Norton Lees Hall & Lodge

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 of this key question under the new provider. This key question has been rated 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 safe care and treatment and staffing.

This service scored 59 (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 had a proactive and positive culture of safety, based on openness and honesty. The new manager listened to concerns about safety and investigated and reported safety events. Lessons had not been learnt to continually identify and embed good practice. However, the new management team had developed new systems and were ensuring they were followed to drive improvements.

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. We saw evidence in care plans of visits and referrals when required. We were shown that staff could produce an emergency pack which would be used to pass on relevant information to healthcare professionals when required. However, information was not always shared and reviewed to ensure people’s needs were met. Care records were not always kept up to date or reviewed in a timely way. Information in the electronic care plan system was not easy to find.

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. Staff understood safeguarding procedures and reported incidents immediately to management.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People's capacity was assessed in line with MCA and decisions were made, where people did not have capacity, in their best interest. People had Deprivation of Liberty Safeguards (DoLS) in place to protect their rights and the service complied with these.

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 and enabled people to do the things that mattered to them. Risks associated with people’s care were not consistently identified. Care plans did not reflect people’s current needs and were not updated in a timely way to record changes to their care. Moving and handling care plans lacked detail, so staff were not able to ensure people’s safety. For example, 1 person’s care plan stated they required 2 staff and a standing hoist for all transfers due to high risk of falls. Loop configurations were not recorded and there were no details or instructions on how to safely support the person with their moving and handling. We also observed staff did not follow people’s care plans. For example, 1 person’s care plan had good information about how to meet their social stimulation needs to ensure their wellbeing, however, this was not followed by members of staff.

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 found areas of the home required attention to ensure people’s safety. For example, there were a number of trip hazards; wardrobes were not fixed to walls, and a fire door was not attached to the hinges. Following our visit the provider addressed the areas, and they have assured us the improvements would continue.

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 work together well to provide safe care that met people’s individual needs. The provider used a dependency tool to determine staffing levels and there appeared to be sufficient staff available to meet people's needs. However, staff lacked guidance and leadership and often needed direction to ensure they were deployed effectively. We also observed care staff carrying our numerous non-care duties which impacted negatively on the support people received. For example, staff were expected to collect the meals from the kitchen, serve meals, lay and clear tables, wash up and clear away. This meant people did not receive care and support when they needed it, and calls bells were not responded to in a timely manner. All staff we spoke with raised concerns regarding staffing levels. Staff told us they were expected to do many tasks which impacted the care and support they could provide for people. Staff said this had even more impact on nights because they were still expected to do the additional jobs but with fewer staff. Staff told us the staffing levels were not suitable to keep people safe. The management team were working on night shifts to engage with staff to determine what changes and support were required to improve safety.

Feedback we received from people and their relatives also highlighted staffing concerns. They said staff were often rushed or not available. All people said there were not enough staff. One relative said, “[Name] was sat over 20 minutes waiting to be taken off the toilet.” Another said,” [Name] is able to get out of bed for an hour, but there are not the staff available to put them back to bed as it takes 2 of them, so they leave them in bed, as it is easier for them.” A person said, “I’m not sure about staffing, I often have to go looking for help.” We observed a number of people did not have call bells, 1 person said, “I have to wait for someone to pass by [their room] and shout if I need anything.” Relatives also told us there was lack of consistency and staff did not seem to know people well or understand their needs.

Staff received training and the provider had identified areas were more training and support was required. The provider was in the process of delivering more training. The provider had agreed a voluntary suspension on nursing admissions until staff were fully competent.

Staff had not received appropriate supervision and support; however, the new management team had identified this and were implementing improved support for staff.

The provider did not always assess or manage the risk of infection. We carried out a tour of the service and found some areas were not clean and others were not well maintained so were not able to be effectively cleaned. These included lounge and dining chairs, kitchenette units, seals at back of sinks, work tops, refrigerators, dishwashers and microwaves. The provider replaced the fridges and microwaves on the day of our site visit and assured us the kitchenettes will be repaired or replaced.

Staff had access to appropriate stores of personal protective equipment (PPE). Members of staff had access to infection prevention and control policies. The new manager had developed an action plan which ensured audits we reviewed and areas for improvement were identified. The provider had an environmental action plan which was being implemented to make improvements to the care home.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People received their medicines as prescribed. The provider had policies and procedures in place to support the safe management of medicines, and staff had received appropriate training to administer medicines safely. In addition, the clinical lead supported nursing staff to improve their skills and competencies.