Archived: Norton Lees Hall and Lodge

Updated 19 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 6 February 2018 and was unannounced. This meant no one knew we would be visiting the service. The membership of the inspection team consisted of four adult social care inspectors, a specialist advisor and two experts by experience. The specialist advisor was a registered nurse who had experience of caring for older people. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection, we reviewed the information we held about the service. This included correspondence we had received and notifications submitted by the service. A notification must be sent to the Care Quality Commission every time a significant incident has taken place, for example, where a person who uses the service experiences a serious injury.

We gathered information from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. This information was reviewed and used to assist with our inspection.

Before the inspection, the provider had not been asked to complete a Provider Information Return (PIR) due to the rescheduling of the inspection. This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.

We used a number of different methods to help us understand the experiences of people who used the service. We spent time observing the daily life in the service, including the care and support being delivered. We spoke with 13 people, nine relatives, the manager, two improvement managers, the administrator, a deputy manager, six care staff, the activities worker, two domestic staff, the laundry assistant, the cook and a kitchen assistant. We also spoke with an external healthcare professional who was visiting the home. We were not able to fully communicate with some people living at the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We carried out an observation in both the Hall and the Lodge. We looked round different areas of the service; the communal areas, bathroom, toilets, and some people’s bedrooms. We reviewed a range of records including people’s care records, four staff files, medication administration records, incident records and other records relating to the management of the service.

Updated 19 May 2018

The inspection took place on the 6 February 2018 and was unannounced. This meant staff and the registered provider did not know we would be visiting. Norton Lees Hall and Lodge is a residential care home. The service can accommodate up to 80 people. The Hall and the Lodge each have forty bedrooms. The two buildings share the laundry and kitchen facilities. At the time of the inspection there were 62 people living at the service. The service was originally registered as two services, Norton Lees Hall and Norton Lees Lodge. The registered provider registered as one service on the 12 April 2017. The Norton Lees Lodge service was last inspected on 24 January 2017 and its overall rating was ‘Good’. The Norton Lees Hall service was last inspected on 17 October 2016 and its overall rating was ‘Requires Improvement’.

At this inspection we found five breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating of the service is ‘Inadequate’ and the service is 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

We saw leadership of the service had been weak and inconsistent since the registered manager had left in April 2017. Relatives we spoke with told us there had been a lack of consistency in the management of the service and this had caused some concerns about the care of their family member. The registered provider’s improvement management team and senior managers had been overseeing the service at the end of 2017. A new manager had started working at the service at the beginning of January 2018.

The new manager told us they had submitted an application to register with the Care Quality Commission. 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 had a plan of care in place. We saw the life story work for people diagnosed with dementia was detailed and personalised. However, some people’s daily charts were not being fully completed. The records did not evidence these people were receiving the care they needed to reduce and manage their risks.

The management of medicines was not always safe and required improvement.

During the inspection we received concerns from relatives and the staff about the staffing levels at the service. This showed there was not enough staff deployed to appropriately meet people’s needs.

Staff rotas and feedback received from relatives showed the service was using a high level of agency staff. This meant people were receiving care and support from agency staff who may not know and understand their history, likes, preference and needs.

The service was not kept sufficiently clean and properly maintained.

We saw some people did not have access to a call bell in their room so they could call for assistance from staff. Following the inspection the manager confirmed action had been taken to ensure people who could use a call bell had one in their room to use. They told us regular checks would be completed.

The staff recruitment records we looked at showed people were cared for by suitably qualified staff who had been assessed as safe to work with people.

The staff were aware of their responsibility to protect people from harm or abuse.

We found there were satisfactory arrangements in place for people who had monies managed by the service.

People told us they were treated with dignity and respect, but we found that some people’s dignity was not always upheld.

People we spoke were satisfied with the quality of care that had received and made positive comments about the staff. However, records showed that people were not receiving the care they required.

We received mixed views from relatives about the quality of care their family member had received. Some relatives were satisfied, but other relatives shared concerns about the care their family member had received.

We found the registered provider had not ensured where a person lacks mental capacity to take particular decisions, any made on their behalf must be in their best interests. There was no evidence to show that a best interest meeting had been undertaken to administer one person’s medication covertly.

Staff received induction and refresher training to maintain and update their skills. We received mixed views from the staff about how they had been supported at the service. There had been a number of changes to the management of the service since the registered manager left the service.

The registered provider had not ensured all complaints were identified, received, recorded, handled and responded to.

We saw the arrangements to provide person centred activities for people living at the service required improvement. We found the registered provider had not ensured people living with dementia did not become disengaged with their surroundings.

There were end of life care arrangements in place for people living at the service. The service was working closely with the district nurse and the local GP to ensure people had a comfortable and dignified death.

Our findings during the inspection showed some of the systems and processes to monitor the quality and safety of the service were ineffective in practice.