Norley Hall Care Home

We found the following examples of good practice.

There was a booking system in place to stagger visitors and visiting times to facilitate safe visiting.

Alternative forms of maintaining contact were used. These included using the service’s portal, which could be used in people’s own rooms for privacy, mobile telephone calls, ipads, zoom meetings and window visits. The service ensured their Facebook page was kept up to date so families could see what was going on within the home.

There was good support in place to help maintain people's well-being when being isolated. This included extra activities, access to methods of communication with loved ones and entertainers performing in outside areas to help raise people's spirits.

The provider had assessed the impact on residents of how PPE may cause fear and anxiety for residents, particularly those who had limited mental capacity and had mitigated these concerns.

Cleaning staff had cleaning schedules, which they were required to complete and that included frequency of cleaning of high touch areas. Records showed compliance with the cleaning schedules.

Norley Hall Care Home is registered to accommodate older adults and people living with dementia. The home is situated in its own grounds on the outskirts of Wigan. The accommodation is divided over two floors. Norley Hall Care Home can accommodate up to 52 people. At the time of the inspection 47 people were living at the home.

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

People and their relatives spoke positively about the care provided at Norley Hall. Each one told us they would recommend the home to others and that the staff were fantastic and went out of their way to help people.

People received care which was extremely person centred and met their needs. People were supported to make wishes; which staff strove to fulfil. People were supported to reconnect with hobbies, interests or professions they had not completed or been involved in for some time.

People's wellbeing was at the heart of the service, and they had introduced a number of projects to ensure people's experience of care was positive and rewarding.

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.

People told us they felt safe at all times within the home. Staff were knowledgeable about how to identify and report any safeguarding concerns, which had been referred to the local authority as per guidance. People stated there was always enough staff on shift to meet their needs.

Accidents, incidents and falls had been recorded and analysed to look for trends and prevent a reoccurrence. Safety checks of the premises and equipment had been completed as per guidance, to ensure they were fit for purpose and safe to use.

Medicines were being managed safely. People received their medicines as prescribed by staff who had been trained and assessed as competent to do so.

Staff received sufficient training and supervision to enable them to carry out their roles and feel supported. Team meetings had been held regularly to pass on key information and involve staff in the running of the home.

People and their relatives were complimentary about the food and drink provided, confirming they received a good choice and generous portions. People requiring a modified diet or thickened fluids, received these in line with guidance.

People’s healthcare needs were being met, through ready access to a range of professionals. The home had referred people promptly when any issues or concerns had been noted, such as unplanned weight loss. Equipment was in place to support people to stay well, such as pressure relieving mattresses and cushions, for people at risk of skin breakdown.

Care files contained personalised information about people, their background, likes, dislikes and how they wanted to be supported. Staff were knowledgeable about people’s needs, and through observations it was clear they knew the people they supported and had formed effective therapeutic relationships with them.

People's social and recreational needs were met through a varied activities programme, which included regular access to the local and wider community. The home understood the importance of intergenerational relationships, with a local school regularly visiting the home to engage in activities and events.

The home used a wide range of systems and processes to monitor the quality and effectiveness of the care and support provided. Actions plans had been generated to address any issues identified through the auditing process.

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 requires improvement (report published November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Norley Hall 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 provides accommodation and personal care for up to 52 older people, which is divided over two floors. At the time of inspection 49 people were living at the home.

The home was last inspected on the 20 and 28 October 2016, when it was rated as Good and was meeting all regulatory requirements. At this inspection we identified five breaches in four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, safeguarding people from abuse or improper treatment, staffing and good governance. We also made recommendations about capturing people and/or their relative’s involvement in care planning and reviews and reviewing the system used to determine staffing levels. You can see what action we asked the provider to take at the back of the full version of this report.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Each person we spoke with told us they felt safe living at Norley Hall and had no concerns with the standard of care provided. Relatives were equally complimentary, stating their loved ones were being well looked after and cared for in a way they would like.

The home had appropriate safeguarding policies and reporting procedures in place and had submitted notifications to the local authority and CQC as required. However, whilst staff knew how to identify the different types of abuse and the procedure for reporting concerns, we found completion of safeguarding training was inconsistent and not regularly refreshed.

We found systems to ensure both the premises and equipment was safe and fit for purpose required strengthening, as not all required safety certificates and checks were in place or up to date. There was no annual schedule of when checks should be completed, which would minimise the risk of these being overlooked.

We saw medicines were stored, handled and administered safely. Staff responsible for administering medicines had been trained and had their competency assessed. However, we identified shortfalls in the maintaining of fridge temperatures, management of topical medicines and completion of daily audits.

Our observations found the home to be clean with detailed cleaning checklists and appropriate infection control processes in place. Staff had easy access to and wore personal protective equipment (PPE) to prevent the spread of infection.

Feedback received from people and their relatives indicated enough staff were on duty to safely meet people’s needs. Overall, staff also felt enough were deployed, though some suggested additional support at night would be useful, due to having to make and serve supper as well as support people to get ready for bed.

Staff spoke positively about the support and training provided, reporting enough was provided and training was completed regularly. However, the training matrix revealed large gaps in training provision and inconsistencies in how many sessions each staff member had completed. Similarly, staff told us they received regular supervision, whereas the matrix indicated this had not been provided in line with company policy and at least a quarter of staff had not received supervision at all this year.

We found the home was not consistently adhering to the principles of the Mental Capacity Act 2005 (MCA). Applications to allow the home to legally deprive people of their liberty had not been submitted for all those who met the requirements, with no clear system in place for determining who required an application and who did not. Best interest meetings had not been held consistently, to make decisions on behalf of people who lacked capacity and had no legal representative such as a Lasting Power of Attorney (LPA) to do so on their behalf.

We found meal times to be a positive experience, with people being supported to eat where they chose. People were able to choose what they wanted to eat and those requiring a modified diet, such as soft or pureed meals, received these as per their care plan. Food and fluid charts had been used where people had specific nutritional or hydration needs, with clear guidance in place for staff to follow.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. People spoke highly of the care, compassion and kindness displayed by staff and had no concerns or complaints about how they were supported. Staff were seen to be caring and treated people with kindness, dignity and respect.

People living at the home were encouraged to maintain their independence, make decisions and choices about their care and had these choices respected. Care plans contained a rights and choice section, in which this information had been captured.

The home used an electronic care planning system. We looked at nine electronic care files, all of which contained basic personalised information about the people who used the service, along with details of how they wished to be supported and cared for. People and their relatives told us they had been involved in the care planning process and communication with the home was very good, however these interactions had not been captured in the care plans or associated documentation.

Peoples’ social and recreational needs were being met by the activities programme provided. As well as in house activities, such as exercises, ball games and visiting artists, external outings and events had been arranged. The home displayed photographs from the outings and activities people had engaged in which served as a reminder to people of what they had done.

We found the home had insufficient systems and processes to monitor the quality and effectiveness of the service. Formal audits of medicines and care plans was being completed, though this was inconsistent and they had not identified some of the issues we found during our inspection. The home did not have an ongoing action plan in place to demonstrate continuing improvement.

This was an unannounced inspection which took place on the 20 and 28 October 2016.

The service is required to have a registered manager in place. There was a registered manager in place at Norley Hall Care Home. A registered manager is a person who has registered with the CQC 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 present during this inspection. People told us the registered manager was approachable and fair. During our inspection we found the registered manager to be open, caring and committed to providing a good quality caring service.

People told us they felt safe at Norley Hall Care Home. Staff had received training in safeguarding adults. They were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy in place in the service. They told us they were certain any concerns they raised would be taken seriously by the managers in the service.

Robust recruitment procedures were in place which ensured staff had been safely recruited. Staff received the training, support and supervision they needed to carry out their roles effectively.

Medicines were stored safely and securely and procedures were in place to ensure people received medicines as prescribed.

Peoples support needs were assessed before they moved into Norley Hall Care Home. Care records were written in a person centred way and contained good information about people’s support needs, preferences and routines. Risk assessments were in place for people who used the service and staff. They described potential risks and the safeguards in place. Care records we had been reviewed regularly and had been updated when people’s support needs had changed. People and their relatives had been involved in planning and reviewing the care provided.

The service had an infection control policy; this gave staff guidance on preventing, detecting and controlling the spread of infection and staff received training in infection prevention and control.

We found the building to be clean, bright and well decorated with no malodours. The bedrooms we went in were spacious, well-furnished and were personalised with people's own photographs and ornaments.

Accidents and incidents were appropriately recorded. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately.

People had their health needs met and had access to a range of health care professionals. People at risk of poor nutrition and hydration had their needs regularly assessed and monitored. The food within the service was nutritionally balanced and plentiful. All the people we spoke with told us the food was good.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was meeting their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected.

All the people we spoke with were positive about the support they received and the caring and kind attitude of the staff. We found the atmosphere to be homely and interactions between staff and people who lived at the home were warm, friendly and relaxed. We found that the registered manager and staff we spoke with were able to tell us about the people who used the service. They knew their likes, dislikes, support needs and things that were important to them.

There were a range of activities and social events in the home and in the community on offer to reduce people’s social isolation. People told us they enjoyed the activities.

Policies and procedures we reviewed included protecting people’s confidential information and showed the service placed importance on ensuring people’s rights, privacy and dignity were respected.

We saw there was a system for gathering people’s views about the service. There was a system in place to record complaints and the service’s responses to them. People told us they didn’t have any complaints but were confident that they would be listened to and action would be taken to resolve any problems they had.

There was a robust system of weekly, monthly and annual quality monitoring and auditing in place to help improve the quality of the service provided.

Everyone we spoke with was positive about the service and the way it was managed. Staff told us they enjoyed working for the service and felt supported in their work.

The service had notified CQC of any DoLS authorisations, accidents, serious incidents and safeguarding allegations as they are required to do.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

During our inspection, we saw people who used the service were treated with dignity and respect. We spoke to several people and they told us they felt safe and their needs were met at the care home. A family member told us, "People are kept safe and well cared for."

Procedures were in place which helped ensure the provider and staff members learnt from any accidents or incidents. This minimised any possible risk to people who used the service and continually helped the quality of service to improve.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made.

Is the service effective?

People who used the service had their care needs assessed and their choices and preferences had been identified and recorded. All care was provided in accordance with the wishes of the person.

People who used the service and their families were invited to regular meetings and were also asked to complete surveys related to the quality of care being provided at the care home. Any identified shortfalls had been addressed.

Is the service caring?

We saw staff who were patient when providing care and support to people and showed a good understanding of how their needs should be met. We observed staff knocking on people`s doors before entering which showed respect for the person`s privacy.

We spoke to several people who used the service and one told us, "All the staff are lovely, they work so hard." Another person told us, "It`s absolutely champion here. No problems."

Is the service responsive?

The provider listened to the needs and wishes of people who used the service. People took part in a range of activities, both within the care home and around the local community. Neighbours from the surrounding area and pupils from local schools regularly attended events at the care home at the request of people who used the service.

People we spoke to knew how to make a complaint if they needed to. We looked at the last recorded complaint and saw it had been recorded and responded to appropriately in accordance with the provider`s policy.

Is the service well-led?

We saw that the provider worked well with other professional agencies, which included doctors and community nurses. On the day of our inspection, a community practitioner attended the care home. We were told, "He drops in regularly just to make sure everything is ok. If we ask him to see one of our residents, he does straight away."

Procedures were in place which helped ensure the quality of care provided to people who used the service continued to improve. Staff members we spoke to were clear about their roles and responsibilities.

We found that people were cared for in clean, organised and well maintained environment that was free from unpleasant odours. We looked at staffing rotas and we found that there were sufficient numbers of suitably qualified qualified, skilled and experienced staff to meet people's needs.

We checked people's records and found that they were kept in appropriate places and that they were accurate and up to date.

We saw that there were appropriate systems in place to monitor the quality of care that people received the home and that the manager responded to comments and suggestions made by people, their relatives and members of staff.