Normanshire Care Services Ltd

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Normanshire Care Services is a residential care home which provides accommodation and personal care to up to 6 adults living with a learning disability or autism. The service is provided in one building across two floors with a garden. At the time of inspection 6 people were using the service.

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

Right Support

The model of care and the setting maximised people’s choice and control. People had their own bedroom and had access to shared facilities including a garden. People were protected from the risks associated with the spread of infection and were supported to take their medicines safely.

People’s risks were assessed in a person-centred way. Care plans and risk assessments were regularly reviewed and involved relatives and advocates as appropriate. People who may become anxious or distressed had proactive plans in place to reduce the need for restrictive practices.

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

Right Care

People’s needs were assessed before they began to use the service to ensure the provider could meet those needs. People had care and support plans that were personalised, holistic, strengths-based and reflected their needs and aspirations, included physical and mental health needs.

Relatives confirmed they were included in decision making about their relative’s care. People were supported to eat and drink enough to maintain a balanced diet. Staff involved people in choosing their food and planning their meals. Staff supported people to maintain their health and worked jointly with healthcare professionals to improve outcomes for people.

Right Culture

Management were visible in the service, approachable and took a genuine interest in what people, staff and other professionals had to say. The management team worked directly with people and led by example. Relatives and staff confirmed they would be able to raise concerns to enable improvements to be made to the service. Relatives were asked by the provider about their opinions of the service.

Staff were recruited safely and there were enough staff on duty to meet people’s needs. People were protected from abuse and poor care. The provider supported staff with training and supervision. Training included learning disability and autism so care could be provided effectively.

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 16 September 2021)

At our last inspection we made a recommendation in relation to the referral and assessment of people’s needs. At this inspection we found the provider had taken action on this and improvements had been made.

Why we inspected.

We received concerns in relation to the general care and safety of people using the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains good based on the findings of this inspection.

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 found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, and well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Normanshire Care Services Ltd had taken step to ensure visitors were safely facilitated within the service. They had made creative use of space to ensure that people could continue to receive visitors without causing disruption to other people living in the home.

People had been supported to continue to engage with activities of their choosing in a safe way even when national restrictions made this more challenging.

We saw that staff did not always adhere to guidance about wearing PPE when social distancing cannot be maintained. The management team were aware of this and were committed to addressing it.

There was a plan in place to address maintenance issues within the home.

Normanshire Care Services Limited is a residential care home which provides accommodation and personal care to up to six people. At the time of the inspection four people were living at the service. Normanshire Care Services Limited is a care home set up in an adapted residential building with a garden.

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

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.

This service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The model of care provided to people focused on giving choice and promoting independence. However, we found the service did not always meet all of the principles. This meant people’s quality of life was at risk because they were not always getting the right support they needed. We have made a recommendation in relation to placement referral and assessing people’s needs.

Relatives felt people were well looked after and safeguarding procedures were embedded in the service. Systems for recording incidents and accidents and complaints were in place and learning from these were recorded.

The provider assessed people’s health related risks to protect them from the risk of avoidable harm. Staff were aware of their responsibilities and knew what action to take should they suspect any form of abuse. People were protected from risks associated with the spread of infection.

Systems were in place to support staff in their role including supervision.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The provider and staff understood the need to obtain consent before delivering care.

Staff demonstrated how they got to know people and their care needs once they started living at the service. The provider involved people in choices and decisions about their day-to-day care. Staff provided a service that met people’s diverse needs. Support staff took steps to promote people’s privacy, dignity and independence on a daily basis, however, the provider’s systems were not effective enough to always support people’s dignity and independence.

Care plans were personalised. Staff understood how to provide a person-centred service. People’s communication needs were met. The service had a policy in place to provide people with end of life care if required.

Staff spoke positively about the changes in leadership in the service, the team leaders and the new service manager. The new service manager was settling into the service and keen to make improvements. The provider had systems to capture feedback from relatives about the quality of the care provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was inadequate (published 12 November 2019) and we served a warning notice in relation to safe care and treatment and there were multiple other breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 12 November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and concerns raised in relation to management of the service.

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.

Normanshire Care Services is a residential care home providing accommodation and personal care to five people with learning disabilities or autism spectrum disorder at the time of the inspection. The service can support up to six people in a converted house over two levels.

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

We received information following a whistleblowing to the local authority raising concerns about the lack of activities, reporting of accidents and incidents, risk management, safeguarding, staffing, food and nutrition and how people were supported when presenting with behaviours that challenged the service.

We received mixed feedback from relatives and representatives. Whilst all said they felt their relative was safe, some felt changes in staffing had an impact on the consistency of care for some people using the service.

Relatives told us they felt people had enough food and drink to meet their nutritional and hydration needs.

People participated in various indoor and outdoor activities to stimulate them and help maintain their health and well-being. The home had employed an activities coordinator.

Relatives felt able to approach the registered manager or service manager with any concerns.

Incidents were not always recorded in line with the provider’s policies and procedure. The provider had not always notified CQC of safeguarding concerns.

Staff said they felt supported by management and able to approach them with their concerns.

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 inadequate (published 12 November 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received from a whistleblower about the service. The inspection was prompted due to concerns received about people’s welfare and how the service monitored, recorded and reported incidents and accidents.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Normanshire Care Services Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Normanshire Care Services is a residential care home providing personal and nursing care to five people with learning disabilities aged 25 and over at the time of the inspection. The service can support up to six people in one adapted building.

The service has not 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 did not 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’s safety had been compromised. The provider failed to ensure people were safe and safeguarded from possible abuse. We found evidence to substantiate concerns raised in relation to the care provided to people. These concerns included failure to meet people’s nutritional and health needs, failure to ensure people received care according to their needs and insufficient staffing levels to meet people’s individual needs.

People were supported by staff who had not received appropriate training to effectively carry out their role.

Recording of PRN (‘as and when required’) medicines, such as paracetamol and topical creams, required improvements. We made a recommendation in relation to medicine management.

The provider had not always worked with professionals to seek advice or share information about people’s health conditions. We found opportunities had been missed where the involvement of a health or care professional would have benefitted people.

Care plans were written in a person-centred way and detailed people’s likes and dislikes. People’s communication needs were documented in their care plan. However, information in care plans was not always accurate. During our visit we observed staff spoke in a caring and kind manner to people. Staff spoke passionately about people and the care they provided. However, we found care was not always delivered to people in line with their plan of care. We received mixed feedback from relatives about the care their relative received. People were not always treated with dignity and respect.

The service did not apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as a possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People did not always have the appropriate support to give them choice and control and people’s independence was not always promoted.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Governance arrangements at the service were poor. Systems for monitoring the quality of the service were not effective and did not highlight the concerns found during our inspection.

The provider was not aware of their responsibilities under Duty of Candour and failed to report notifiable incidents to the CQC.

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 5 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, staffing, management of the service and the quality of care. This inspection examined those risks.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring, Responsive and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to people receiving safe care and treatment, person-centred care, safeguarding people from improper treatment or abuse, staffing and good governance.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Normanshire Care Services Ltd is a ‘care home’ for people who have a learning disability. People in care homes receive accommodation and personal care as 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 accommodates a maximum of six people in one terrace house. At the time of our inspection there were six people living at the home.

There was a registered manager at this service. 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.

People’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans were in place to monitor and reduce risks. People had access to relevant health professionals when they needed them. There were sufficient numbers of suitable staff employed by the service. Staff had been recruited safely with appropriate checks on their backgrounds completed. Medicines were stored and administered safely. The home environment was clean and infection control procedures were being followed.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their own best interests. We saw people were able to choose what they ate and drank. The home was well decorated and adapted to meet their needs of the people

Relatives told us that people well treated and the staff were caring. We found that care plans were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service. People had access to a wide variety of activities. The service had a complaints procedure in place.

Staff told us the service had an open and inclusive atmosphere and the registered manager was approachable and open. The service had various quality assurance and monitoring mechanisms in place. These included survey and audits.

The service provides accommodation and support with personal care for up to five adults with learning disabilities. At the time of our inspection four people were using the service. This was the first inspection of the service since it was registered with the Care Quality Commission.

There was a registered manager at the service at the time of our 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 experiences of people who lived at the home were positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. We found staff had a good understanding of their responsibility with regard to safeguarding adults.

People’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans in place to monitor and reduce risks. Medicines were stored and administered safely.

Staff undertook training and received regular supervision to help support them to provide effective care. Recruitment records demonstrated there were systems in place to ensure staff were suitable to work with people. The registered manager and staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is law protecting people who are unable to make decisions for themselves or whom the state has decided their liberty needs to be deprived in their own best interests.

People told us they liked the food provided and we saw people were able to choose what they ate and drank. People had access to health care professionals as appropriate.

People’s needs were met in a personalised manner. We found that care plans were in place which included information about how to meet a person’s individual and assessed needs. The service had a complaints procedure in place.

Staff told us the service had an open and inclusive atmosphere and the registered manager was approachable and accessible. The service had various quality assurance and monitoring mechanisms in place. These included surveys, audits and staff and resident meetings.