Archived: Norfolk House

We found the following examples of good practice.

Processes were in place to prevent visitors from catching and spreading infections. This included the provision of personal protective equipment (PPE), such as masks, gloves, aprons, hand washing facilities and hand gel. Temperature tests were done and a COVID-19 questionnaire was completed. Lateral flow rapid COVID-19 testing was done. A secure area of the home had been identified for visiting relatives.

There was adequate access and take up of testing for staff and people using services.

Robust cleaning arrangements, including frequent deep cleaning, were in place. Staff wore a full range of PPE appropriately and consistently. Staff training, practices and deployment showed the service could prevent transmission of infection and manage any outbreaks.

Norfolk House is a residential care home providing personal care to 13 people aged 65 and over at the time of the inspection. The service is registered to support up to 18 people. The house is a large converted property situated in the Springfield area of Wigan close to local amenities.

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

People and relatives were very positive about the home and said that it was safely run. The risks to people were assessed and minimised and people were protected from the risk of abuse. People were supported to take their medicines as required and this was regularly reviewed with the doctor. There were suitable systems for ensuring the home was clean and equipment was safe for use.

Staff worked very closely with other healthcare professionals to ensure that people had the right type of support. Professionals told us the registered manager was highly proactive in ensuring that people had their needs met and had an excellent understanding of best practice. 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 home had very detailed assessments of a person’s mental capacity which were decision specific and the right people were involved in best interested decisions for people who lacked capacity. The policies and systems in the home supported this practice.

People told us staff were kind and caring. Staff supported people to maintain their independence and encourage people to remain mobile. The registered manager, provider and staff knew the people living at Norfolk House very well and had excellent rapport and supporting relationships.

Care plans were very detailed and provided guidance for staff to support people with their care and support needs. These records were maintained and updated as required. People felt able to raise any concerns and make complaints and these were addressed by the registered manager. Staff provided a range of activities based on input from people living at Norfolk House and we observed that people engaged well with these activities. The home accessed a range of activities available within the local community and support people to engage with their individual interests and preferences.

People and their families were very happy and felt the home was being well run. Everyone spoke very highly of the registered manager and felt the home had significantly improved. People were supported by a team of staff who were happy in their jobs and passionate about delivering good quality care. The registered manager completed a range of regular checks on the quality and safety of the service and was committed to driving improvement within the home.

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 21 March 2017).

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.

At the previous inspection the home was found to be meeting regulations, however the service was given an overall rating of Requires Improvement because further improvements were required to ensure newly recruited staff accessed safeguarding training; chemicals needed to be stored securely and more improvements were required to the general environment to ensure it was suitable for people living with a dementia. At this comprehensive inspection on 25 January 2017 we found improvements had been made to meet the relevant requirements previously identified at the inspection on 29 July 2015.

Norfolk House is a privately owned care home that offers personal care and support for up to 18 older people. The house is a large converted property situated in the Springfield area of Wigan close to local amenities. At the time of the inspection there were 14 people using the service.

There was a registered manager at the home. 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 who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise risk. We observed good interactions between staff and people who used the service during the day. People felt staff were kind and considerate.

Recruitment of staff was robust and there were sufficient staff to attend to people’s needs.

Medication policies were appropriate, comprehensive and medicines were administered, stored, ordered and disposed of safely. Safeguarding policies were in place and staff had an understanding of the issues and procedures.

People’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks. Staff responded and supported people with dementia care needs appropriately. Care plans included appropriate personal and health information and were up to date. We saw evidence within the records of appropriate assessments being carried out.

People’s health needs were responded to promptly and professionals contacted appropriately. Records included information about people’s likes and dislikes and we observed that people had choices, for example, about when to get up, what to do and when and where to eat.

There was an appropriate complaints procedure and complaints were followed up appropriately.

People who used the service and their relatives spoke positively about how the service was managed.

Staff told us the registered manager was always available and approachable. Staff told us they attended regular meetings with the manager and we saw evidence of recent staff meetings.

Meetings with residents and relatives were conducted approximately every three months and relatives we spoke with confirmed they were aware of these meetings and received notification in advance.

Annual questionnaires were sent to people’s relatives. Resident’s questionnaires were also completed and we saw an evaluation of the two most recent questionnaires done in 2016.

Staff supervisions were undertaken regularly and we saw that these were used to discuss issues on a one to one basis.

The manager carried out a comprehensive range of audits and we saw historical audit records were in place.

Throughout the course of the inspection we saw the registered manager walking around and observing and supporting staff.

The service worked alongside other professionals and agencies in order to meet people’s care requirements as needed.

During the inspection we looked at respect and dignity, care and welfare, suitability of staff, staffing levels and quality assurance.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families, speaking with visiting professionals and looking at records:

Is the service caring?

We saw staff interacting with people who used the service in a caring and respectful way. There was evidence, from speaking with staff and within records that people's privacy and dignity was respected and preserved at all times.

We saw evidence within the care records of people's individual choices being noted and followed.

Is the service responsive?

People received an assessment prior to being admitted to the home. The care records included a large amount of information about the person's needs, wishes and preferences. We spoke with a professional visitor to the home who told us they felt the staff responded to individual needs, making appropriate referrals, seeking advice when needed and following instructions correctly.

People's mental capacity was taken into consideration with regard to decision making and families and professionals were consulted to help ensure decisions were made in the person's best interests.

Is the service safe?

Risk assessments were in place in the care records, along with clear guidance for staff to follow. These risk assessments were reviewed and updated regularly to ensure people's needs were met safely.

Staff were recruited safely and their induction was thorough, so staff were suitably qualified for their roles. There were enough staff on duty at the time of the visit, although staff rotas indicated that this may not always have been the case in the past. This had been addressed recently and an extra staff member now covered peak times in the mornings and evenings.

We were told by staff there was a good mix of experienced and less experienced workers on each shift. This helped ensure the safety of the people who used the service.

Is the service effective?

We spoke with three care staff who demonstrated a good understanding of people's individual needs. People were well presented and looked well cared for.

Staff were aware of the importance of care plans, understood how and when care plans should be consulted and were alerted to changes to people's care needs.

There were a number of activities on offer within the home and people were encouraged to join in at a level which was within their own capabilities and skills.

Is the service well-led?

Although there was no registered manager on site at the time of the visit, the providers were in the process of recruiting a new manager. In the meantime there was an acting manager, or a provider on site to oversee the running of the home.

There was evidence that communication between management and staff was good and effective. Handovers were clear and staff had knowledge of their roles and responsibilities.

There were quality assurance systems in place to ensure any issues were identified and addressed in a timely and appropriate manner.

When we visited we found that the people living at the service were settled within the lounge areas and were suitably dressed and well presented. The atmosphere was calm and settled and the people that we spoke with chatted to us and did not raise any concerns.

The provider had introduced a number of new documents and ways of working. An example of this was a communication book for staff to write in to ensure that relevant information such as hospital appointments was transferred to the relevant staff, relatives and other professionals so that people living at the service did not miss important appointments.

We looked at another document, the fault recording book. The purpose of this was to record the date that a fault had been found in the environment and when it had been repaired. We saw that although this had been completed correctly a systematic approach had not been taken as we also found areas in the home that required attention that had not been recorded. Examples included aluminium door thresholds that had lifted from the floor causing potential trip hazards and some windows that had broken catches, no opening restrictors or were sealed and not allowing any fresh air in to the room. We discussed this with the provider who told us that they would attend to the issues urgently and would inform us within one month.

The care manager informed us on the 20th January 2014 that these actions were now completed.

The care manager was continuing to act in the role of manager and had made an application to C.Q.C. to become the registered manager of the service. The registered manager continues to be on leave from the service.

We also found at the inspection that the registered manager remains on long term leave and the care manager continues to manage the service in her absence.

We spoke to members of staff, a visiting health professional, a visitor and people who lived at Norfolk House and received a variety of responses. A relative told us that they were happy with the care provided and a thank you letter received in to the home thanked the staff for the exceptional care that their relative had been given.

One person told us that they felt that concerns previously raised by CQC (Care Quality Commission) had been an accurate account but that the support staff were kind and hardworking. Another person had concerns in relation to the assessment of individuals needs prior to being cared for at Norfolk House and of the dignity afforded to some of the people who lived there.

We found that the care manager was continuing to act in the role of manager and he told us that he had made an application to CQC to become a registered manager at the service.

There had been an improvement in documentation but this was an area that would still benefit from additional attention.

We saw that the provider had worked to address the issues that had been raised in the previous report and had received support from an infection control specialist.

However, we continued to have concerns in relation to the care and welfare of people using the service at Norfolk House, particularly in relation to supporting people who were approaching the end of their life and we have outlined these in the report.

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When we arrived at the home the staff on duty were unable to tell us who was in charge of the building. We found that a lot of people living at the home were up and about and having their breakfast. They were dressed and well presented.

We noted several areas of concern in relation to infection control and safety and spoke with staff on duty, a contractor, four relatives and several people living at the home.

People we spoke with told us that they thought the '' care was good. Comments such as '' ''My relative is fine and the carers are lovely.'' were made. One visitor told us that ''the service could possibly have more staff,'' but that their relative was kept clean.

A person living at the home told us that they enjoyed the food and there was plenty of it.

During the inspection the providers told us that the absence of the registered manager continued and the person who had been assuming the role on a temporary basis had now left the service. They told us that they had recruited another person who would take charge during the managers continued absence.

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We were also told that some staff members listed on the rota were not always working on that day and that students were listed on the rota as if they were staff members. We were told that at night there were two staff on duty and at times this meant that medication could not be given as some staff were not trained to give medication. We were also informed that there were some staff members working at the home from other countries who were not entitled to work in the UK and may not have gone through the required checks. We found that students were listed on the rota and on two occasions they were included in staff numbers for that day. We did not find any evidence to support the other allegations about staffing that had been made.

The relative told us that ''the staff are fantastic'' and that the family were 'kept in the loop' in relation to their relatives care. They told us that the relatives had been informed of new measures that had been implemented in relation to the fire doors in the home. They also thought that the service had improved in recent weeks.

One service user who we spoke to told us that the food was O.K. and they could choose off the menu. They had also been able to take a bath.

A visiting health professional told of their concerns in relation to staffing levels in the home, particularly in the morning.

Staff members told us of their concerns in relation to staffing levels and leaving service users unsupervised at times when they were elsewhere in the building.

We found that improvements had taken place since our last visit in relation to communications within the home between the provider and service users and relatives. A notice board was displaying relevant information and agendas for meetings. We saw evidence of service users involvement in the home and that some issues raised by them had been addressed.

A jubilee party had taken place and a trip to Blackpool lights and a Christmas Fayre were planned.

The manager was still absent from the service.The acting deputy was taking charge in her absence alongside the provider.