Background to this inspection
Updated
14 July 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 22 May 2015 and was unannounced. It was carried out by two inspectors.
We normally ask the provider to complete a Provider Information Return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. On this occasion we did not ask the provider do this as we were responding at short notice to information and some concerns that had been raised. We looked at previous inspection reports and notifications we had received. A notification is information about important events which the provider is required to tell us about by law. We also looked at information received from social care professionals.
We looked around all areas of the service, and talked with eight people who lived at the service. Conversations took place with people in their own rooms, and in the lounge areas. We observed the lunch time meals and observed how staff spoke and interacted with people. Some people were not able to explain their experiences of living at the service to us due to their dementia. We therefore used the Short Observational Framework for Inspection which is a way of observing care to help us understand the experience of people who could not talk with us.
We talked with two relatives who were visiting people; four care staff, kitchen staff, the activity co-ordinator. We spoke with the registered manager, the new manager and the area manager.
We also had conversations with two visiting professionals who visit the service regularly.
The previous inspection was carried out in September 2013. No concerns were identified at this inspection.
Updated
14 July 2015
The inspection visit was carried out on 22 May 2015 and was unannounced.
Norfolk House provides care for up to 30 older people some of whom may be living with dementia. On the day of the inspection there were 28 people living at the service. Norfolk House offers residential accommodation and has communal areas over three floors. It is located on the seafront of Westgate on Sea. The service is situated next door to another care service run by the same provider and shares staff and management with the other service.
The service also offers respite facilities to people. This facility is used by local doctors and social services care managers. People could refer themselves for a stay at Norfolk house if they wanted to. Sometimes respite places were used for emergency situations and this avoided people being admitted to hospital.
There was a registered manager working at the service. They were also the registered manager for the service next door. The provider was in the process of training and mentoring a new manager to take over this role so each of the services had their own registered manager. At the time of the inspection the new manager had been in post for one month. A deputy manager had also been appointed and was new to the post. The new manager supported us throughout the inspection with support from the area manager who was the providers’ representative. 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 and associated Regulations about how the service is run.
Before people decided to move into the service their support needs were assessed by the manager to make sure they would be able to offer them the care that they needed. If people came to stay at the service as emergency placements then the manager received an assessment from care managers from the local social services team.
People were satisfied with the care and support they received. Everyone had a care plan which was personal to them and that they or their representative had been involved in writing. The contents, information and quality of care plans varied. Care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best and kept them safe. Potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving interventions they needed to keep them as safe as possible.
A system of recruitment was in place to make that the staff employed to support people were fit to do so. However, all the safety checks that needed to be carried out on staff to make sure they were suitable to work with people had not been completed by the registered manager.
There were not always sufficient numbers of staff on duty in the afternoon to make sure people were safe and received the care and support that they needed when they needed it. People, their relatives and staff said that sometimes there was not enough staff available and they had to wait a while for the care and support they needed. People said that they knew staff would come as quickly as they could.
Parts of the environment were looking a bit worn and tired and were in need of refurbishment and decoration. There was plan in place to address this. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection the new manager was in the process of applying for DoLs for people who were at risk of having their liberty restricted. They were waiting the outcome from the local authorities who paid for the people’s care and support. The new manager showed that they understood their responsibilities under the Mental Capacity Act 2005 and DoLS. When people were unable to make important decisions for themselves relatives, doctors and other specialists involved in their care and treatment and decisions were made in people’s best interest. Mental capacity assessments and decisions made in people’s best interest were recorded.
Staff were caring and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly. Staff were respectful, kind and caring when they were supporting people. People were comfortable and at ease with the staff.
People were involved in activities which they enjoyed. Staff were familiar with people’s likes and dislikes, such as if they liked to be in company or on their own and what food they preferred. Staff knew how people preferred to be cared for and supported and respected their wishes.
People said and indicated that they enjoyed their meals. People were offered and received a balanced and healthy diet. They had a choice about what food and drinks they wanted. If people were not eating enough they were seen by dieticians or their doctor and supplement nutrition was provided. People received their medicines safely and when they needed them and they were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.
People were protected from the risk of abuse. Staff had received safeguarding training and they were aware of how to recognise and process safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the new manager or outside agencies if needed.
Staff had support from the new manager to make sure they could care safely and effectively for people. Staff said they could go to the new manager at any time and they would be listened to. They said the new manager was very supportive. Staff had received regular one to one meetings with a senior member of staff.
Staff had completed induction training when they first started to work at the service and some had gone on to complete other basic training provided by the company. Some staff had not received the all the training they needed to make sure they had the skills, knowledge and competencies to carry out their roles effectively. The new manager had identified this shortfall and there were plans in place to make sure all staff received the training they needed. There were regular staff meetings so staff could discuss any issues and share new ideas with their colleagues to improve people’s care and lives.
There were quality assurance systems in place. Audits and health and safety checks were regularly carried out. The registered manager had not formally sought feedback from people, their relatives and other stakeholder about the service for over a year. Their opinions had not been captured, and analysed to promote and drive improvements within the service. Informal feedback from people, their relatives and healthcare professionals was encouraged and acted upon wherever possible. Staff told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within Norfolk House which allowed them to suggest new ideas which were often acted upon. The complaints procedure was on display. People, their relatives and staff felt confident that if they did make a complaint they would be listened to and action would be taken.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.