Archived: Norton Lees Hall and Lodge

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.

Norton Lees Lodge is a residential service that provides care for up to 40 people. At the time of our inspection 38 people were living at the service.

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. 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.

We found the service had appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.

People we spoke with told us they felt “safe” and had no worries or concerns. Relatives we spoke with felt their family member was in a safe place.

Staff had undertaken safeguarding training and were knowledgeable about their roles and responsibilities in keeping people safe from harm.

We did not receive any concerns from relatives or people living at the service regarding the staffing levels at the service. Our observations during the inspection told us people’s needs were being met in a timely manner by staff.

All the people we spoke with made positive comments about the quality of care they had received.

All the relatives we spoke with were very satisfied with the quality of care their family member had received.

People had individual risk assessments in place so that staff could identify and manage any risks appropriately. Care plans were detailed; they were reviewed regularly and changed to reflect current needs.

There was evidence of involvement from other health care professionals where required, and staff made referrals to ensure people’s health needs were met.

We saw the service promoted people’s wellbeing by taking account of their needs including daytime activities. People told us they would like more activities and more opportunities to go on trips. We shared this feedback with the area manager and registered manager. The area manager told us the provider had recently purchased a mini bus for their services in Sheffield to share, so there would be more opportunities for people to go out.

Staff had undertaken training which was regularly updated to ensure they had the skills and knowledge to support people effectively.

Staff had received appropriate supervision and appraisal as is necessary to enable them to carry out the duties they were employed to perform.

People’s nutritional needs were monitored and actions taken where required. People made positive comments about the food. Preferences and dietary needs were being met.

There was a complaints procedure available to people and their relatives. Relatives we spoke with told us they would speak with the registered manager if they had any complaints or concerns. They told us they felt confident the registered manager would listen and take appropriate action to address their concerns.

People and relatives we spoke with made very positive comments about the staff working at the service.

We saw that people responded well to staff and they looked at ease and were confident with staff. Staff were respectful and treated people in a caring and supportive way.

Resident and relatives meetings and surveys took place so people had opportunities to feedback about the service and suggest improvements.

Accidents and untoward occurrences were monitored by the registered manager to ensure any trends were identified.

There were quality assurance systems in place to monitor the quality and the safety of the service provided.

People using the service and their relatives told us that care and treatment was planned and delivered in a way that ensured people's safety and welfare and that they were involved in their care. Some comments from people using the service included 'I like it here. They have a big clock so you can tell what time it is. I like the food here.'

All the people and relatives we spoke with said they had no concerns about abuse in the home. A person using the service told us 'I feel safe here.'

We found that staff received appropriate professional development. People who used the service and their relatives were positive about the staff and their skills in providing care. Some comments from staff included, "I find it quite alright working here. I have had supervisions with the manager. I had an induction and refresher training. The training is good and enjoyable. There is good morale among the staff.'

We found that that there was an effective quality monitoring system to analyse, identify and reduce risk.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.