Normanhurst Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment, the rating has changed to Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment and the way people’s medicines were managed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

There was a system for reporting accidents and incidents, and accident and incident forms were completed. These described what had happened, any investigations that had taken place and actions taken. Staff understood how to identify and report safety concerns. However, care plans and risk assessments had not always been updated to reflect the incident, or what measures had been put in place. We found a risk assessment had not been followed which meant the risk of reoccurrence had not been reduced.

Despite the above concerns we saw from analysis of accidents and incidents the registered manager identified there had been an increase in the number of falls at night. This was due to the increased needs of people. Therefore, agreement had been reached with the provider that staffing numbers would be increased at night.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Before people were admitted to the home an assessment was completed. The registered manager told us, that as far as possible, these were completed face to face. If it was not possible an assessment would be completed over the phone. The registered manager told us they had developed robust assessment questions which helped ensure people’s needs and choices could be met at the service. They said, “If I am doing the assessment and I am not confident with the answers, or that we can meet people’s needs, then I will arrange a face-to-face assessment on another day.”

The provider did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The registered manager told us about actions taken when safeguarding concerns had been identified, this included referral to the local authority safeguarding team. However, we identified an occasion when a safeguarding concern had not been referred to the local authority safeguarding team. There were no risk assessments in the person’s care plan related to this concern which meant there was no guidance for staff to follow. Whilst a risk assessment for staff was in place, we saw this was not always followed. This left people at risk from abuse and staff at risk from the allegation of abuse.

Staff understood safeguarding and what actions to take if they had any concerns. They told us there was always someone they could report to, this included the office managers and the providers. People told us they felt safe living at the home. One person told us everything about the home made them feel safe and added, “There’s nothing that makes me feel unsafe."

Mental capacity assessments (MCAs) had been completed on the system, by staff, using information from external professionals. However, these did not include all the relevant information about how this was recorded. Where best interest decisions had been made there was no evidence of the person or their representative being involved in making the decision. Staff told us they did not know they were able to complete mental capacity assessments. They believed this should be completed by a health or social care professional. We discussed this with the registered manager who told us they would arrange for staff to receive further training to support them to complete MCAs.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that staff and management worked within the MCA. DoLS authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions, they had choice, control and freedom over their lives.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive.

Care plans and risk assessments did not include all the guidance staff may need to help keep people safe and ensure they received consistent care. We were told about risks associated with how one person may display their feelings. There was no guidance within the care plans and risk assessments to ensure this person was supported safely and consistently. People’s mobility had been assessed and there was information in the care plans and risk assessments about the support people needed. However, this did not include all the information staff may need. Where people required the use of a mechanical hoist to assist with transfers there was no information about sling types that should be used. Where people were living with diabetes, care plans and risk assessments were inconsistent. Some included detailed guidance for staff. Others did not include details of how people may present, or what actions to take if their blood sugar levels were low or high. Other care plans, for example, relating to catheters and the use of oxygen contained incomplete or inconsistent guidance.

Staff knew people well and were able to tell us about people and the risks associated with their care. However, the lack of guidance left people exposed to risk of inconsistent care as care plans and risk assessments did not contain detailed or sufficient information on how to manage individual risks consistently.

People told us that risks associated with their support were discussed and they felt safe living at the home. One person said, “All the risks were discussed.” Another person told us they felt safe at the home because of, “having the staff around mainly."

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We identified an area of risk in the environment that had the potential to cause harm to people. Oxygen cylinders that were not in use were not stored safely. We raised this with the registered manager as an area that needed to be addressed and made safe. Following the inspection, we contacted the registered manager and provider. The registered manager told us the oxygen cylinders were now stored safely. This was supported by a risk assessment.

The maintenance staff had identified that although window restrictors were in place these did not meet current health and safety guidance. An installation program had commenced, starting at the top of the building. Following the inspection the registered manager told us the window restrictors were fully installed.

There was a system to ensure the home and equipment was maintained and serviced. There were regular servicing contracts which included gas safety, electrical safety and fire risk assessment. Checks took place to ensure a safe environment was maintained. These included fire safety and water temperature checks. Staff received fire safety training and fire drills were undertaken to ensure staff knew what actions to take in an emergency.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

The registered manager told us they had identified there were not always enough staff working each shift to meet people’s needs. They told us this was because of an increase in people’s needs, related to frailty of age, and not an increase in the number of people living at the home. Some people told us that on occasions they had to wait for call bells to be answered. They all recognised staff were busy with other people. One person said, “Sometimes maybe at times it does feel short staffed, you have to wait and that is the downside."

Staff told us there were not enough of them working each shift. We asked staff about the impact of this. One staff member said, “It’s the timing of care, giving people choices. It means care is not person centred.” Staff also spoke about their colleagues working at night. One staff member said, “I feel for them, at least in the day we have housekeepers and others who can chat with people and call us if there is an issue, but at night there is just not enough of them.” Staffing is an area that needs to be regularly assessed to ensure levels meet people’s needs.

The registered manager told us that recruitment was underway to increase night staff numbers. Staffing numbers were being reviewed for day staff.

We observed staff were proactive in attending to people in a timely way. They responded to call bells promptly. When they could not attend to people immediately, they explained why and told them when they would return.

There was a training program which staff completed and was regularly reviewed and updated. Following training, staff completed knowledge checks to demonstrate their understanding. However, we identified that staff had not received training relating to the needs of all the people living at the home. This included diabetes, oxygen management and catheter care. Staff had not completed mandatory training on learning disability and autism. There is a requirement that all staff complete this training at a level appropriate to the role of the individual member of staff.

Some staff told us they had previously received training but not recently. We were told that there were records of staff training in individual staff files. However, staff training that, that had not been organised through the training program, may not have been recorded and there was no overview.Therefore, it was not clear what training staff had received.

Some staff provided more complex care to people and they had received individual training and competency checks from external health care staff to ensure they could meet people’s needs safely. Staff had good knowledge and understanding of the care and support people needed.

There were processes to ensure staff were recruited safely. This included appropriate checks for staff from overseas to ensure they had the right to work at the service. When staff started work, they completed a period of induction and commenced their training. This included a period of shadowing where they worked with more senior staff to understand the day to day running of the service and meet people who they would be supporting

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean and tidy throughout. One person told us, “The cleanliness of my room is very good." Another person said they had asked for their room to be cleaned and, “The housekeeper is good.”

Staff received infection prevention and control training. Housekeeping staff were responsible for the daily cleaning of the home. There were processes in place to prevent the risk of infection and maintain the cleanliness of the home. Personal protective equipment and handwashing facilities were available throughout the home and staff were observed to be using these appropriately. The laundry arrangements were appropriate and segregated dirty and clean washing. This helped to reduce the risks of cross contamination. Some people had specific requests in relation to their laundry and these wishes were respected.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Improvements were needed to the management of medicines.

Some people had been prescribed ‘as required’ (PRN) medicines. People only took these when they needed them, for example, pain relief. However, guidance about when, why, and how often this medicine may be required was not always in place. There was no information about what actions to take if it was not effective and records did not show if the medicine had been effective.

On occasions staff added handwritten instructions for a new medicine that had been prescribed. These handwritten entries had been added by 1 staff member. Best practice guidance states that handwritten entries should be witnessed and signed by 2 staff members. The registered manager and some staff told us that this is what staff should have been doing.

Staff told us, and we observed the morning medicines took a long time to administer. The registered manager told us this was something they were reviewing. We found medicine record folders were bulky and contained a lot of information that was not pertinent to people’s medicine. This meant staff spent unnecessary time locating each person’s Medicine Administration Records (MAR) within the folder.

These issues left people at risk of harm as medicines were not always managed safely.

People told us they did not have any concerns about their medicines. Only staff who had received medicine training and been assessed as competent gave people their medicines. Staff were knowledgeable about the medicines people had been prescribed and how people liked to take them. MARs were completed when medicines had been given. Medicines were given at the times people needed them.