Norcott House

Norcott House is a residential care service which can accommodate up to 11 people with learning disabilities or autistic people. 10 people were using the service at the time of the inspection. People who used the service lived in ground floor accommodation with four separate kitchens on each unit, lounges, bedrooms and bathrooms.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support

People were not always kept safe from the risk of infection and the provider took action to put things right following the first day of our inspection. Accidents and incidents were recorded, although it was not always clear what had been done to mitigate risks and reduce incidents.

We have made a recommendation the provider ensures debriefs are detailed after each incident, to help identify possible triggers and prevent a reoccurrence.

Staff were recruited safely to care for people and there were enough staff to meet people’s needs. Medicines were managed safely overall.

People had some involvement in planning their care and future goals, and staff used activity checklists to include in each person’s support plan. Activity planners did not always fully reflect people's choices, although staff supported people with independent living skills and people chose their own activities daily. Staff were kind and patient and said they supported people in the least restrictive way possible and in their best interests. People had their own living areas and they were supported to engage in the community and maintain family relationships.

Right Care

Care promoted people’s dignity, privacy and human rights. People were supported when they wanted to eat and helped to make some choices in their day. Staff spoke with people in a respectful and caring way. Care plans and risk assessments were person centred, although some staff told us they did not always have time to read these. However, the provider showed us a signed list to show staff had stated they read and understood people’s care plans. People were mostly well safeguarded from the risk of abuse and staff understood the procedures to follow if they had any concerns. Some people told us they did not always feel safe living in the service. The management team were aware of this and tried to give reassurance. Risk assessments were in place, but not always reflective of people’s needs or followed by staff.

Right culture

Quality checks were not always robust enough to maintain and improve the quality and safety of the service. There were missed opportunities to identify lessons learnt when things went wrong. People and staff felt supported by the management team and felt they were approachable, although not all staff felt their views were considered.

We have made a recommendation in relation to ensuring quality checks are more robust.

Staff supported people in ways which were appropriate for their needs. However, the complexities of people’s needs, and the dynamic of people living together within the service, meant at times some people did not feel safely supported.

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 5 April 2018)

Why we inspected

We undertook a targeted inspection to routinely provide assurance in relation to infection, prevention and control. We inspected and found there was a concern with infection prevention and control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, responsive and well-led. We undertook this inspection to assess that the service is applying the principles of right support right care right culture.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Norcott House is registered to provide accommodation and personal care for up to 11 people with learning disabilities. The home comprises of two separate buildings, each containing two living units, which provide gender specific accommodation. Each unit contains shared kitchens and bathrooms. Depending on their assessed needs, some people shared lounge areas and some people had their own lounge areas.

Norcott House is a ‘care home’. 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.

The home had a registered manager. 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.

Medicines management and administration at Norcott House was safe. We identified some issues with medicines recording which the registered manager took immediate steps to address.

Norcott House was clean and odour-free. Support workers were responsible for cleaning and we saw they encouraged people to get involved in order to promote their independence.

Sufficient staff were deployed to meet people’s needs. Recruitment records showed procedures in place for vetting prospective new staff were robust.

A range of person-centred risk assessments were in place for each person according to their assessed needs. People were supported to take risks if the benefits outweighed them.

A range of feedback measures were in place to ensure the service learned lessons when things went wrong.

Support workers had access to training and supervision to help them provide people with effective care and treatment. They told us they felt supported by managers at the home.

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.

Most feedback from people and their relatives about the food at Norcott House was positive. Action was being taken to adapt meal choices to better meet one person’s preferences.

Staff at the home worked well together as a team.

People were supported to access a range of healthcare professionals in order to meet their wider health needs.

People and their relatives told us staff were kind and caring and that they promoted people’s privacy and dignity. We saw people were supported to be independent.

People and their relatives told us, and records showed, people were involved in planning and reviewing their care.

The service ensured people’s expressed cultural and diversity needs were met. Those people who needed support with decision-making had access to advocacy services.

People’s care plans contained information about their communication needs in line with the Accessible Information Standard. The registered manager planned to review the guidance and implement any further requirements.

People and their relatives told us they felt able to complain about the service if they needed to. One complaint had been made and resolved since the last inspection.

People’s care plans were detailed and person-centred. Staff were responsive to incidents where people experienced behaviours which may challenge others and any such incidents were analysed to ensure care plans contained up to date information.

People had access to a range of meaningful activities and had opportunities to go on holiday. Records showed they were regularly consulted about their activities preferences and supported to stay in touch with their relatives.

People, their relatives and staff gave us positive feedback about the registered manager and deputy manager at Norcott House.

A comprehensive system of audit was in place which involved various levels of the organisation and encouraged the sharing of good practice.

People, their relatives and staff were encouraged to feed back about the service at regular meetings, and people and relatives received questionnaires.

We looked around both units and saw all of the bedrooms had en-suite toilets and sinks. Communal bathrooms and shower rooms were located close to people's bedrooms. We saw people's bedrooms had been personalised and contained items such as photographs and soft toys.

We spoke with three people who used the service and they told us they were happy at the home. We saw each person had a structured activity programme in place. This showed the service was meeting the social needs of people who used the service.

During our inspection we looked at the recruitment procedures in place for the service. This showed that staff were being properly checked to make sure they were suitable and safe to work with vulnerable people.

We looked at how people were made aware of the complaints system in place. We found this was provided in a format that met people's needs.

We looked at people's care records and other records relevant to the management of the service. We found records were kept securely and could be located promptly when required.