Norton Lodge

Norton Lodge is a residential care home providing personal care to up to 32 people. The service provides support to older people, a number of whom live with dementia. Accommodation is provided over 2 floors with shared living spaces on the ground floor. At the time of our inspection there were 27 people using the service.

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

We found improvements were needed to ensure people received their medicines safely and also have appropriate risk assessments and care plans which reflected their current care needs. Equipment used to reduce risks to people’s physical health were not always routinely serviced and in full working order.

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.

Routine audits and checks had either not identified the improvements needed at Norton Lodge; or sufficient action had not been taken in a prompt manner to address the improvements which were needed.

There had been a change in manager at Norton lodge since our last inspection and recent new additions of a new deputy and operations managers were imminently planned. The provider told us they were confident the additional resources would support the manager to drive improvements.

Although we found some improvements were needed, people did speak positively of the care they received at Norton Lodge and they were supported by staff who knew them well. Appropriate checks on staff were in place to ensure they were suitable for the role before working with people.

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 requires improvement (published 08 June 2022). 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 the provider remained in breach of regulations. The service remains rated requires improvement.

Why we inspected

We received concerns in relation to the safe management of medicines and meeting people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 Norton Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, consent and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Norton Lodge is a residential care home situated in a residential area of Runcorn. The home provides accommodation and personal care to up to 32 people across two floors. At the time of this inspection, there were 29 people living at the home.

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

Medicines were not always managed safely. Not all risks were safely assessed and mitigated to maintain people's safety. Records relating to people's risks were not always complete or accurate. Systems and processes did not always identify risks relating to fire safety. Audits were not always effective as they failed to identify the issues we found with fire safety, risk assessments and medicines management.

Staff followed good infection control practices and used PPE (personal protective equipment) to help prevent the spread of healthcare related infections. We observed friends and relatives visiting their loved ones during the inspection. Relatives told us that there were no restrictions on visiting and described how this was done safely

Staff had received training in safeguarding. Staff understood how to recognise, report and safeguard people from abuse. People and their relatives told us they felt the care provided by staff was safe. Comments included, "I know [person] is safe there which is a big comfort to me.”

Staff were safely recruited. People and relatives told us that staff were competent and had the necessary skills to perform their roles safely. There were enough staff to meet people's needs.

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 home had a new registered manager in post. The management team had identified some areas for improvement and had started to make changes to address those areas. Commissioning partners and professionals who work with the home were positive about the service and the management team. Comments included, “the home has improved significantly over the last few months with more continuity for the residents.”

The registered manager encouraged a culture of learning from incidents. The registered manager notified CQC of any incidents and events that occurred at the service, which demonstrated they understood their responsibilities in line with regulatory requirements and their responsibility to be open and honest when things had gone wrong.

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 21 April 2018).

Why we inspected

We undertook a targeted inspection to look at the preparedness of the home in relation to infection prevention and control during this period of high levels of coronavirus infections.

We inspected and found there was a concern with the environment and risk management, so we widened the scope of the inspection to become a focussed inspection which included the key questions of safe, and well-led.

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.

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 has changed from good to requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

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. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

This inspection took place on 7 and 15 March 2018. The first day was unannounced and the second announced.

Norton Lodge is a privately owned care home set in large grounds in the Norton Village area of Runcorn. A bus route and train station is nearby and Halton Lea shopping centre and Runcorn old town are within easy travelling distance.

The home provides personal care for people who experience mental health issues, alcohol related problems, learning disability or dementia. The accommodation is provided over two floors and is registered to take up to thirty two people. At the time of our visit there were twenty four people living at the home, on the first day one person was in hospital.

We last inspected the service in January 2017. During that visit we identified breaches of the Health and Social Care Act (Regulated Activity) Regulations 2014 with regard to Regulations 11, 13, and 17 and of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The service received an overall rating of Requires Improvement. Following that inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective and Well-led to at least ‘good’. During this inspection we found that the service had made the required improvements and was no longer in breach of those regulations.

The home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People told us that they felt safe at Norton Lodge. Policies and procedures were in place to protect people from the risk of abuse or neglect.

On the first day of inspection we saw that a bath had been filled and left unattended and staff were initially unclear about systems for temperature checks. The registered manager was able to clarify the process and addressed this with the members of staff involved.

Medication management and administration processes were reviewed. An electronic medicines administration system was used which mitigated the risk of errors. Although information regarding controlled drugs was held on the electronic system, within the paper records staff had sometimes signed in the wrong box and the form of medication was not always noted i.e. tablet etc.

We observed staff carrying out safe moving and handling practice. There was a policy and procedures were in place to prevent and control the spread of infection.

Arrangements were in place for checking the environment at Norton Lodge to ensure it was a safe place for people to live. We spot checked safety certificates and found these were up to date. We were told that improvements had been made to the environment since the new owner took over.

People had a personal emergency evacuation plan (PEEP) detailing the support they would need in the event of any major incidents/emergencies.

Risks to people’s health and wellbeing were assessed and we saw that measures were put in place to support people to remain safe. Safe recruitment procedures were followed.

People said they felt cared for, respected and listened to, that staff were kind to them and that the care they received was effective. We saw that staff interactions were considerate and were not rushed.

The service operated within the principles of the Mental Capacity Act 2005 (MCA). The registered manager maintained records of Deprivation of Liberty Safeguards authorisations and a system was in place to ensure that these were renewed as required. People told us that staff asked for their consent before care was provided.

People were supported to access health care professionals when needed to support their health and wellbeing. The district nursing team were supporting one person with regard to pressure care however a service care plan had not been put in place. Following discussion, a detailed care plan was implemented.

We observed breakfast and mealtime services and saw that people enjoyed their meals. Staff supported people discreetly and an alternative was offered for a person who was reluctant to eat.

Staff received the necessary training, supervision and appraisal they needed to carry out and be supported in their role. Training was provided via a mixture of e-learning and face to face sessions.

People were supported to maintain relationships with family and friends and we could see that there was an evident emphasis on people’s emotional wellbeing. Staff supported people to be as independent as they could be.

We saw that care plans contained person centred information although in some instances the written plans did not reflect all person centred care taking place. The registered manager had identified further development of care plans as part of their on-going action plan. We discussed care plans for health conditions, for example epilepsy. Following the inspection we saw evidence of care plans implemented in this regard which were detailed, reflective and demonstrated the improved standard.

The service employed an activities co-ordinator and on the second day of inspection we observed a visit from local school children who sang and chatted with the people living at Norton Lodge. This was obviously enjoyed by all who watched and took part.

There was a policy and procedure in place to manage complaints although none had been received and the people we spoke with said that they had none. Several compliments had been received about the standard of care provided.

During the morning of the first day of the inspection some areas of the home were cold as windows had been left open. Some people said that they felt cold and were subsequently offered blankets. The home felt warm in all areas during the afternoon and on the second day of inspection.

The people living at Norton Lodge and staff felt that the service was well-led and that the registered manager was fair and approachable.

The service had quality assurance processes in place to ensure the quality of the service and reviewed these to capture learning. The registered manager operated an open door policy and satisfaction surveys were distributed to staff, people using the service and relatives to gather their views.

During the inspection records requested were readily available, clear and were well organised. The registered manager engaged with the inspection process in an open and transparent way and received feedback positively.

Norton Lodge is a privately owned care home set in large grounds in the Norton Village area of Runcorn. A bus route and train station is nearby and Halton Lea shopping centre and Runcorn old town are within easy travelling distance. The home provides personal care for people who experience mental health issues, alcohol related problems, learning disability or dementia. The accommodation is provided over two floors and is registered to take up to 30 people. There were 28 people living in the home at the time of our visit.

At the time of the inspection the registered manager had just resigned her post but has not yet submitted an application to cancel her registration with CQC 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.

This was the first inspection of this service since it was purchased by the current providers in December 2015. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safeguarding service users from abuse, consent, staff training and supervision and governance. The registered provider and registered manager had also failed to notify the Care Quality Commission about events and incidents at the home in line with the regulations. You can see what action we told the provider to take at the back of the full version of this report.

Although staff had received some training, some refresher training was overdue and staff had not received regular supervision.

Staff had appropriately referred safeguarding incidents to their registered manager but these had not then been dealt with in accordance with the local Safeguarding Adults Interagency policy, therefore they may not have been investigated or addressed correctly.

Although staff worked cooperatively with people living at the home records were not available to show that people without capacity to make their own decisions were protected by the MCA framework.

Quality assurance processes were not sufficiently robust to ensure that risks to people’s health and safety were mitigated or to ensure that the quality of the service improved. People who used the service and their relatives were high in their praise of the staff and services provided. They told us that staff were kind and caring and understood their needs.

We saw that staff had developed effective communication methods with people to meet their individual needs. We saw staff used verbal and non-verbal interactions to ensure people were able to speak their mind and have choices in all aspects of their daily life.

Care plans held some information about the individual’s needs and choices. They also held risk assessments which balanced the potential benefits and risks in order to support people wherever possible to live a life of their choice. However some care plans were very brief and were in need of updating to ensure current needs were recorded. We saw that some care plans were not signed by the individual or their next of kin to evidence their consent to the care and support provided.

Staff records showed that there was a low turnover of staff and staff files indicated that recruitment policies ensured that all relevant checks had been undertaken prior to staff working at the home.

People told us that they were supported by consistent staff who knew the people very well.

We saw the service had good links with community nurses to enable staff to make necessary referrals in areas such as behaviour which challenged which were followed up appropriately.

The service promoted healthy eating. People were also assisted to eat safely and healthily using guidance from Speech and Language Therapists (SALT) workers.

The service had recently undergone some changes to its management structure and staff told us that this had greatly improved the staff morale. Staff said the deputy manager led by example and the providers had been most supportive. Staff told us that they now felt valued and empowered. We saw that staff worked well together. There was a no blame culture permeating throughout the service and staff worked together to monitor and improve the service.

We saw that updated policies and procedures to monitor the quality of the service had been introduced with a view to ensuring continuous improvement. This included introduction of new care plans, falls risk assessments and a care plan review system.