Archived: Norwood Trust

At the last inspection on 16 and 17 February 2016 we rated the service as requires improvement. At that inspection we identified one regulatory breach of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to staff not receiving regular on-going training to enable them to maintain their knowledge and skills when carrying out the duties they are employed to perform.

Following the inspection the registered manager sent us an action plan detailing how the identified breach would be addressed. This inspection was to check improvements had been made and to review the ratings.

Norwood Trust was established in 1985, is a registered charity and functions within the regulations of the Charity Commission.

Norwood Trust is a care home providing accommodation without nursing for up to 15 adults, with a learning disability. Eleven people can be accommodated in the main house and four people can live in a purpose built bungalow in the grounds.

Accommodation comprises of all single rooms. No en-suite facilities were provided. Facilities in the main house included a lounge, a lounge/dining room, a bathroom, a walk in wet shower room and three separate toilets. In the bungalow there was a lounge, a kitchen, a laundry room, a separate toilet and a walk in shower room.

There were 15 people living at the home at the time of our inspection.

The home is located in Marple, a suburb of Stockport and is situated within easy walking distance of local services and amenities. The main house is a three storey Victorian semi-detached building.

Since the last inspection in February 2016 the manager had registered with the Care Quality Commission (CQC) and was present throughout the three days of inspection. A registered manager is a person who has registered with CQC 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 and associated regulations about how the service is run.

At this inspection we found that the breach identified in February 2016 in relation to the gaps in staff training had been met and further improvements had been made to the quality of the service being delivered to people. At this inspection we did not identify any breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found the registered manager and the deputy manager were responsive to our feedback and were fully committed to further improving the service delivered to people living at Norwood Trust.

The medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

Staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken and staff were seen to obtain consent prior to providing care or support.

There were no restrictions in place to prevent people’s movement within the home and we saw people coming and going throughout the three days of inspection.

Although some internal areas of the home were tired and dated in appearance, the home was clean and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection to people. We saw that some refurbishment had been undertaken since the last inspection and was ongoing to improve the environment for the people living at Norwood Trust.

Detailed and comprehensive care records were in place which reflected peoples identified health care and support needs. Information about people’s dietary requirements, how people wanted to be supported, when support was required and how this was to be delivered were clearly detailed in the care files we examined. We saw that people were encouraged to be as independent as possible and were supported to make choices about how they wanted to live their life.

Since the last inspection the personalised activities that people participated in had been reviewed with the person and some changes had been made based on the preferences expressed by people during the care reviews undertaken. We saw that people were encouraged and supported to undertake a wide range of activities that were of interest to them.

Staff working in the home understood the individual needs of the people who lived there and we saw that care was provided with kindness, respect and dignity. We saw that people who used the service looked clean, well dressed, relaxed and comfortable.

We saw staff had good relationships with people and had an excellent understanding of the individual needs and personal preferences of the people they were caring for.

We saw that there were sufficient numbers of staff on duty at the time of the inspection to provide safe care.

We saw people could make choices about their food and drink and where to eat their meals. We saw a good choice of alternative meals that were available if people did not want what was on the menu.

We saw robust recruitment processes were in place to ensure only suitable staff were employed and staff were receiving on-going supervision and annual appraisals as required.

Staff understood how to recognise and report abuse which helped make sure people were protected.

Newly employed staff undertook a thorough induction process and were enrolled to the Care Certificate framework. This replaces the Common Induction Standards and National Minimum Training Standards.

We last inspected Norwood Trust on 2 & 4 March 2015. At that inspection we found that the service was not meeting four of the regulations we assessed. These related to the management of medicines, the recruitment of staff, staff not receiving an annual appraisal and there were not effective processes to monitor all aspects of the quality of the service. During this inspection we checked to see if those regulations had been met.

Norwood Trust was established in 1985 and is a registered charity. Norwood is a care home providing accommodation without nursing for up to 15 adults, with a learning disability. Eleven people can be accommodated in the main house, a three storey Victoria semi-detached building, and four people can live in a purpose built bungalow in the grounds.

Accommodation comprises of all single rooms. No en-suite facilities were provided. Facilities in the main house included a lounge, a lounge/dining room, a bathroom, a walk in wet shower room and three separate toilets. In the bungalow there was a lounge, a kitchen, a laundry room, a separate toilet and a walk in shower room.

There were 14 people living at Norwood Trust at the time of our inspection.

Norwood Trust is located in Marple a suburb of Stockport and is situated within easy walking distance of local services and amenities. .

At the time of this inspection the manager was not registered with the Care Quality Commission (CQC). The acting manager had applied to CQC for registration and her fit person interview was arranged for 4 March 2016. 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.

During this inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found there were gaps in staff training which meant that not all staff were suitably trained to meet the needs of the people living at Norwood Trust.

The staff we spoke with were able to describe how to keep people safe from harm and understood their role in protecting people and making sure people remained safe although not all staff had undertaken safeguarding adults training.

We have made a recommendation that the service considers accessing the Mental Capacity Act and Deprivation of Liberty Safeguards awareness training for all staff as a priority.

During our tour of the building we saw some areas of the home were tired and worn in appearance but there were no unpleasant odours and all areas were found to be clean. We have made a recommendation about the need for more detailed cleaning schedules and regular internal checks of the levels of cleanliness.

Medicines were managed and safely administered by staff that had received appropriate training.

Newly employed staff were undertaking induction training, which followed the Care Certificate framework. This replaces the Common Induction Standards and National Minimum Training Standards.

Personalised activities for people using the service were encouraged and provided on a daily basis.

Staff working in the home understood the individual needs of the people who lived there and we saw that care was provided with kindness, respect and dignity. We saw that people who used the service looked clean, well dressed, relaxed and comfortable.

We saw that there were sufficient numbers of staff on duty at any one time to provide safe care.

We saw people could make choices about their food and drink and where to eat their meals. We saw a good choice of alternative meals that were available if people did not want what was on the menu.

We saw staff had good relationships with people and had an excellent understanding of the individual needs and personal preferences of the people they were caring for.

We saw that staff asked people’s permission before any care was undertaken.

People who used the service demonstrated that they liked the management team in the home and felt able to discuss any issues with them. Relatives we spoke with spoke highly of the acting manager and told us they found them approachable.

Members of staff we spoke with told us that the management team were very approachable and supportive.

The systems in place to monitor the quality of service being provided were greatly improved from the last inspection. However it was acknowledged by the acting manager that further improvements were needed. We made a recommendation that service consider implementing a more formal process of systems and process such as regular audits to monitor and improve the quality and safety of the service provided.

The acting manager explained to us that they had liaised directly with the local hospital and had registered the name and individual details of each person living at Norwood Trust so if anybody was admitted to hospital the hospital system would flag up the need for possible additional support or extra resources to support that persons learning disability needs. This meant that every effort had been made to support people’s individual needs should they need to access external healthcare services.

The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, four committee members and from looking at records.

Is the service safe?

All of the people living at Norwood Trust had lived there for a number of years. All the people living at the home had a learning disability so for some of the people we spoke with communication was limited. The people we did speak with told us they were happy and we observed that people were freely coming and going throughout our inspection visit.

Each person had an individual care file that included some risk assessments and a care plan that described how to meet individual care needs. The care plans we looked at were found to lack detail of how staff should effectively meet peoples care needs and some identified care needs did not have a plan of care in place. These shortfalls meant that people could be at risk of not having all of their needs appropriately met.

During our visit we looked at the premises to see if they were suitable for their intended purpose. The home was clean and tidy and there was some evidence of on going maintenance at the home. However the lack of records relating to fire safety checks, health and safety risk assessments and environmental risk assessments was of concern. We were told that there was an evacuation plan in place in the event of a fire but this could not be located on the day of this inspection. The lack of safety checks meant that people could be at risk of living in unsafe or unsuitable premises.

Is the service effective?

Prior to this inspection visit we had received some concerns relating to the quality of food provided for people living at the home. During this inspection we saw the quality of food provided was of an acceptable standard. However we had some concerns due to the lack of choices given to people with regards to their evening meal and drink served with that meal. We witnessed that the evening meal was served in bowls rather than on a plate and juice was poured out for people without asking what the person would like to drink. We did not see that people were consulted regarding the meal provided.

Is the service caring?

The atmosphere in the home felt relaxed, pleasant and friendly. From our observations we saw that care staff had a good understanding of people's individual needs and personalities. We saw that staff were kind and sensitive in their approach to people.

We observed that people looked well cared for and were appropriately dressed.

All of the people we spoke with who were living at the home indicated that they were happy and had everything they needed.

Is the service responsive?

We saw that where appropriate the service had accessed advice and care from other health care professionals. For example we saw evidence of visits to the GP, the chiropodist, the opticians and we saw that people attended hospital appointments. This meant the provider sought relevant professional advice and guidance appropriately.

Is the service well-led?

At the time of this inspection visit the service was being managed by an acting manager who was not registered with the Care Quality Commission. From information we received prior to this visit and from speaking to some staff there was a certain amount of unrest at the home due to changes made in the management of the home. We felt confident that the acting manager and the committee members were aware of the concerns and were in the process of addressing them.

We found that since the last inspection visit improvements had been made to the formal systems for assessing and monitoring the quality of the service provided.

During this inspection we saw that the provider was in the process of making alternative management arrangements to cover current management shortfalls within the home.

As part of this inspection we spoke with the temporary Chair of the Committee, two Committee Members and the Treasurer.

We found that some progress had been made in the assessing and monitoring the quality of service being delivered but shortfalls were still identified.

We saw that some progress had been made in relation to the quality of records but shortfalls were identified.

During this inspection we spent time looking around the home, looking at records, talking to people who used the service and the staff who worked there.

All of the people who lived at Norwood Trust had lived there for a number of years and most of the staff had been employed for a long time.

The atmosphere in the home was pleasant and friendly. It was obvious that the people who lived at the home were relaxed in the company of staff and had good relationships with the staff. Some of the comments we received from people were: 'I am happy here. All the staff are nice' and 'We are well looked after.'

We found that records kept in the home were of a poor quality.

We found some improvements were needed to ensure care plans contained detailed and up to date information to make sure peoples individual care needs were appropriately met.

We found that improvements were needed to the formal systems to assess and monitor the quality of the service provided.

At the time of this visit the registered manager was on maternity leave and the home was being covered by an acting manager. The inspection was undertaken with a senior residential social worker employed by the service because the acting manager told us he did not have a good knowledge or understanding of what was expected of him in relation to the current regulations.