Norbury Hall

Norbury Hall is a residential home for up to 81 older people, many of whom were living with dementia. At the time of the inspection 75 people were receiving personal and nursing care.

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

The registered manager was experienced and understood their role and responsibilities well overall, as did staff. The registered manager engaged well with people using the service, relatives and staff and staff felt well supported by them. The registered manager notified CQC of significant events, such as allegations of abuse, as required by law and understood their legal responsibility to be open and honest with people when something goes wrong.

Risks relating to people’s care were well managed, although risks relating to pressure ulcers for one person could be improved as their pressure mattress was not always at the correct settings. There were enough staff to support people safely and the provider had invested significantly to improve staffing numbers since our last inspection. Recruitment was robust and ongoing. Staff received training in infection control, including the safe use of personal protective equipment (PPE), to reduce the risk of COVID-19 transmission. People received the right support in relation to their medicines and the registered manager oversaw this. The premises were maintained safely with regular checks.

Staff received the training and support they needed to understand and meet people’s needs with specialist training available. People were supported to maintain their health and to attend appointments with professionals involved in their care. People received food and drink of their choice, meeting their dietary and cultural needs and preferences, with snacks available outside of mealtimes. 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.

People liked the staff who supported them and were comfortable in their presence and staff knew people well. People were encouraged to be involved in their care as much as they liked. Staff treated people with dignity and respect and protected people’s confidential information. Staff received training in equality and diversity and understood people’s differences. People’s care plans were based on their individual needs and preferences and were kept up to date. The registered manager investigated and responded to any concerns or complaints in line with their policy and people had confidence in how they would respond.

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 August 2019) and there were 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. At our last inspection we recommended that people’s nutritional outcomes should be improved and also that food hygiene should be improved. At this inspection we found that the provider had acted on our recommendations and had made improvements.

Why we inspected

This inspection was prompted due to concerns raised by the London Ambulance Service (LAS) regarding restraint and to check improvements made since the last inspection. We found the issues raised by the LAS were no longer of concern and the service had improved since our last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Norbury Hall is a residential care home that provides support and personal care for up to 81 older people, some people using the service were living with dementia. The service is set in a landscaped park. One section of the home is an older large Grade ll listed building with 40 bedrooms and the other is a purpose-built extension with an additional 41 en-suite bedrooms. Accommodation within the home includes bedrooms on the ground, first and second floors. When we inspected the first-floor area of the older building was being refurbished and was not in use. There are two passenger lifts to access all floors. At the time of our inspection 59 people were using the service.

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

Improvements has been made in the environment to help reduce the risks to people and to help people call for help when they needed to. However, sometimes people’s risks had not been identified or recorded properly on people’s electronic care records. This meant people may not receive the care they needed from staff to keep them safe.

People’s choice of food was limited. People had mixed views about the food available and we did not see people involved in choosing the food they wanted to eat. People did not have access to food or drinks outside of mealtimes unless they asked for them. People and their relatives told us there were limited snacks between meals and no healthy options such as fruit appeared to be available. We have made a recommendation about improving people’s nutritional outcomes.

Improvements had been made to the service to make some areas easier to clean and for staff to carry out hand washing before and after supporting people. However, we found there were issues with kitchen hygiene. Cleaning schedules did not have enough detail to show what had been cleaned and when, and foods were not always stored properly. We made a recommendation about the management of food hygiene.

Staff told us staffing levels had improved since our last inspection and we found changes had taken place to increase the number of skilled staff during the night shifts and make more staff available during the day. However, the number of staff required had not been based on people’s needs and it would take time for us to see if the improvements in staffing had a positive impact of people’s safety.

There had been changes in the managers at the service since out last inspection. A new management team was in place to support the sole director of the provider organisation who was also the registered manager. A detailed audit had been completed to identify ongoing issues with the service and the management team were working to put things right. Staff told us they thought things had improved. Relatives told us they did not know who the new managers were but some relatives told us they had recently been involved in their family members care and thought this was positive.

The provider had failed to display the last CQC rating of requires improvement at this service and on their website, as required. This meant it was harder for people to find out what we thought of the service.

People continued to be complimentary about staff and told us they were kind and caring. People thought staff had the right skills and records confirmed staff had received training over the last year to help improve their skills and knowledge.

People were supported to have 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 CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 October 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

During this inspection we have identified breaches in relation to, identifying and managing people’s risk, involving people to have choice and to receive person centred care and, for failing to display the CQC rating.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

During this inspection we found four breaches in safe care and treatment, staffing , person-centred care and good governance. We found the provider was responsive to all our findings and has either already rectified or is in the process of making improvements to the service. You can see the action we asked the provider to take on the back of our full-length report.

Norbury Hall is a residential care home that provides support and personal care for up to 81 older people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Norbury Hall is set in a landscaped park. One section of the home is an older large Grade ll listed building and the other is a purpose-built extension. Accommodation within the home includes bedrooms on the ground, the first and second floors. There are two passenger lifts to access all floors. At the time of our inspection 50 people were using the service.

We met with the manager at this inspection who was in the process of becoming a registered manager with the 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.

People were not always protected from the risk of harm due to environmental concerns. We found adequate window restrictors were not in place meaning people could fall from height. We found call bell cords had been tied up and some areas of the service were not clean. On the second day of our inspection we found the provider had fitted window restrictors and work had started to deep clean some areas.

Not all risks had been identified for people and some risk assessments had not been reviewed after people had fallen. Some information about people’s care was not always complete. This meant staff did not always have the guidance they needed to support people and manage their risk according to their individual needs.

There were not enough staff to keep people safe. People and their relatives told us the service needed more staff. There had been a large about of unwitnessed falls at the service and relatives told us they thought this was due to a lack of staff. We saw staff were task focused in the mornings and woke people early to get them washed and dressed. The provider had not completed an assessment of needs for each person so could not be sure how many staff were needed and at what time of the day to support people safely. Not all floors or communal areas were staffed during our inspection resulting in an increased risk to people sustaining injuries, or not receiving the care they needed. The provider assured us they would address these issues.

People and staff told us they liked the new manager and the changes they planned to make. We found communication methods were in place to obtain the views of people and their relatives although it was not always clear how these were acted upon.

We found some systems were not in place to ensure all care records and risk assessments were up to date and accurate. Audits were regularly completed, however, some health and safety and infection control audits were missing so issues that could put people who used the service and staff at risk had not been identified.

Newly introduced care records focused on people and gave a good picture of the individual including their physical, health and social needs. Plans were in place to update all care records, but at the time of inspection not all care records provided accurate or complete information about people’s needs.

Staff recruitment procedures were safe and staff told us they received regular supervision. All staff received an induction when they first started to use the service and staff were in the process of completing their mandatory training.

Medicine management was good and people received their medicines as and when they should. The storage of people’s medicine was not always safe as temperatures sometimes exceeded the recommended levels. However, the provider put systems in place during our inspection to rectify this.

People had opportunities to access the community and in-house activities were provided by two activities coordinators. Staff knew people well, their likes and dislikes and life history’s and could tell us how they involved people to stop them feeling socially isolated.

People had access to healthcare services and received on-going healthcare support when they needed this, records of visits with healthcare professionals were in people’s files and feedback from healthcare professionals was good.

People and their relatives spoke highly of the staff at Norbury Hall. We observed kind and considerate interactions between staff and people using the service. Staff were friendly and polite when speaking with people. Staff respected people’s privacy and maintained their dignity.

Norbury Hall is a residential care home that provides support and personal care for up to 81 older people. It is set in a landscaped park. One section of the home is an older large Grade ll listed building with 40 bedrooms. A new purpose built extension with an additional 41 en-suite bedrooms was recently completed. Accommodation within the home includes bedrooms on the ground, the first and second floors. There are two passenger lifts to enable people access all floors. At the time of our inspection 36 people were living at the service, one person was in hospital.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge and understanding of how to identify if people were at risk of abuse and knew what to do in these circumstances. People told us they felt safe and were treated with dignity and respect. Staff recruitment showed some shortfalls in procedures which the manager acknowledged and addressed promptly.

We saw the home had systems in place for the safe storage, administration and recording of medicines. Each person’s medicine was stored securely and only senior competent staff were authorised to administer medicines. During the inspection all medicine records we observed had been filled out correctly and medicine audits were completed to ensure medicine procedures were robust. The manager was introducing changes to medicine policies and procedures that included annual competency assessments.

Staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

Staff reported positively about the training available. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were kept up to date. We observed positive and appropriate interactions between the staff and people who used the service. Staff were caring and treated people with kindness, dignity and respect. People who used the service and their relatives were complimentary about staff and the quality and the standard of care received. There were nominated dedicated dignity champions within the staff team. Events that promoted qualities such as dignity included “Dignity Teas” Relatives spoke of feeling reassured that their family members were respected and had their dignity promoted.

People’s nutritional needs were monitored and appropriate actions taken where required. People made positive comments about the food. Preferences and dietary needs were being met. People were supported to maintain good health and had access to appropriate healthcare services. There were two dedicated doctors for people and a weekly GP surgery was held at the home. People with nursing needs and requiring insulin or wound care were seen by the district nurses, referrals were made promptly to the community team when a nursing need was identified. Family members confirmed that their relatives were seen regularly by doctors and district nurse as well as other healthcare professionals such as community psychiatric nurses.

Communication was excellent among the staff team, handovers were thorough. If a person was unwell staff made sure information was shared with their colleagues to make them aware of the changes. Staff made sure they monitored closely the person’s progress, giving any additional support the person required. Relatives were kept informed about their family member’s wellbeing.

The home employed activity coordinators and this had a positive impact on the quality of life people experienced. People enjoyed the variety and frequency of activities available, the activity schedule catered for all interests and abilities and included involvement from external agencies who provided massage and music therapy. For people with dementia pet and doll therapies were used effectively to encourage engagement with people.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a weekly and monthly basis and covered a wide range of areas including medication, care files, infection control and the overall provision of care.

Relatives we spoke with made positive comments about the care their family members had received and about the staff working at the service. The service demonstrated it retained minimum staffing levels and the manager and provider kept staffing levels under review. Our observations during the inspection told us people’s needs were being met in a timely manner by staff. People told us staff responded to their call for assistance when they used their call bells.

The provider had a complaints process in place. One relative said, “They listen to you in the home. We can always rely on the manager getting back in touch when we have a query.” Resident and relatives meetings were held at the service and the service produced a regular newsletter. This meant people and their relatives or representatives were kept informed about information relevant to them.

The information we had received had focused on two main areas. These areas included the building and sleeping environment and the effect of this information on the care and welfare of people using the service.

During our inspection we spoke with the registered manager and deputy manager of the home.

We spent several hours at the home which included inspecting the building and sleeping environment. We looked at care plan records for people who use the service. We found no substance for the concerns that had been reported.

At the time of our inspection there were 30 people residing at Norbury Hall. We used different methods to help us understand the experiences of people who use the service as not everyone who lived at the home was able to communicate verbally with us in a meaningful way. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We met and spoke with 7 people using the service, 2 family members and or visitors to the home and 7 members of staff including the deputy manager. Feedback from people who use the service was generally positive. They told us they were happy with the care and support provided at the home and felt the staff were kind and very helpful. One person told us 'I can get up when I want and have something to eat when I want. The staff help me to retain my independence'.

During our inspection we observed positive staff interactions with people who used the service. Generally staff interactions were characterised by kindness, warmth, understanding and empathy.

People's views and experiences were taken into account in the way the service was provided and delivered and there were effective systems in place to record, monitor and resolve any complaints, comments or suggestions made.

Two inspectors visited Norbury Hall unannounced as we had received anonymous information that was of concern.

The information we had received had focused on three main area; the building and environment, staffing levels and nutritional needs.

We spent approximately two hours at the home, and found no substance for the allegations that had been made.