Normanhurst Care Home

We found the following examples of good practice.

The premises was clean and hygienic and there was a designated housekeeping team. The cleaning schedule included cleaning of frequently touched surfaces and there were charts in designated areas such as the lift for staff to sign when they had cleaned the buttons. Signs had been put up around the home to identify ‘pinch points’, narrow areas of the home where staff were likely to cross one another. This reminded staff to be aware of other people coming towards them in these areas.

Staff were wearing personal protective equipment (PPE) in line with government guidance. Staff had received training in how to safely put on and take off PPE as well as in infection prevention and control (IPC).

Staff found it difficult to encourage people to socially distance but had changed the environment to support social distancing such as spreading out chairs out in the lounge. Activities had been adapted at the home to be suitable for smaller groups. The home had recently re-introduced an externally led keep fit class for people. The instructor completed a lateral flow test, temperature check and health screening each time they entered the building and ensured they kept a safe distance away from people. The activity team had focused on one to one and small group activities for people.

People were able to receive visits from their loved ones. The home had a designated visitors area and a risk assessment in place for visits. Throughout the pandemic, visits for people at the end of their life had been supported by staff. For people who were not able to receive visitors, staff had supported people to use video calling technology.

The registered manager had kept relatives and people living at the home up to date with any changes through the home’s newsletter. For example, when the Prime Minister’s road map out of lockdown was announced, the newsletter produced explained each step and what it meant for people living at the home.

The home also had a designated COVID-19 team, this team was responsible for calling all relatives of the home to keep them up to date with current visiting guidance. The COVID-19 team was responsible ensuring safe IPC practices were followed in the visitors and the testing area.

Normanhurst Care 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 personal care and accommodation for up to 75 older people. At the time of the inspection there were 59 people living there. Most people were independent and had capacity to make decisions about the support and care provided; they went out into town and for meals with relatives and friends. Other people, due to frailty and health care needs, were assisted with personal care and mobilising around the home.

At the last inspection in August 2017 the overall rating for Normanhurst Care Home was Requires Improvement as more work was needed to ensure their quality assurance system identified areas where improvements were needed. at this inspection we found this had been addressed and the overall rating had improved to Good.

The registered manager was present during 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 Nursing Home and Normanhurst EMI Home.

The quality assurance system had been reviewed and areas for change had been identified and prioritised to drive improvement. The care planning process had been changed and an electronic system had been introduced, which was audited as part of their monitoring process. People were involved in writing and reviewing their care plans and decided with staff how much support they needed, based on their preferences. Regular resident’s meetings offered people opportunities to discuss the services provided at the home and put forward suggestions to develop them.

Activities had been developed and planned with people living in the home, which resulted in a range of group and one to one activities that people could participate in if they wished. People, visitors and staff clearly enjoyed these and they were comfortable in each others company.

Risk had been assessed and people were encouraged to be independent in a safe way, with the provision of walking aids and assistance from staff as required. Staff had completed relevant training, including infection control, medicines and safeguarding. They understood people’s needs; how to protect people from abuse and what action they could take if they had any concerns. Supervision and staff meetings ensured staff were up to date with current best practice and they had a good understanding of their and their colleague’s roles and responsibilities. Robust recruitment procedures meant only suitable staff were employed and there were enough staff working to provide the care people needed.

Staff understood the Mental Capacity Act 2005 and consistently asked if people needed support or assistance. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS applications had been requested when required to ensure people were safe.

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 that people had different communication needs and could explain how they supported people to communicate.

People said the food was very good, choices were offered for each meal and snacks and drinks were available at any time. People kept in touch with relatives and friends. Relatives said they were always made to feel very welcome and participated in activities with their family members.

Normanhurst Care Home was a large building. Accommodation was provided over four upper floors, ground floor and a semi-basement. Two passenger lifts were available to support people in getting between each floor. Lounges and a separate dining room were provided on the ground floor. The home was situated on the sea-front in Bexhill on Sea.

Normanhurst Care Home 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. The registered manager was also the registered manager for Normanhurst EMI Home, which was next door to Normanhurst Care Home. The providers for the service were Mr David Lewis and Mr Robert Hebbes. They also owned Normanhurst Nursing Home and Normanhurst EMI Home.

Normanhurst Care Home was last inspected in June 2016. At this comprehensive inspection 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. The provider had not always ensured care was provided in a safe way to people. This was because they did not consistently assess risks to people and do all they could to mitigate such risks. 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 21and 24 August 2017 was to see if improvements had been made and embedded into practice. We found that many improvements had been made and the breaches of regulation met.

Since the last inspection systems and processes to assess and monitor the quality of the service to drive improvement had been developed. However further development was required in certain areas to ensure that risk was mitigated to ensure people’s health and well-being was protected. This was in respect of infection control measures and the information documented in care plans.

The provider had not correctly displayed their CQC rating on their website and the information on the website was misleading. This was identified and rectified during the inspection process.

We recommend the provider ensures they understand all legislation in respect of providing care and treatment.

This inspection found 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 reflected 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 documentation reflected peoples personal preferences and health needs. A new computerised plan was due to go live in the next week. Risk assessments that guided staff to promote people’s comfort, nutrition, skin integrity and the prevention of pressure damage were in place and 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 in place 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 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 confirmed they had regular supervision and yearly appraisals.

People 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.

Normanhurst Care Home was a large building. Accommodation was provided over four upper floors, ground floor and a semi-basement. Two passenger lifts were available to support people in getting between each floor. Lounges and a separate dining room were provided on the ground floor. The home was situated on the sea-front in Bexhill on Sea.

Normanhurst Care Home 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. The registered manager was also the registered manager for Normanhurst EMI Home, which was next door to Normanhurst Care Home. The providers for the service were Mr David Lewis and Mr Robert Hebbes. They also owned Normanhurst Nursing Home and Normanhurst EMI Home.

Normanhurst Care Home was last inspected on 9 September 2014. No issues were identified at that inspection.

During their audits of service provision, the provider had not identified a range of areas. This included some assessments of risk for people. For example where people had an accident, their individual accident reports were not used to assess and reduce their risk. The provider’s audits had not identified that people did not consistently have care plans developed, including where people lived with dementia or had specific care needs. Some documentation about people was not completed, to ensure people received consistent care. The provider had also not identified that parts of the home environment did not follow guidelines on supporting people who were living with a disability or dementia. There was a lack of audit of staff supervisions, to ensure relevant areas were identified. Recruitment systems were not audited to ensure that all staff folders included all required information and the provider’s policies were consistently followed.

Some staff had not been trained in their responsibilities under the Mental Capacity Act 2005 (MCA). People’s assessments in relation to the MCA were not decision specific and did not ensure the requirements of the Act were followed. Deprivation of Liberties (DoLS) applications were made, however there was a lack of best interest decisions documentation where people needed to have their liberties restricted, for example by the use of bed rails.

Some staff did not fully engage with people who were frail and living with dementia, this included in the dining room, lounges and where people remained in their own room all the time. Other staff were responsive and consistently supported people in the way they needed.

Certain areas for supporting people with medicines relating to individual assessments and protocols, required improvement. In other areas, staff supported people in taking their medicines safely and ensured appropriate systems for storage of medicine. Staff had effective systems for liaison with external healthcare professionals where people needed support.

There were a wide range of meals offered to people. People commented favourably on the meals service. Where people required support with their food and drinks, they were helped in the way they needed. There were a wide range of activities provided for people. People could come and go from the home as and when they wanted.

People said they were supported by kindly, caring staff. They said there were enough staff on duty to meet their needs, and they felt safe in the home.

Staff said they were supported by the provider’s induction and training programme. Staff showed a clear understanding of how to protect people from risk, including risk of abuse.

We found a number of breaches 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.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

To see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained.

There were policies in place that ensured people were protected against the risks associated with falls.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While there were no applications that needed submission, proper policies and procedures were in place.

Is the service effective?

People told us that they were happy living in the home and the care they received. It was clear from our observations and from speaking to staff that they understood people's care and support needs well.

We saw from training records that staff had received appropriate training to meet the needs of the people living at the home.

Is the service caring?

People were cared for by kind and attentive staff. We saw that staff were patient with people giving them enough time and encouragement to carry out tasks of daily living. One person told us " The staff are very attentive and caring."

People who lived at the home told us that they were happy living there. They told us that staff were caring and attentive. One person told us " I love it here." Another told us that "This is one of the best homes in the area." Another said " I have no complaints."

We saw that care delivered was good and met individuals assessed needs. People were cared for in a clean environment by staff who received appropriate training and professional development and support.

Is the service responsive?

People's needs were assessed and care delivered according to individual needs. Records outlined people's needs, interests and preferences. People had access to a wide range of activities and were given choices on how they wished to spend their time.

Is the service well-led?

Staff were well informed about the quality assurance processes in the home. People were asked their views and we examined surveys and audits carried out in the home. Staff told us that any concerns were dealt with by management promptly and that they were clear about their roles and responsibilities. There was an 'open door policy' and staff could discuss their views and concerns openly with the manager who would take them into account.

We saw that care delivered was good and met the individuals assessed need. People were cared for in a clean environment by staff who received appropriate training and support.

People were listened to and any complaints were addressed appropriately.