Norton Lodge

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People were not involved in their care planning and decision making. Care plans did not always contain enough information for staff to support people safely. The service was not always following the principles of the Mental Capacity Act, and people’s rights were not always respected. For people who were unable to make decisions for themselves, there was no evidence of engagement with family members or the advocacy service, in line with the Mental Capacity Act. People’s nutritional needs were not always recorded appropriately and accurately to ensure people received the correct diet to prevent aspiration and choking. Where people diets required fortification to prevent weight loss, this was not always provided. The service only employed one chef and relied on care staff to support in the kitchen in the chef’s absence. There were no visual menus available to support people in making meal choices, which is particularly important for people living with dementia. There were limited activities available to encourage social interactions, although the provider employed an activity worker.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not involved in the planning of their care. Relatives told us they had never seen a care plan.

Staff told us they didn’t have time to read all the care plans. One staff member was not aware that a person being supported had a diagnosis of diabetes, despite this being documented in their care plan. However, staff we spoke with told us they knew people well.

We were not assured that people were involved in their care plans. There was no evidence within care plans to demonstrate that people had been consulted about their care and support. When people’s needs changed, these were often not updated within the care plan. The service was in the process of moving electronic systems.

Most people were happy with the nutrition they received; however we observed limited options available at mealtimes, and there were no visual menus to support people living with dementia.

Staff did not support people who required a diabetic diet. The kitchen staff did not provide an alternative diet as they were not aware they were supposed to. They were also unaware of individuals who required a fortified diet, therefore were not providing this. When this was discussed with the manager, we observed a jug left on the side in the dining room labelled “fortified,” however the liquid inside had curdled and was not appealing.

People’s nutritional needs were not always recorded appropriately and accurately to ensure people received the correct diet to prevent aspiration and choking. For people who required a diabetic diet, care records did not contain guidance on what this meant. The kitchen staff did not provide any alternative meals for people who were diabetic. Drinks were not safely stored to ensure people who required thickened fluids did not have access to fluids that hadn’t been thickened. There were no risk assessments in place to ensure that where fluids were readily available, risks to others had been mitigated.

People told us they were not involved in their care planning. As a result, they were not given the opportunity to share their personal information or provide information crucial to tailoring support to their own needs. This approach could hinder the delivery of person-centred care and prevent personalised and meaningful information being shared to other services involved in supporting people.

Staff told us they were not always aware who was supporting people to appointments. Some staff reported going in on their day off to ensure people could be supported to all appointments.

Partners told us there had been an improvement since the new manager into post, and some positive changes had been made.

There was no effective communication system in place. Handovers between day and night staff did not always occur, and staff meetings that did take place were not frequent. Care plans in place did not ensure people’s needs and wishes could be shared across different services if required. Staff did not always have access to correct information regarding people’s needs. due to care plans not always being updated and a lack of information sharing.

People who we spoke to had access to a GP. A relative told us, “when [person’] fell this was dealt with instantly”

Staff told us they reported any concerns regarding people’s health and wellbeing to the senior or to the manager. However, we observed that people’s care records and daily notes did not reflect what staff had told us, such as people's past medical history or other health needs.

Whilst there was an activity coordinator employed, they did not work full time, meaning there were days when there were no activities taking place. Staff would support when possible, however due to people’s needs and the staffing levels, this was not always possible. There was no signage within the home to orient people to promote their independence.

Feedback from people and their relatives was positive in relation to the support they received; however, people were not aware of their care and support plans therefore were not involved in devising any outcomes. We could not be assured people were supported to achieve positive, personalised outcomes.

Staff informed us that the relationship between night and day staff was not always positive, which resulted in a lack of information being shared during handovers. We could not be assured that staff were aware of people’s current needs.

Care plans lacked personalised information. Information within care plans was based around people’s needs, but the identified outcomes were not always reviewed or adapted as required.

People were happy with the care they received, however at times felt staff were rushed.

Some staff did not understand the concepts of the Mental Capacity Act 2005. Staff were making decisions on behalf of people without recognising the need for Mental Capacity assessments and best interest decisions.

People who required a Deprivation of Liberty Safeguard due to lacking capacity to make decisions had these in place. However, records failed to demonstrate that assessments of people’s capacity had been conducted for specific decisions, or that decisions were made in line with the Mental Capacity Act 2005. There was conflicting information within people’s care plans in relation to their capacity. We identified that people had received the flu vaccine without ensuring consent was sought.