nursing Home when we inspected. People cared for were all older people. They were living with a range of nursing and care needs, including arthritis, stroke and heart conditions. Some people were also living with dementia. People needed support with most of their personal care, nutritional care and mobility needs. The home also provides end of life care and short stay respite care when required.

Normanhurst Nursing Home had accommodation provided over three floors. A passenger lift was available to support people in getting between each floor. A lounge and separate dining room were provided on the ground floor and there was a wheelchair accessible garden. The home was situated near the sea-front in Bexhill on Sea

There was a 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. The providers for the service were Mr David Lewis and Mr Robert Hebbes. They also owned Normanhurst Care Home and Normanhurst EMI Home.

Normanhurst Nursing Home was last inspected in June 2016. At this comprehensive the overall rating for this service was Requires Improvement. Four breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. This was because audits of service provision had not identified a range of areas that needed to be improved. This included no audit of the training needs of staff to ensure they could meet peoples’ needs safely. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by August 2017.

This inspection on 31July and 01 August 2017 was to see if improvements had been made and embedded into practice. We found that many improvements had been made. However medicine practices need to be improved further to ensure medicines were given as prescribed and ensured peoples’ health and well-being was protected. We found multiple signature omissions for the month of July 2017, along with medicines being out of stock for essential medicines for up to five days. There were also some irregularities in respect of GP instructions and staff documentation.

Quality monitoring systems and daily documentation completed by staff needed further development to ensure best practice in all areas, for example, medicines and fluid intake charts.

We recommend that the service seeks advice from a reputable source to ensure that staff use the appropriate equipment for people with variable mobility.

The provider was meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were completed in line with legal requirements. Deprivation of Liberty Safeguards had been requested for those that required them. The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the MCA 2005 and DoLS.

People received care that person specific to reflect both their health and social care needs. Care plans had been reviewed and there was acknowledgement from the management team that there was still work to be done to ensure that all reflected peoples personal preferences. There were plans to review the organisational documentation that would streamline peoples care plans to ensure that they were easy for staff to use and access. Risk assessments that guided staff to promote people’s comfort, nutrition, skin integrity and the prevention of pressure damage were accurate. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Equipment used to prevent pressure damage was set correctly and people identified at risk from pressure damage had the necessary equipment to prevent skin damage. There were activities for people to participate in as groups or individually to meet their social and welfare needs.

Staffing numbers and the deployment of staff ensured that people were safe and supported to spend their day as they wished. There had been a consistent usage of agency staff as many permanent staff have left. However new staff were being recruited and the organisation were committed to further recruitment.

People were complimentary about the food at Normanhurst Nursing Home and the dining experience was an enjoyable experience for people. People were supported to eat and drink in a safe and dignified manner. The meal delivery ensured peoples nutritional and hydration needs had been met and offered a wide range of choice and variety of nutritious food.

The home was clean and well presented. Risks associated with the cleanliness of the environment and equipment had been identified and managed effectively.

There were arrangements for the supervision and appraisal of staff. Staff supervision took place to discuss specific concerns. Staff confirmed that they had regular supervision and yearly appraisals.

People we spoke with were complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff were respectful to people and there was plenty of chat and laughter heard.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by the Normanhurst Nursing Home all had registration with the nursing midwifery council (NMC) which was up to date.

We found a breach of the HSCA 2014 Regulations. You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Requires improvement

Updated 19 September 2017

Normanhurst Nursing Home was not always safe. Whilst meeting the legal requirements that were previously in breach we found a new breach of regulation. This was because people were not consistently protected by the safe management of medicines.

There were enough staff on duty to meet the needs of people. Appropriate checks where undertaken to ensure suitable staff were employed to work at the service. There has been high agency usage that was now reduced with new staff being employed by the organisation.

Staff had received training on how to safeguard people and were clear on how to respond to any allegation or suspicion of abuse.

People had individual assessments of potential risks to their health and welfare. Staff responded to these risks to promote people’s safety. The environment and equipment was well maintained to ensure safety.

Effective

Good

Updated 19 September 2017

Normanhurst Nursing Home was effective and was meeting the legal requirement that was previously in breach. However some areas required time to become fully embedded into everyday practice.

Mental capacity assessments met with the principles of the Mental Capacity Act 2005. However some DoLs documentation had been misplaced.

Processes were now in place to make sure each person received appropriate person centred care and treatment which was based on an assessment of their needs and preferences.

Training had been identified as required and the training plan confirmed training completed, and training in progress. This meant staff were working with the necessary knowledge and skills to support people effectively.

People received a nutritious and varied diet. People were provided with menu choices and the cook catered for people’s dietary needs.

Caring

Good

Updated 19 September 2017

Normanhurst Nursing Home was caring.

Staff knew people well and had good relationships with them. People were treated with respect and their dignity promoted.

People and relatives were positive about the care provided by staff.

People were involved in day to day decisions and given support when needed.

Responsive

Good

Updated 19 September 2017

Normanhurst Nursing Home was responsive and was meeting all the legal requirements that were previously in breach.

There were activities for people to participate in as groups or individually to meet their social and welfare needs.

People told us that they were able to make everyday choices, and we saw this happening during our visit.

Care plans showed the most up-to-date information on people’s needs, preferences and risks to their care.

A complaints policy was in place and complaints were handled appropriately. People felt their complaint or concern would be resolved and investigated.

Well-led

Requires improvement

Updated 19 September 2017

Normanhurst Nursing Home was not consistently well led. Whilst we saw improvements had been made, there were areas that still needed to be embedded in practice to ensure that improvements were consistently sustained.

A new quality assurance system was in place. However, some areas of documentation needed oversight to ensure they were completed consistently and information was appropriately recorded.

The registered manager and staff in the service were approachable and supportive.

There had been a number of positive changes made to the day to day running of Normanhurst Nursing Home and there was a clear programme in place for continual improvement