Norden House

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.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

People had raised concerns with the management about call bells not always working as they should, however the previous manager had not acknowledged these concerns. There was an effective system in place to allow the interim manager to investigate however the issue had not been addressed at the time of our assessment. We observed instances where the call bell system did not always alert staff to people’s needs. Whilst there had not been an increase of incidents or accidents related to staff failing to respond in a timely manner, the potential for this to happen was present. We raised our concerns senior management, who worked with the system provider to identify the shortfalls and improve people’s experiences. On our next visit staff had received further training on how to use the system correctly.

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.

People’s care and support needs were pre assessed before being admitted into the service, to establish if they could be appropriately met.

Staff communicated changes in people’s conditions to senior members of the team who made referrals to specialist services when needed, for example staff observed a person showing signs they were struggling to safely swallow food and drink, a referral to the SALT team (Speech and Language Therapy team) was made and advice sought to lower the risk of choking.

Staff supported people to access mental health services. For example, a person who was observed to be having periods of emotional distress had input from these services to support their wellbeing.

People told us they used equipment to change position dependent on their needs including stand aids and hoists. One person said, “I’m not rushed and feel safe using it.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Leaders had embedded a strong understanding of safeguarding within the staff team, who had revived training in safeguarding people across all roles, and knew the signs of abuse and how to respond appropriately to them. One staff member said, “I report anything I think is a safeguarding concern in case it’s happening to someone else.” Another said, “My understanding of safeguarding is protecting vulnerable people from harm and abuse.” People felt confident to raise concerns with staff, one person said, “I feel safe here.” Leaders informed the local authority of safeguarding concerns when they had identified potential abuse.
Where appropriate people were supported to have Dols applications made, safeguarding people's human rights where they do not have the mental capacity to consent to their care arrangements. There were systems in place for these to be monitored.
 

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.
People had care plans detailing their support needs, with associated risks identified and actions for staff to follow to reduce these risks whilst encouraging independence. Information about peoples likes, wants, preferences and goals were included.

During our assessment we observed people taking part in daily life activities, for example making drinks for themselves with access to hot water dispensers, the provider had a risk assessment in place with measures to reduce risks around the use of these dispensers.

Risks around emergencies had been planned for, an example of these was a plan for people who may need assistance, for instance, a person with impaired mobility, to evacuate a building or reach a place of safety in the event of an emergency.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service was divided into separate areas supporting people’s specific care needs, for example residential, nursing and dementia had dedicated units with systems in place to promote people’s safety.

The environment was adapted to meet people’s mobility requirements with a lift and level flooring. For people living with dementia, corridors were shaped to help guide people towards communal areas and signage was displayed.

Equipment used to support people with daily life activities and in the event of an emergency was available. Staff said, “We have enough and get training about how to use it.”

As part of the manager’s compliance processes, audits of the environment were completed helping to identify issues which could have the potential to cause harm.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We observed staff supporting people in a calm manner, who told us there were enough staff to meet people’s needs. The manager explained whilst recruitment is ongoing, they were working with regular agencies to ensure enough staff were available to safely support people.
The provider had followed a robust recruitment process. As part of our assessment, we saw documents showing staff had been through the relevant checks to establish if they were suitable candidates, who then had a probationary period with ongoing supervision.
Staff received an induction before they provided people’s care. One staff member said, “It’s been wonderful, I had a two-week induction and get all the training I need to do my role.” Staff had received relevant training to fulfil their roles including Dementia awareness, The Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS) and Dysphagia Awareness. Systems were in place for managers to monitor and track staff training compliance levels.

 

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 environment was visibly clean and well-maintained at the time of our assessment. A dedicated domestic team was in place, who were knowledgeable around their role of creating a hygienic environment. A member of the team said, “I have the training I need and get good support to do my job.” A cleaning schedule was in place and leaders followed the infection control policy which included carrying out audits of the environment.

Staff had access to sufficient personal protective equipment (PPE) and people told us this was being used. One person said, “They always wear gloves when they support me.”

During our assessment a person was receiving barrier care, staff were aware of how to support them and lower the risk of viruses spreading. Barrier care is where staff employ enhanced infection prevention measures to prevent the spread of infections. These precautions, including physical barriers, are designed to protect residents without restricting their mobility or access.

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

We found there were some delays in following up on medication related concerns. Staff were not always clear about escalation pathways when medication errors or incidents occurred. This meant issues were not consistently reported, reviewed with trends identified and learned from to improve practice.
There were instances where medicine stock control systems did not accurately identify low or unavailable stock resulting in delays to people receiving their prescribed treatment. Whilst no impact on people was identified around unavailable medication stock, these delays had the potential to impact people`s health and wellbeing, particularly where medicines were required to manage ongoing conditions.
We were also informed of other medication related incidents that had occurred prior to our assessment which had not always been formally escalated through the provider`s governance systems. Although no harm occurred to the people involved, the lack of consistent reporting meant opportunities for learning and improvement were missed.
These concerns were discussed with the provider during the assessment. The provider escalated the identified incidents and confirmed they were reviewing their medicine management and stock control systems.
The provider told us they were taking action to ensure medication errors and concerns were recognised, reported and escalated appropriately and in a timely manner and that systems are strengthened to reduce the risk of delays to treatment in the future.