Norfolk House

The home accommodates up to 76 people in one purpose-built building. Care is provided across three floors which each have their own communal facilities and dining areas. One floor provided residential support to people living with dementia. Two floors provided nursing care to people with a variety of long-term conditions and disabilities. At the time of our inspection there were 61 people living at the service.

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

People told us they were happy living at Norfolk House and described feeling safe and well cared for. One person said, “I can’t tell you how good the staff are.” A relative told us, “I have total reassurance that my relation is safe and well cared for.”

There were enough staff to care for people safely. Risks to people were identified, assessed and managed and staff understood how to support people’s specific needs. There were safe systems in place to ensure that people received their medicines as prescribed. Staff understood how to safeguard people from harm and how to protect them with the prevention and control of infection.

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. Staff had received the training and support they needed to care for people’s needs. One relative told us, “I cannot fault anything, the staff have been fantastic.” Staff training reflected people’s diverse and complex needs, staff told us they felt confident in their roles. One staff member told us, “Working here has made me a better nurse.”

People were receiving enough to eat and drink and they told us they enjoyed the food. Risks associated with eating and drinking were assessed and managed effectively. Staff were proactive in supporting people to access health and social care services. Communication systems supported staff to deliver effective care. One staff member said, “I love the way we can share ideas here and with other services.”

Staff knew people well and supported them and, when appropriate, their relatives to be involved in making decisions about their care. People told us staff were caring, kind and treated people with respect. Staff supported people to remain independent and protected their dignity.

People were receiving personalised care. Staff were familiar with people’s needs, their routines and preferences. Relatives described the positive impact of having consistent staff who knew people well. Records included details of people’s personal history, their likes and dislikes and the things and people that were important to them. Staff recognised when people’s needs changed, care was flexible and responsive. People were occupied with activities that were appropriate for their needs and interests and people were supported to maintain relationships and connections that were important to them. Staff supported people to plan for end of life care. One relative told us, “The staff support me too, they understand and help me as well. Nothing is too much trouble.”

Systems and processes supported the registered manager to retain oversight of quality at the home. Staff spoke highly of the management of the service and described a positive atmosphere where they felt able to raise concerns and to make suggestions. People and their relatives said they felt comfortable to raise any complaints and were confident that appropriate actions would be taken. People described the registered manager as approachable and one person said, “He has a real interest in the people here”. A visitor told us, “The manager is first class and the atmosphere amongst the staff is excellent.”

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 (published 15 August 2018) and there were three breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

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.

Norfolk House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Norfolk House accommodates up to 76 people in one purpose built building. Care is provided across three floors which each have their own communal facilities and dining areas. One floor provided residential support to people living with dementia. Two floors provided nursing care to people with a variety of long term conditions and disabilities. At the time of our inspection there were 61 people living at the service.

There was a registered manager in post. 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.

There were not sufficient numbers of staff at the home to keep people safe. On a unit for people living with dementia, we identified a lack of staff presence to ensure people were kept safe. There were also shortfalls in relation to support and monitoring of staff medicines practice on one floor. Medicines were managed, stored and administered safely throughout the rest of the service.

Care was not always provided in a person-centred way. Care plans lacked detail, particularly around the support required for people living with dementia. Important information about people’s backgrounds and their preferences with relation to end of life care were also missing. The provider carried out checks and audits but these had not identified and addressed the concerns identified on this inspection in a proactive manner. People also told us that they did not have regular contact with management.

People’s healthcare needs were met by trained and competent nursing staff. We saw evidence of staff liaising with healthcare professionals where required and these staff had the support and training required to support them in their roles. The provider carried out checks on new staff to ensure that they were suitable to be working in an adult social care setting. Staff felt supported by management and we saw evidence of regular meetings to involve staff in the running of the service. The home environment was tailored to people’s needs, but for those living with dementia interaction with the home environment was limited due to staffing levels. Staff ensured the environment was clean and there were robust processes in place to reduce the risk of the spread of infection.

Staff were kind, caring and committed to their roles. Care was provided in a way that involved people and staff offered day to day choices to them. Regular reviews were carried out to identify any changes to people’s needs and the provider conducted surveys to gather feedback from people and relatives. Regular meetings took place to provide people with opportunities to make suggestions and we saw examples of recent suggestions being actioned by management. There was a complaints policy in place and management recorded and responded to complaints appropriately.

Risks to people were assessed and staff implemented plans to reduce hazards to people. People’s independence was promoted by staff who were knowledgeable about how to empower people. Where incidents had occurred, appropriate actions were taken to keep people safe. Staff understood their roles in safeguarding people from abuse and we saw evidence of staff working alongside safeguarding teams where necessary to ensure people’s safety. People were supported in a way that was respectful of their privacy and dignity. Staff sought people’s consent and where people were unable to provide consent, the correct legal process was followed.

Norfolk House is a purpose built care home with nursing which can accommodate up to 76 people. On the day of the inspection there were 59 people living at the service, some of whom were living with dementia.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At our last inspection of Norfolk House in September 2016 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had made improvements.

Staffing levels within the service had increased and people told us that staff responded promptly to requests for support. However, some people told us that the responsiveness and flexibility of staff at busy times was reduced. Whilst staff were generally attentive to people’s needs and spoke to people kindly, we observed occasions where interaction with people was lacking.

Risks to people had been assessed and staff had taken appropriate action to reduce these risks. There were plans in place to ensure that people would continue to receive their care in the event of an emergency. Appropriate checks on staff were completed before they started work, to help ensure only suitable applicants were employed. Staff understood safeguarding procedures and were aware of the whistle-blowing policy. Medicines were managed safely and people received their medicines in line with their prescriptions.

People were supported by staff who had the skills and experience needed to provide effective care. Staff had induction training when they started work and ongoing refresher training in core areas. Staff received regular supervision which gave them the opportunity to discuss their performance and training needs.

People’s legal rights were protected as the registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff routinely asked for people’s consent prior to supporting them.

People enjoyed the food provided and could have alternatives to the menu if they wished. People’s nutritional needs had been assessed and action was taken where substantial changes to people’s weight was noted. People were supported to stay healthy and to obtain medical treatment if they needed it. Staff monitored people’s healthcare needs and sought advice from healthcare professionals if they became unwell.

Staff understood the importance of respecting people’s privacy and dignity. Relatives told us they were welcomed to the service and there were no restrictions on the times they could visit. People had opportunities to take part in activities at the service and to go out to local places of interest.

Assessments were completed prior to people moving into the service and this information was used to complete detailed care plans. Records of people’s care were regularly reviewed and people and their relatives were involved in the process. Details of people’s life histories and preferences were recorded and used by staff to prompt discussion.

Quality assurance audits were completed and actions were addressed where improvements were required. There was a system in place to deal with people's comments and complaints had been addressed.

The registered manager provided good leadership for the service. Relatives told us the service was well run and that the registered manager was open and approachable. Staff told us the registered manager provided good leadership and promoted a positive culture at work. They said they felt the service had improved since the registered manager had been in post. People and their relatives were involved in the running of the service through regular meetings and where changes were requested the registered manager took action.

Since that inspection we received concerns about the number of staff on duty and that this had led to inadequate care being delivered for people. In response those concerns we carried out this inspection on the 15 August 2014 to specifically review the staff levels and whether this met people's needs.

We spoke with 10 people who used the service, seven relatives who were visiting, nine member's of staff and the registered manager.

Although the registered manager told us they had experienced some staffing difficulties mainly in June and July this year they had now recruited new staff who were starting to work.

The vast majority of people, relatives and staff we spoke with told us there were enough staff to meet people's needs. People's comments included, " I'm comfortable here and the staff are very good." " It's home from home and I like it here." and " The staff always come when I need them." relatives said, " It is good care here and there are enough staff." and " They always look after X very well I have no complaints."

However, two relatives we spoke with disagreed with these positive views and despite earlier complaints to staff and management remained unsatisfied. They felt there were inadequate staff to meet their family member's particular needs at all times. The registered manager assured us that they would offer any relatives a further opportunity to meet in order to discuss their views and attempt to resolve their concerns.

Our inspection team was made up of two inspectors. We asked our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

From our observations we saw people were treated with respect and dignity by the staff. People that we spoke with told us the staff were kind and helpful.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The provider reported safeguarding alerts to the local authority and notified CQC. They had worked cooperatively with social services during recent alerts that had been sent to them by the home. This reduced the risks to people and helped the service to continually improve.

The registered manager set the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met. The registered manager told us they still used some agency workers but planned to be fully staffed by August so would no longer need this help.

Is the service effective?

People's health and care needs were assessed with them and their families. We saw that people and their relatives had been encouraged to be involved in writing their plans of care.

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

The premises had been adapted to meet the needs of people with physical impairments. Regular health and safety checks were in place that ensured corridors and stairs were clear of clutter during the home's refurbishment.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People benefited from some activities in and outside the service regularly arranged by staff.

We saw the complaints policy displayed on the notice board. People could be assured that if a complaint had been received there was a system in place which would ensure their complaint would be investigated and appropriate action taken.

Is the service well-led?

The service worked well with the local authorities that had placed people at the home. This ensured people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and that quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We received a number of positive comments about the home, especially the ongoing refurbishment which had improved the environment for residents. However, we also noted some health and safety matters, related in the main to the refurbishment, that needed to be addressed.

During this follow up visit in March 2014 we found recruitment records for staff now contained all the relevant information required by regulation.

We reviewed the staffing levels and found more work was needed. However, comments from residents and relatives were mainly positive, and included "Staff are very helpful", "I'm quite content with everything here", and "They seem to be nice people." The manager was on leave on the day of this visit so some areas we identified for improvement were passed on to senior staff for their attention.

We also reviewed record keeping and found some areas of good practice. These included the new electronic care planning system, and the new method of recording of food and fluid intake of residents.

During this follow up visit we found that whilst improvements had been made, there were still shortfalls related to staff recruitment records.

We asked people if staff gained their consent before supporting them with care and treatment. Responses were all positive and included 'Yes, they are very courteous.' We asked people if they received the care they needed and if staff looked after them well. Responses varied from 'Yes, reasonably' to 'Very well.' We asked people about the meals at Norfolk house and we were told that 'On the whole it is good.' Other comments included 'Very nice' and 'Excellent.'

All those we spoke to who were able to answer the question on safety, confirmed they felt safe living at Norfolk House. We asked people if they would know who to report to if they had any complaints, and those who were able to answer this question said they would speak to staff or the manager. On the overall quality of the service, responses ranged from 'Alright' to 'First class.'