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Normanhurst Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 7 December 2018

This inspection took place on the 17 and 19 September 2018 and was unannounced.

Normanhurst Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide nursing and personal care and accommodation for up to 31 older people and people living with dementia. At the time of the inspection there were 25 people living there. Some people had complex needs and required nursing care and support, including end of life care. Other people needed support with personal care and assistance moving around the home due to frailty or medical conditions, such as diabetes and stroke and, some people were living with dementia.

A registered manager had not been in place since May 2018. A manager had been appointed and was applying to register at the time of the inspection. 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 are Mr David Lewis and Mr Robert Hebbes. They also own Normanhurst Care Home and Normanhurst EMI Home.

We carried out a comprehensive inspection at Normanhurst Nursing Home in June 2016 when we found the overall rating was Requires Improvement, with four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because improvements were needed in the quality assurance process as a number of areas for improvement had not been identified and audits had not been completed for some aspects of the services.

At the last inspection on 31July and 01 August 2017 we found that improvements had been made. However, medicines practices needed to improve further, to ensure people’s health and well-being was protected and the quality assurance process needed further development. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the overall rating was Requires Improvement.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and confirm it had improved. We found improvements had been made. However, the quality assurance system was not effective as it had not identified all areas where improvements were needed, such as medicine records and nutrition. Additional work was needed to ensure all areas of the service provided were monitored and that this was part of everyday practice to drive improvements. This is the third time the overall rating for this service is Requires Improvement.

Staff understood the Mental Capacity Act 2005 and consistently asked people if they needed assistance. People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had completed relevant training, including moving and handling, infection control, medicines and safeguarding. They had a good understanding of people’s needs, how to protect people from abuse and the action they would take if they had any concerns. Robust recruitment procedures ensured only suitable staff were employed and there were sufficient staff working in the home to provide the care people needed. Supervision and staff meetings kept staff up to date with current best practice and they understood their roles and responsibilities.

Staff supported people to be independent, make choices and plan the support they received with staff. People told us staff provided the care they needed and staff treated them with respect. Care plans were based on people’s assessed needs and had been agreed with people and/or their relatives. They included risk assessments and clear guidance for staff to follow to reduce risk as much as possible.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff were aware people had different communication needs and explained how they supported people to communicate.

People said the food was good, staff assisted people if required and referrals were made to healthcare professionals if there were any concerns about a person’s diet. Relatives and friends could visit at any time and were involved, if appropriate, in planning and reviewing people’s care.

Inspection areas

Safe

Requires improvement

Updated 7 December 2018

The service was not consistently safe.

Staff had not followed current guidance to ensure people received their prescribed medicines.

Staff had attended safeguarding training and understood abuse and how to protect people.

Risk to people had been assessed and there was guidance for staff to follow to ensure people’s safety.

There were enough staff working at the home to meet people’s needs. Recruitment practices were robust and only suitable staff were employed.

Effective

Good

Updated 7 December 2018

The service was effective.

Staff understood the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of their responsibilities.

Staff attended relevant training to ensure staff had a good understanding of people’s needs and the support they wanted.

People were supported to have a nutritious diet, staff assisted people as required and referrals were made to health professionals if staff had any concerns.

Caring

Good

Updated 7 December 2018

The service was caring.

People made decisions about their day to day care, they decided how and where they spent their time and staff respected their choices.

Visitors were welcome at any time and people were encouraged to maintain relationships with relatives and friends.

Responsive

Good

Updated 7 December 2018

The service was responsive.

People needs had been assessed and support and care was planned and delivered based on people’s preferences and choices.

Group and individual activities were organised for people to participate in if they wished

People and visitors knew how to make a complaint and would talk to the manager if they had any concerns.

Well-led

Requires improvement

Updated 7 December 2018

The service was not consistently well led.

The quality assurance system was not effective, as areas for improvement had not all been identified and action had not been taken to ensure people received appropriate care and support.

Feedback was sought from people, relatives and staff through regular meetings and satisfaction questionnaires.

The manager kept staff up to date with changes to the services and staff were encouraged to put forward suggestions for improvements during daily team meetings.