• Care Home
  • Care home

Archived: Norfolk House

Overall: Requires improvement read more about inspection ratings

39-41 Sea Road, Westgate-on-Sea, Kent, CT8 8QW

Provided and run by:
Indigo Care Services Limited

Important: The provider of this service changed - see old profile

All Inspections

30 May 2017

During a routine inspection

This inspection was carried out on 30 May 2017 and was unannounced.

Norfolk House provides accommodation and personal care for up to 30 older people. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. The top floor was not being used at the time of our inspection. There were 22 people living at the service at the time of our inspection.

A manager was working at the service and had applied to the Care Quality Commission (CQC) to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of Norfolk House in October 2016, the service was rated ‘inadequate’. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 and we asked the provider to take action to make improvements. We issued requirement notices relating to the staffing levels, safeguarding people and protecting them from harm, supporting people to make choices and have freedoms, managing medicines, following health care professionals advice, record accuracy and checking and improving the quality of the service. The provider sent us an action plan. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made and the breaches met. However, there were still areas for improvement.

People, their relatives and health care professionals told us that the service had improved since our last inspection. We found this was correct and action had been taken to address the shortfalls we found at the last inspection. The manager and operations manager agreed that further improvements were required to the service and they had plans in place to make continual improvements. One person told us, “It is like a hotel here, the staff are all lovely without exception. It is like family and we are taken care of brilliantly”.

The provider and manager had increased oversight of the service and the effectiveness of checks and audits had improved. The majority of the shortfalls in the service that we found at the last inspection had been addressed. Staff now received the support they required to provide people with the care they needed. They knew about their roles and responsibilities and were held accountable. Staff morale had increased and staff worked well together as a team.

Previously safeguarding risks had not been identified and referred to the Kent local authority safeguarding team for their consideration or investigation. Staff knew how to identify concerns and were confident the manager would take action to protect people. Staff had reported any concerns they had to the manager and these had been acted on.

Action had been taken since our last inspection to make sure risks to people were identified, assessed and reviewed. Guidance had been provided to staff about how to keep people safe while maintaining their independence, including the use of pressure relieving equipment. Staff acted on advice from health care professionals to keep people as well as possible. People had been supported to have regular health checks such as eye tests.

Assessments of people’s needs had been completed accurately following our last inspection. Detailed guidance was now available to staff about how to meet people’s needs.

Action had been taken to make sure people received their medicines in the way they preferred to keep them comfortable. Medicines were recorded accurately but not always stored safely.

Following our last inspection the local Fire and Rescue Service had visited the service to provide advice, which had been acted on. Staff were now competent to evacuate people in an emergency and had guidance to refer to if needed.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been made to the supervisory body for a DoLS authorisation when people were restricted. No one was the subject of an authorisation at the time of our inspection and people were not restricted

Staff had completed training in the principles of the Mental Capacity Act 2005 (MCA) since our last inspection and put these into practice. Staff knew what day to day decisions people were able to make and supported them to do this. Decisions made in people’s best interests had been recorded to demonstrate how the decision had been made and by whom.

At our last inspection people told us they would like more to do. At this inspection we found that action had been taken to support people to participate in more activities but further improvements were required. Staff now had time to spend time with people in communal areas and those who chose to be in their bedrooms.

Accurate records were now maintained about the care and support people received. Action had been taken to make sure people’s personal information was kept safe.

People and their representatives remained confident to raise concerns and complaints they had about the service. At this inspection we found that action had been taken to resolve people’s complaints to their satisfaction and use them to continually improve the service.

People and their relatives were asked for their views about the quality of the service and their suggestions were acted on.

People’s needs continued to be considered when deciding how many staff were required on each shift. Action had been taken since our last inspection to make sure sufficient staff were deployed to meet people’s needs at all times.

Safe recruitment procedures were followed for all new staff. All the required checks had been completed including obtaining a full employment history with dates of employment. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff now met regularly with a manager to discuss their role and practice and told us they felt supported. Staff had completed the training they needed to provide safe and effective care to people, including refreshers following our last inspection.

At our last inspection although people and their relatives told us that staff were kind and caring, we found that people were not always treated with respect. At this inspection we found action had been taken to address this and people were treated with respect and given as much privacy as they wanted. Staff offered people assistance discreetly without being intrusive.

People told us they liked the food at the service. Meals were balanced and included fruit and vegetables.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. The manager understood when CQC should be notified of some significant events and we had received notifications are required.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We have made recommendations about activities for people living with dementia and staff recruitment.

14 October 2016

During a routine inspection

This inspection was carried out on 14 and 17 October 2016 and was unannounced.

Norfolk House provides accommodation and personal care for up to 30 older people. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. There were 23 people living at the service at the time of our inspection. The service is situated next door to another care home service run by the same provider and shares staff and management with the other service.

The registered manager for the service next door was leading the service and had applied to the Care Quality Commission (CQC) to also be the registered manager at Norfolk House. The previous registered manager had resigned and had stopped working at the service a couple of weeks before our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider and manager did not have oversight of the service. They had not supported staff to provide a good level of care and staff were not all aware of their role and responsibilities. Checks on the quality of care being provided had been completed but the shortfalls in the service that we found at the inspection and not been identified.

Safeguarding risks had not been identified and referred to the Kent local authority safeguarding team for their consideration or investigation. The manager reported their concerns to the Kent local authority safeguarding team during our inspection. Staff knew the signs of possible abuse, and how to whistle blow to the provider, Kent local authority safeguarding team and CQC.

Risks to people had not been consistently identified, assessed and reviewed. Action had not always been taken to reduce risks and provide staff with guidance about how to keep people safe while maintaining their independence. On one occasion a person had not been provided with prescribed pressure relieving equipment and this had caused them harm.

Plans were not in place to keep people safe in an emergency, including plans and equipment to evacuate people from the building. Following the inspection the manager contacted the local Fire and Rescue Service for advice.

Assessments of people’s needs had not been consistently completed to identify their needs. Detailed guidance had not been provided to staff about how to meet people’s needs. No guidance had been provided to staff about how to provide one person’s care. People had not been supported to have regular health checks such as eye tests.

People did not always receive their medicines in the way they preferred to keep them comfortable. Medicines were stored safely and recorded accurately.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been made to the supervisory body for a DoLS authorisation when people were restricted. Staff did not know who applications had been made for. Care had not been planned to make sure restrictions to people’s liberty were minimised.

Staff did not follow the principles of the Mental Capacity Act 2005 (MCA). When people needed to make a specific decision their capacity to do so had not been assessed. Staff disagreed about people’s ability to make important decisions. Decisions made in people’s best interests had not been recorded to demonstrate how the decision had been made and by whom. Care staff assumed people could make day to day decisions, however, guidance was not provided for staff about what decisions people were able to make.

People told us they would like more to do. Some people were not supported to participate in activities and staff did not spend time with people who chose to be in their bedrooms.

Accurate records were not maintained about the care and support people received. Information was not available to staff and health care professionals to help them identify any changes in people’s needs. People’s personal information was not always kept safe.

People and their representatives were confident to raise concerns and complaints they had about the service. However, action had not been taken to resolve people’s complaints to their satisfaction and use them to continually improve the service.

People and their relatives were asked for their views each year. Many people did not return the survey they were sent. Action had not been taken to explore other methods of obtaining people’s views and involving them in developing and improving the service. Staff did not have regular opportunities to share their experiences of the service. Suggestions they had made had not been considered and staff had stopped making suggestions until very recently.

People’s needs had been considered when deciding how many staff were required on each shift. However, the provider had not taken action to make sure sufficient staff, who knew people, were deployed to meet their needs. Staff worked as a team to meet people’s needs.

Safe recruitment procedures were followed for most staff. Gaps in employment had been questioned.

Staff had not regularly met with a manager to discuss their role and practice. Staff told us they had not felt supported and appreciated until very recently. They were confident to raise concerns with the manager and other senior staff.

Staff had completed the training they needed to provide safe and effective care to people.

Although people and their relatives told us that staff were kind and caring, people were not always treated with respect. For example, people did not always receive their laundry back from the laundry and their clothes were found in other people’s wardrobes.

People told us they liked the food at the service. Meals were balanced and included fruit and vegetables. All meals were homemade. People were offered a choice of food to help keep them as healthy as possible. Food was prepared to meet people’s needs and preferences.

People were treated with dignity. Staff offered people assistance discreetly without being intrusive.

The manager had not notified CQC of some significant events that had happened at the service. Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.