Norbury Court

Updated 14 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by an inspector, a specialist advisor, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The specialist advisor was a nurse with experience of working with older people, including those living with dementia.

Service and service type

Norbury Court is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Norbury Court is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection, there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with four people who used the service and 12 relatives about their experience of the care provided. We spoke with 15 members of staff, including the regional manager, the registered manager, five nurses, four care workers, the housekeeper, two kitchen staff, and the chef. We also spoke to one visiting health professional.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 14 July 2022

Norbury Court is a nursing service that provides care for up to 60 people. It is a purpose-built care service and has three floors. At the time of our inspection 50 people were living at the service.

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

At this inspection, we identified concerns with the management of risk, care planning, the delivery of care, the management of medicines and governance.

The provider had a range of audits in place to monitor the quality and safety of the service. These audits had identified similar concerns with medicines and the environment, yet there was little evidence any action had been taken to address these concerns. This resulted in the same concerns being identified at this inspection.

Medicines were not always managed safely across the home, which placed people at risk of harm. We also found people’s medical and health needs were not sufficiently monitored by nursing staff to ensure their health and wellbeing was being maintained or to identify possible early signs of ill-health. This placed people at risk of avoidable harm.

Risks to people's health, safety and wellbeing were not managed safely. People’s care plans did not contain adequate details of their medical conditions and the clinical care they required, to keep them safe and well.

Staff did not always follow infection control procedures and the home was not clean in some areas.

Staff did not always receive on-going support on the job to ensure they carried out their roles as necessary. This included a lack of regular supervision, appraisal and observation on the job. People and staff reported they felt more staff were needed to meet people's wishes and choices. We have made recommendations about this.

Overall, 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. We have made a recommendation about the review of MCA and best interest decisions.

Staff we spoke with told us the management team were supportive and team meetings were taking place.

People received support from a range of health and social care professionals including dieticians; mental health teams; speech and language therapy and their local GP.

The registered manager and regional manager were open and honest about the shortfalls at the service. They engaged with the inspection positively and were committed to making any necessary improvements.

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 02 August, 2017).

Why we inspected

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

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

Enforcement

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.

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.