Archived: Norfolk House

Updated 22 June 2017

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 30 May 2017 and was unannounced. The inspection team consisted of two inspectors and an expert by experience in older persons care. 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 the inspection we reviewed the Provider Information Record (PIR). The PIR is a form that asks the provider to give us some key information about the service, what the service does well and improvements they plan to make. We reviewed notifications we had received from the service. Notifications are information we receive from the service when significant events happen, like a serious injury. We spoke to a local authority commissioner, a clinical nurse specialist for older people in care homes, a GP and a frailty matron.

During our inspection we spoke with fifteen people living at the service, four people’s relatives and friends, three health professionals, the manager, the operations manager and staff. We visited some people’s bedrooms with their permission; we looked at care records and associated risk assessments for three people. We looked at management records including staff recruitment, training and support records, health and safety checks for the building, and staff meeting minutes. We observed the care and support people received.

Some people were unable to tell us about their experience of care at the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We looked at medicines records and observed people receiving their medicines.

This last inspected Norfolk House in October 2016 and rated the service Inadequate.

Updated 22 June 2017

This inspection was carried out on 30 May 2017 and was unannounced.

Norfolk House provides accommodation and personal care for up to 30 older people. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. The top floor was not being used at the time of our inspection. There were 22 people living at the service at the time of our inspection.

A manager was working at the service and had applied to the Care Quality Commission (CQC) to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of Norfolk House in October 2016, the service was rated ‘inadequate’. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 and we asked the provider to take action to make improvements. We issued requirement notices relating to the staffing levels, safeguarding people and protecting them from harm, supporting people to make choices and have freedoms, managing medicines, following health care professionals advice, record accuracy and checking and improving the quality of the service. The provider sent us an action plan. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made and the breaches met. However, there were still areas for improvement.

People, their relatives and health care professionals told us that the service had improved since our last inspection. We found this was correct and action had been taken to address the shortfalls we found at the last inspection. The manager and operations manager agreed that further improvements were required to the service and they had plans in place to make continual improvements. One person told us, “It is like a hotel here, the staff are all lovely without exception. It is like family and we are taken care of brilliantly”.

The provider and manager had increased oversight of the service and the effectiveness of checks and audits had improved. The majority of the shortfalls in the service that we found at the last inspection had been addressed. Staff now received the support they required to provide people with the care they needed. They knew about their roles and responsibilities and were held accountable. Staff morale had increased and staff worked well together as a team.

Previously safeguarding risks had not been identified and referred to the Kent local authority safeguarding team for their consideration or investigation. Staff knew how to identify concerns and were confident the manager would take action to protect people. Staff had reported any concerns they had to the manager and these had been acted on.

Action had been taken since our last inspection to make sure risks to people were identified, assessed and reviewed. Guidance had been provided to staff about how to keep people safe while maintaining their independence, including the use of pressure relieving equipment. Staff acted on advice from health care professionals to keep people as well as possible. People had been supported to have regular health checks such as eye tests.

Assessments of people’s needs had been completed accurately following our last inspection. Detailed guidance was now available to staff about how to meet people’s needs.

Action had been taken to make sure people received their medicines in the way they preferred to keep them comfortable. Medicines were recorded accurately but not always stored safely.

Following our last inspection the local Fire and Rescue Service had visited the service to provide advice, which had been acted on. Staff were now competent to evacuate people in an emergency and had guidance to refer to if needed.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been made to the supervisory body for a DoLS authorisation when people were restricted. No one was the subject of an authorisation at the time of our inspection and people were not restricted

Staff had completed training in the principles of the Mental Capacity Act 2005 (MCA) since our last inspection and put these into practice. Staff knew what day to day decisions people were able to make and supported them to do this. Decisions made in people’s best interests had been recorded to demonstrate how the decision had been made and by whom.

At our last inspection people told us they would like more to do. At this inspection we found that action had been taken to support people to participate in more activities but further improvements were required. Staff now had time to spend time with people in communal areas and those who chose to be in their bedrooms.

Accurate records were now maintained about the care and support people received. Action had been taken to make sure people’s personal information was kept safe.

People and their representatives remained confident to raise concerns and complaints they had about the service. At this inspection we found that action had been taken to resolve people’s complaints to their satisfaction and use them to continually improve the service.

People and their relatives were asked for their views about the quality of the service and their suggestions were acted on.

People’s needs continued to be considered when deciding how many staff were required on each shift. Action had been taken since our last inspection to make sure sufficient staff were deployed to meet people’s needs at all times.

Safe recruitment procedures were followed for all new staff. All the required checks had been completed including obtaining a full employment history with dates of employment. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff now met regularly with a manager to discuss their role and practice and told us they felt supported. Staff had completed the training they needed to provide safe and effective care to people, including refreshers following our last inspection.

At our last inspection although people and their relatives told us that staff were kind and caring, we found that people were not always treated with respect. At this inspection we found action had been taken to address this and people were treated with respect and given as much privacy as they wanted. Staff offered people assistance discreetly without being intrusive.

People told us they liked the food at the service. Meals were balanced and included fruit and vegetables.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. The manager understood when CQC should be notified of some significant events and we had received notifications are required.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We have made recommendations about activities for people living with dementia and staff recruitment.