We carried out a review of the data available to us about Norwood House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Norwood House, you can give feedback on this service.
We found the following examples of good practice.
• Staff followed government guidance in relation to personal protective equipment (PPE) and infection prevention and control (IPC). The home had ample supplies of PPE and stock levels were monitored by the registered manager.
• All staff and people living at the service received regular Covid-19 testing. Appropriate processes were in place and followed should anyone display any symptoms of Covid-19.
• All staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.
• Consideration had been given to cohorting staff and zoning floors of the home should an outbreak occur, to reduce the risk of spreading infections.
• Staff supported people's social and emotional wellbeing. The service had used different methods including information technology to assist communication. The provider and staff kept family members up to date about the latest guidance and their relative's health via regular telephone calls and other technology including video calls. A thorough process was in place in relation to professionals visiting the service.
• Regular Infection Prevention and Control audits had been completed to ensure the service was providing safe care and staff were following guidance. Observations of staffs practice in relation to donning and doffing PPE and hand hygiene had been completed.
Norwood House is a care home providing personal care to nine older people at the time of the inspection, some of whom were living with dementia. The service can support up to 20 people in one adapted building.
People’s experience of using this service and what we found
Effective systems were now in place to monitor the quality and safety of the service. People had been asked for their views on the service and improvements had been made following any suggestions they made.
Risks to people were well managed. Risk assessments contained sufficient information to enable staff to safely manage risks. Regular checks were completed to ensure equipment remained safe to use. Improvements had been made to the management of medicines and people felt safe living at the service.
Good infection prevention and control practices were in place, which had been adapted well to respond to the increased risks posed by COVID-19.
Staff ensured people were provided with a balanced diet. Any concerns in relation to people’s food and fluid intake were appropriately recorded and monitored. Relevant professionals had been contacted when this was required.
Improvements had been made to training provided to staff and records relating to staff support. Regular one to one supervisions, discussions and staff meetings had taken place. A training manager was now employed, and thorough training plans were in place.
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.
For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 28 January 2020) and there was a breach 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 improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 13 November 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their quality assurance and governance processes.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-Led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Norwood House on our website at www.cqc.org.uk.
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.
Norwood House is a residential care home providing personal care to people aged 55 and over, some of whom were living with dementia. The service has four floors. Norwood House can accommodate up to 20 people. At the time of this inspection, 10 people lived at the service.
People’s experience of using this service and what we found
The quality assurance processes in place were not effective. They had failed to identify and address the shortfalls we found during the inspection. There was a lack of provider oversight and sufficient action had not been taken to address the shortfalls found at the last inspection.
Records did not show staff had been provided with sufficient support. Regular recorded supervisions had not taken place and records to evidence new staff had completed an induction when they joined the service had not been kept. Training records were incomplete. Due to recent changes in the management of the service, the new manager could not be sure what training staff had complete.
People told us they felt safe. Risks to people had been assessed but records did not provide staff with sufficient guidance of how to manage and reduce risks. Accidents and incidents had not been appropriately analysed to highlight what action could be taken to reduce the risk of reoccurrence. Topical medicines records were not always completed accurately to show medicines had been administered as prescribed. We have made a recommendation about the safe management of medicines.
Care records did not always reflect people’s current care and support needs. End of life care plans did not provide sufficient details. We have made a recommendation about end of life care planning.
People were provided with sufficient food and drinks; however, staff were not deployed effectively at meal times which meant people had to wait for assistance. Peoples weights were monitored to identify any concerns with weight loss or gain.
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. Where decisions had been made in a person’s best interests, record did not always record who had been involved in the decision.
Following the first day of inspection the manager and provider took action to address some of the concerns we found to mitigate risks. New care plans and risk assessments had been developed, a training and supervision matrix was put in place and new audits to monitor the quality and safety of the service had been developed.
This provider has recognised they do not have the skill or motivation to develop their own knowledge and approach to ensure compliance with regulations. A new provider has applied to take over this service.
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 23 November 2018) and there were multiple 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 enough improvement had not been made or sustained and the provider was still in breach of regulation.
The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Enforcement
We have identified a breach in relation to good governance of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider and request an action plan from 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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Norwood House is situated in Scarborough. The home accommodates up to 20 older people or people living with dementia in one adapted building. They do not provide nursing care.
Inspection site visits took place on 25 and 27 September 2018. At the time of this inspection, the service was providing support to 9 people.
At the last inspection in January and February 2018 the provider was found to be in breach of six regulations. These were Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 15 Premises and equipment, Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper persons employed.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions: Is the service Safe, is the service Effective, is the service Caring, is the service Responsive and is the service Well-led to at least good.
There was a manager in post but they had not yet registered with CQC. At the time of writing this report, an application for the manager to register had been submitted. 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.
Recruitment processes had still not been established and operated to ensure new staff were recruited safely. One to one supervisions had not taken place in accordance with the providers supervision policy. We have made a recommendation about staff supervisions. A plan was in place to ensure all staff were provided with an annual appraisal.
Risks to people had been assessed and recorded although we found some shortfalls in relation to choking risks. Appropriate checks were in place to ensure the environment and the premises were regularly maintained. Risks in relation to windows, bed safety rails and fire safety were in place and regularly reviewed.
Medicines had been stored and administered safely. Assessments of staffs’ competencies in this area had been conducted to ensure they had the skills and knowledge to manage and administer medicines.
The service was generally clean and tidy although further redecoration was needed in some areas where walls were scuffed or marked. A cleaning schedule was in place to ensure the service followed good infection control practice. Malodours were evident in some bathrooms.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Information was not appropriately recorded in relation to best interest decisions. We have made a recommendation about the recording of best interest decisions
People were provided with a variety of meals that they told us they enjoyed. Where people required specialist diets, all staff were not always aware of their needs. Food monitoring charts had not always been completed sufficiently to enable staff to effectively monitor people’s nutritional intake.
People told us staff were kind and caring and treated them with dignity and respect. Where possible, people’s independence was promoted although people were not always presented with information in a format they could understand. We have made a recommendation about accessible information.
Care plans contained person-centred information which focused on the individual. Pre-admission assessments had been completed prior to a person moving to the service. Some professionals raised concerns prior to this inspection that their guidance was not always followed in relation to suitable admissions to the service.
The manager had introduced a large number of monthly audits to monitor and improve the service. However, these did not always state action that was needed to address any shortfalls found or timescales for completion. They had failed to identify the concerns we found in relation to recruitment and shortfalls within some people’s care records.
The provider had failed to implement and conduct effective quality audits to enable them to monitor the service, the managers performance and improvements that were still needed to the service.
Feedback from people, relatives and staff had been sought although it was not clear what action had been taken to address any concerns raised.
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.
At this inspection, we found the provider was in breach of two regulations: Good governance and Staffing. You can see what action we told the provider to take at the back of the full version of the report.
The provider had failed to submit statutory notifications to the CQC when required in relation to Deprivation of Liberty Safeguards authorisations and deaths. This was a breach of Regulation 18 Notification of other incidents of the Care Quality Commission (Registration) Regulations 2009. The provider was also in breach of Regulation 16 Notification of death of a service user. We are dealing with this matter outside of the inspection process.
This inspection took place on 11 January, 1 February and 26 February 2018. The inspection was due but was prompted, in part, by the death of a person who used the service who had fallen from a window. The first day of inspection was unannounced; the second and third days were announced. At the time of our inspection, a registered manager was in post but was taking a period of leave. 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. As a result of the absence of the registered manager the service was being overseen by an interim manager.
At the last inspection undertaken on 22 December 2015, we rated the service as Good.
At this inspection, 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.
Robust systems and process were not in place to ensure the safety of people who used the service in the event of a fire. Regular testing of fire-fighting equipment and safety checks of the environment had not taken place. Fire drills had not been completed with all staff to ensure the procedure would work at different times of the day. This was promptly rectified with all staff attending drills and evacuation practises.
The registered manager and provider had not assessed or properly managed environmental risks. Environmental risk assessments had not been completed and deficits within the service had not been identified and rectified by the provider. For example, we found that combustible materials were stored in a fuse box and wheelchair and bedrail risk assessments were not completed. This put people at risk of avoidable harm. Many of the windows at the service were sealed shut and others opened too widely. Single glazed windows were not adequately protected.
Recruitment procedures were not established and operated effectively to ensure that new staff were of good character. Appropriate checks had not been completed.
Staff were knowledgeable about the people who lived at the service, however, the provider had not ensured staff training was appropriately facilitated and up-to-date. The person delivering training was not qualified to do so, therefore training was invalid.
There was a sufficient number of staff on duty. The deployment of staff was adequate for the number of people who used the service. Staff responded to people’s needs in a timely manner.
People were not supported to have maximum choice and control of their lives and the policies and systems in the service did not support this practice. The registered manager and the provider failed to adhere to the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We found people were unlawfully deprived of their liberty as DoLS assessments hadn’t been requested when required.
Medicines were managed in a safe manner However, the provider had not ensured competency checks were completed on a regular basis to monitor staff's practice.
Safeguarding procedures and policies were in place but staff did not follow these procedures. There were no records of safeguarding meeting minutes and no record of outcomes resulting from the safeguarding process.
Staff respected and protected people’s dignity and privacy, staff knocked on doors before entry. People said staff knew them well and treated them with kindness and compassion. However, shortfalls in the environment and standards of housekeeping and maintenance meant that people’s dignity and well-being were compromised.
Staff supported people to access healthcare services when they required them. Staff had good working relationships with local doctor’s surgeries and the local hospice. They followed health professionals' guidance regarding people's specific needs. People’s preferences around food and drink were respected and support was in place for people with specialist dietary requirements.
At this inspection, we found the provider was in breach of six regulations: safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, good governance, staffing and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report.
This inspection was undertaken on 22 December 2015, and was unannounced. The service was last inspected on 2 September 2014 and found to be compliant with all of the regulations that we assessed.
Norwood House is registered to offer personal care and accommodation for up to a maximum of 20 people. The home specialises in care for people who are living with dementia.
The service has 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 who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and knew what actions to take if they suspected abuse had occurred. Staff who had been recruited safely were deployed in suitable numbers to meet the assessed needs of the people who used the service. People’s medicines were stored safely and administered as prescribed.
People were supported by staff who had been trained to carry out their roles effectively; they had the skills and abilities to communicate with the people who used the service. Consent was gained before care and support was delivered and the principles of the Mental Capacity Act were followed within the service. People were supported to eat a balanced diet of their choosing. When concerns were identified relevant professionals were contacted for their advice and guidance.
People told us they were supported by kind and caring staff who knew their preferences for how care and support should be delivered. During observations it was clear caring relationships had been developed between the people who used the service and staff. People’s privacy and dignity was respected by staff who understood the need to treat sensitive information confidentially.
People were involved with the initial and on-going planning of their care. Their levels of independence and individual strengths and abilities were recorded. People were encouraged to maintain relationships with important people in their lives and to follow their hobbies and interests. The registered provider had a complaints policy which was made available to people who used the service. When complaints were received they were used to develop the service possible as required.
Staff told us the registered manager was approachable, supportive and listened to their views regarding developing the service. A quality assurance system was in place to ensure shortfalls in care, treatment and support were identified. Time based actions plans were developed to improve the service when required. The registered manager understood their responsibilities to report accidents, incidents and other notifiable incidents to the CQC. The registered manager worked closely with the local commissioning teams and an independent care group to ensure best practice was implemented within the service
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
At this visit we looked at the shortfalls that were found with the safety and suitability of the premises. We found that improvements had been made and action had been taken to address the issues that were found in June 2014. A member of staff we spoke with said 'We have taken action to make sure the home environment is safe and pleasant for people.'
Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.
The service had policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DOLS). There was no one currently using the service who had a DOLS in place. The provider knew how to request an assessment if this was required. Staff received safeguarding and MCA training. This meant staff were aware of procedures they must follow in order to ensure people were safeguarded.
When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks.
People were protected from the risk of infection because staff followed good infection control practice and these practices were monitored regularly.
Some areas of the home were 'cluttered' with unused equipment and some items accessible to people which would pose a risk to their health and safety.
There were sufficient care workers to respond to people's health and welfare needs. One person said "There are always enough staff around, I don't have to wait" Another person said "Staff are busy but they do have time to spend with me."
Is the service effective?
An assessment was completed prior to people being admitted to the service which detailed people's needs. Care plans covering areas such as personal care, mobility, nutrition, daily and social preferences and health conditions were completed. We saw corresponding risk assessments in place. We could see that people's care had been reviewed and their plans amended
Is the service caring?
We saw staff were attentive and respectful when speaking with or supporting people. People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere.
One person said 'The staff are very nice we're like a family'. And another person said 'I have no worries about the care my relative gets.'
Is the service responsive?
People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the manager to address any shortfalls or concerns.
Is the service well-led?
The service had a developing quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.
Staff told us the manager was supportive and promoted positive team working.
We reviewed the care and support plans of people who lived at the service and found that they reflected the individual's needs but were not always person centred.
One person told us 'I like it here although no meetings take place". Another person said that they had not lived at the service long but they were"settling in well". We observed staff and people using the service communicating in a relaxed and friendly manner.
There was no fire risk assessment available and no personal emergency evacuation plans for people who used the service as required under the Regulatory Reform (Fire Safety) Order 2005. We issued an immediate compliance action requiring the manager to produce these documents within 24 hours to ensure the safety of people who used and worked at the service.
We had some concerns during our inspection. There was no evidence of any risk assessments linked to infection control and the means by which the service would prevent and monitor those risks.
Following concerns from a previous inspection the manager confirmed that actions had being taken to make improvements.However,the records used to check if areas of the service were safe were not effective because they were not always current.
At the time we visited we observed positive interactions between people who used the service and staff. People were relaxed and comfortable in their surroundings. We saw there were sufficient members of staff to support people with their care in a timely way.
We found that people were cared for in a clean, hygienic environment. The d'cor and furnishings we saw were in keeping with the style of the home and offered people a home-like ambience.
However, we identified that improvements were needed to care planning to make sure that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We found that effective systems to regularly assess and monitor the quality of service that people received had not been developed.
People's consent to care was gained and we saw evidence that people received the care they needed. For example we saw up to date plans of care which considered individual physical, emotional and mental health care needs. We saw risk assessments and that all documentation was kept up to date to ensure people had their changing needs met. We saw that the home consulted with specialists to make sure people had the benefit of expert advice.
People were protected from harm and the risk of harm through staff training and risk assessments. The service referred safeguarding incidents to the local authority and to CQC as required to ensure people were protected. Staff also had training in mental capacity and deprivation of liberty safeguards.
Staff were suitably recruited to ensure they could offer the appropriate care to people. They had received training and supervision to support them in their role for people's benefit.
The home had a complaints procedure, we saw that the home dealt with complaints appropriately and people told us that they knew how to complain.