Background to this inspection
Updated
12 February 2019
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.
We undertook an unannounced comprehensive inspection visit of Norton Grange on 23 January 2019. This inspection visit was completed to check improvements to meet legal requirements planned by the provider after our previous comprehensive inspection had been made. The team inspected the service against the five key questions we ask about services: is the service safe, effective, caring, responsive and well led. The inspection visit was completed by two inspectors, a specialist nurse who had nursing experience of older people and an expert by experience. An expert by experience is a person who has experience of someone using this type of service.
Before our inspection visit, we reviewed the information we held about the service. We looked at information received from the local authority commissioners and the statutory notifications the registered manager had sent us. A statutory notification is information about important events which the provider is required to send to us by law. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority. The commissioners did not share any concerns about the service.
Before the inspection visit, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR enabled us to review the information provided during our inspection visit. We found the information in the PIR highlighted what the service did well and how they planned to drive improvements.
To help us understand people’s experiences of the service, we spent time observing and talking with people in the communal areas of the home, or their bedrooms with their permission. This was to see how people spent their time, how staff involved them in how they spent their time, how staff provided their support and what they personally thought about the service they received. We spoke with six people who lived at Norton Grange and two visiting relatives. Some of the people we spoke with could only give us limited responses due to their communication or cognitive condition.
We spoke with the registered manager, two nurses, one senior lead carer and five care staff. We looked at six people’s care records and other records relevant to their support, such as medicines records, care plans, risk assessments and daily records. This was to see whether the care people received was recorded and delivered according to people’s care plans.
Updated
12 February 2019
This inspection visit took place unannounced on 23 January 2019.
Norton Grange Nursing and Residential Care Home is a two-storey residential home which provides care to older people including people who are living with dementia. Norton Grange is registered to provide care for 29 people. At the time of our inspection visit there were 27 people living at the home. Care and support was provided across both floors and each floor had its own communal lounge and dining area. All rooms were en-suite and people had shared use of communal lounges, dining areas and bathroom facilities.
People in care homes receive accommodation and nursing and/or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
There was a registered manager in post. 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.
At our last inspection we rated the service Requires Improvement overall, and in each key area, except for caring that was rated good. We found people’s choices and decisions about their care were not made in line with the Mental Capacity Act and some people had unnecessary restrictions placed on their freedom. We found the providers audit systems and processes were not thorough so improvements were not always identified and/or actions taken. This meant there was a breach of the Health and Social Care Regulations for safe care and treatment and good governance. The provider sent us an action plan telling us how they would improve in these areas. We completed this inspection visit to check improvements had been made.
At this inspection visit we found improvements had been made and the provider was not in breach of the regulations. Further improvements and time to embed processes and systems of audits was still needed for the registered manager and provider to be confident actions resulted in the quality of service being improved. A range of current audits and checks helped ensure people received safe care that was delivered in a safe environment.
People and relatives were complimentary and satisfied with the quality of care provided at the home. People felt safe living with other people in the home and they were supported by a consistent, kind and caring staff team.
Staff were available at the times people needed and there were enough staff to respond to people’s needs and requests for assistance. Staff were trained but further training was planned to ensure people's care and support needs were met by staff who knew how to support them safely and effectively. Staff understood their responsibility to safeguard people from harm and to report any concerns they had to the management team. Staff were confident actions would be taken.
People's changing needs were responded to by staff and other healthcare providers were contacted when needed. People were treated with respect by staff who addressed them by their preferred names and who supported them in line with their personal preferences and wishes.
No one at the time of our visit received end of life care. The registered manager said care was given so if people wanted, ‘this was a home for life’. Anticipatory and pain relief medicines were arranged so if people’s condition quickly deteriorated, their care could remain as pain free and dignified as possible.
The registered manager worked in partnership with other healthcare professionals to ensure people received effective care that was responsive to their needs. The registered manager had built new relationships with support networks, other healthcare professionals, the local authority, commissioners of services and the local community. This helped people and staff receive better access to supporting people with good outcomes. People’s medicines were stored and managed safely and people received them when required.
People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service had improved and best interest decisions were made, however there was limited records to show how those decisions were reached. The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). DoLS applications were made and they were supported by mental capacity assessments that showed why a restriction was required. People's right to make their own decisions about their care, were supported by staff who understood the principles of the Mental Capacity Act 2005.
People had mixed opinions about the quality of the food and lunchtime experience. Staff supported those people who needed more encouragement to maintain their food and fluid intake. Where people had specific dietary needs, such as soft and pureed foods, vegetarian and culturally, these needs were met.
Staff knew and understood how to limit the risk of cross infection and followed safe infection control practices.
People needed more stimulation and encouragement to be involved to pursue their hobbies and interests. The registered manager recognised supporting people’s interests was important and had plans to improve this within the home.