Norfolk Lodge

Norfolk Lodge is a residential care home providing personal care and accommodation to up to 30 older people. The home is in an 18th century building that has been extended and provides accommodation over two floors. At the time of our inspection there were 28 people using the service.

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

We saw positive interactions between people and staff. However, there were times when decisions staff made in the best interest of one person impacted negatively on others. On the whole staff respected people's privacy and dignity but there were occasions when private information was shared loudly in front of other people.

The provider had systems in place that helped ensure that staff delivered a service that met people's needs and kept them safe. Without exception, staff and relatives said there had been considerable improvement in the service since the current registered manager had taken up post. We received positive feedback from staff, relatives and external professionals about her influence on the service.

Lessons were learned when things went wrong, and actions to bring about improvement shared with staff. The provider's complaints procedure was available in the home. Complaints were investigated and feedback given that included any learning.

People felt safe and relatives trusted staff. Staff knew how to report any concerns to the registered manager, and externally to other organisations, such as the local authority. Staff were confident the registered manager would take any concerns seriously. Risks had been assessed and actions taken to reduce risk where possible. Medication was well managed and people received their prescribed medicines. Infection prevention and control was on the whole well managed. People were supported to eat and drink sufficient amounts. Staff referred people to external healthcare professionals and followed their guidance.

People’s care plans provided detailed guidance for staff to follow. Staff supported people to maintain contact with relatives. People’s opportunities for activities had increased in recent months and everyone had opportunities to go out of the home on local trips. Staff understood and fostered people’s particular areas of interest. Some people were occupied during our inspection with knitting, games, and or television. However, some people were just sitting unoccupied for long periods of time.

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.

Norfolk Lodge is a residential care home providing personal care and accommodation for up to 30 people. At the time of the inspection visit, 28 people were living in the home.

Care is provided at Norfolk Lodge over two floors. There are various communal areas that people can use which include lounges and a dining room.

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

Some risks to people’s safety had not been adequately assessed or reduced as much as practicable. This placed people at risk of avoidable harm. Staff practice was mixed in how they treated people. Most were kind and compassionate when they interacted with people but not everyone experienced this. Improvements were required to the culture of the service to ensure it was wholly person-centred and that people were treated as individuals.

There were enough staff to meet people’s needs but they were busy and often only engaged with people when completing a task. This led to people not always receiving adequate stimulation to enhance their wellbeing. The provider had recognised this issue and had employed a new member of staff with responsibility to improve this area.

In the main, 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. However, people didn’t have access to a secure and safe outside area and were wholly reliant on staff assisting them outside when they were free to do so.

People received enough to eat and drink, but the meal time experience required improvement to make it a more pleasant occasion for people.

Staff supported people with their healthcare needs and worked well with other health and social care professionals for the benefit of people living in the home. People and/or their relatives had contributed to how they wanted care to be delivered.

People received their medicines when they needed them, and staff had been recruited safely. Systems were in place to protect people from the risk of abuse.

There was an open culture within the home where people and relatives could raise concerns or complaints without apprehension. Staff enjoyed working in the home and felt valued. People and relatives overall, were happy with the quality of care that was being provided.

The provider was receptive to our feedback and made some immediate improvements to the quality of care people received.

We have made recommendations to the provider to review best practice guidance in relation to improving the mealtime experience, support with hobbies and interests and the internal and external environment for people living with dementia.

Rating at last inspection

The last rating for this service was Good (published March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified a breach of regulation at this inspection, in relation to the lack of robust monitoring of the quality of care provided to people.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was a registered manager in 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 home is run.

At the last inspection, the home was rated Good. At this inspection we found the home remained Good.

Why the home is rated Good…

People received support to take their medicines safely. Staff knew how to keep people safe from harm, risks were clearly identified and actions to reduce these implemented. There were enough staff to keep people safe and meet their needs.

Staff were competent to carry out their roles effectively and received training that supported them to do so. People were supported to eat a choice of freshly prepared meals, and were supported with special diets. People were able to access and receive healthcare, with support, if needed.

People were able to make choices and were supported to make decisions. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the home complimented this practice.

Staff were kind and compassionate in the way they delivered support to people. People were treated with dignity and respect. Staff ensured that people were able to have visitors, and enabled people to maintain relationships with relatives and friends who did not live nearby.

People were supported to access a wide range of activities and hobbies that meant their leisure time was enjoyable. People and their relatives were confident that they could raise concerns if they needed to.

The registered manager ensured that the home was well run. Staff were committed to the welfare of people living in the home. They regularly engaged with people to seek their view about how they wanted the home to be run, and the activities on offer. The registered manager ensured they kept links within the local community and people were part of many regular events.

A single inspector for adult social care carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Records we looked at showed us that risk assessments were completed where a risk had been identified. Measures were described and in place to reduce or eliminate such risks. Requirements under the Mental Capacity Act 2005 were recognised by members of staff as were deprivation of liberty safeguards (DoLS). Staff confirmed that they had completed regular training and we saw a list of dates when the staff refresher training was due to be updated. This showed that people were supported by members of staff who knew how to provide support in a safe and appropriate way

Full information was on display to provide people with enough detail to take any concerns they may have to the relevant organisation. This information included details of the type of procedures and actions that would be taken by the supporting agency.

Records showed that equipment such as hoists had been regularly serviced and fire checks had been completed on extinguishers. This supported the safety of people who lived at the service, as well as the safety of visitors and staff.

Is the service effective?

Our observations showed us that people who lived at the service were relaxed and confident when they discussed matters with members of staff. Staff took action when they saw anyone who appeared to be in need of support.

Our discussions with people at this time and our review of documents showed us that nutrition was monitored by staff. They took note of how much each person ate at meal times. Alternative options were offered if a person did not want the choices available on the menu. People who were unable to express their choices were shown different meals on a plate to enable them to choose which they preferred. Regular checks on people's weight supported the early detection of any problems.

Is the service caring?

Our observations showed us that people who lived at the service were treated with respect at all times. Discussions with members of staff showed us that they knew the routines that people had chosen and were aware of their care and support needs.

We saw that people were dressed cleanly and appropriately for the weather on the day of our inspection. This showed that people's support needs had been carried out. We also saw that staff spoke with respect and in an appropriate manner when they provided support or care to people in the home.

Is the service responsive?

We saw that people's individual physical needs were being met. People were gently encouraged to decide what they wanted to eat at lunch time. We observed the lunch time meal and saw this was a calm and relaxed time. People were shown meals already served on a plate to assist them to make a meal choice. Staff did not rush anyone and they allowed time for the individual to fully understand their meal choices and the options offered to them. This showed us that staff supported and involved people who lived at the service.

Is the service well led?

Staff explained that they undertook regular training and we saw a list of dates when the staff refresher training was due to be updated. This showed that people were supported by members of staff who knew how to provide support in a safe and appropriate way.

Quality assurance systems were in place and regular quality audits were completed for all areas of the service. We saw records that clearly documented the observations that had been made when any improvements were needed. The dates when tasks had been completed was also recorded to show when any follow up was needed.

One person we spoke with told us, 'Staff look after me but there's no conversation. There's not enough to do here ' colouring and writing for six year olds.' Another person said, 'The girls are nice and it's a nice place to live but I'm sitting around waiting for things to happen.'

We found that people were not always treated with dignity and respect and were not always involved enough in their care. Care records were not always up to date and did not always assess people's needs to ensure their safety and welfare.

We observed food being prepared and served and found that people could be at risk of inadequate nutrition.

During our inspection we saw that medication was obtained, prescribed and administered safely. We found that there were high levels of dust on the tops of fridges and freezers. We also found that some mattresses needed replacing and raised toilet seats needed to be cleaned.

There were not always enough staff to meet the care and welfare needs of the people they were caring for. However, staff and relatives we spoke with were very supportive of the new manager and were confident improvements were taking place.

Staff received regular training in a range of topics relating to the health, safety and welfare of the people using the service. Two people told us they thought staff were well trained.