Normanhurst Nursing Home

Normanhurst Nursing home is a residential care home providing personal and nursing care to up to 31 people. At the time of our inspection there were 19 people living at the home. People had a range of nursing needs and some people were living with dementia.

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

Quality assurance systems were not effective in identifying concerns. The service improvement plan needed improvement in order to be effective. Concerns that were raised around recording were actioned following the inspection by the manager and provider.

Due to the COVID-19 pandemic, relative meetings had stopped. Relatives did not feel involved in the running of the home and told us their views were not regularly sought through other methods. However, relatives all told us they were kept up to date on how their loved ones were.

People told us they were happy with the care they received at the home. They told us they felt safe and well cared for. We observed that staff spoke to people with kindness and spent time with them. There were enough staff to support people. Relative views on staff were mixed.

Medicines were well managed and people’s health needs were cared for. The home was very clean and infection control measures in place were effective.

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

Rating at last inspection

The last rating for this service was good (published 20 December 2019).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating. This enabled us to review the previous rating. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Normanhurst Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

There was a designated ‘Covid team’ at the home. This staff team were responsible for the testing of staff, residents and visitors. The team had received training in administering the tests. They were also responsible for keeping up to date with the latest government guidance on infection control and care home policies throughout the pandemic. The covid team were responsible for the visitor and testing centre and ensured that staff and visitors followed the correct infection prevention and control (IPC) procedures.

Staff had received training in putting on and removing personal protective equipment (PPE). The manager had received breach training and investigated any incidents in which there had been an infection control breach. This meant if there were any incidents where infection control procedures had not been followed correctly, these were investigated to prevent reoccurrence. If a staff member was responsible for this breach, the manager explained what the breach had been and why it was important not to repeat it. The staff member then signed to say they had been made aware of the breach.

The home was clean and hygienic. There were signs around the home which identified ‘pinch points’. These were busy areas of the home where it would be difficult to socially distance. The signs alerted people to check if anyone was approaching before walking through the area. There was a clear system in place for ensuring that rooms that were no longer in use had been left for 72 hours before receiving a deep clean. Bedroom doors had signs on them informing staff of the date rooms could be safely cleaned.

Normanhurst Nursing Home is a care home providing personal and nursing care for up to 40 people aged 65. At the time of the inspection 31 people were living at the home. Most people needed support from two members of staff for personal care and moving around the home safely. They were living with a range of health care needs. This included people living with diabetes, dementia and physical disability, following a stroke.

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

People were positive about the care and support provided at the home. They said they were comfortable, they felt safe and were assisted by staff who had a good understanding of their needs and how they should be met. People told us the staff were kind and caring; they had a good understanding of people’s preferences and provided the care they wanted.

There had been changes in the management of the home since the last inspection. The registered manager of the two sister homes, on the same sight, had registered with CQC as the registered manager for Normanhurst Nursing Home and was responsible for the day to day management of all three homes. This meant that staff could work in all three homes and the culture and expectations were the same throughout. Staff were consistently positive about this change.

The quality assurance system had been reviewed and the same audits now monitored the services provided in all three homes. These identified where improvements were needed and action had been taken to address them.

Changes had been made to the management of medicines to ensure they were given as prescribed and when people needed them.

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 home supported this practice.

People were protected from the risk of abuse, harm or discrimination because staff had completed safeguarding training and knew what action they should take if they had any concerns.

There were enough staff working in the home and a robust recruitment procedure meant only suitable staff were employed. Ongoing training ensured staff had a good understanding of people’s needs and staff were supported, through supervision, to develop an understanding of their roles and responsibilities.

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

Rating at last inspection

The last rating for this service was requires improvement. (7 December 2018)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Normanhurst Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide nursing and personal care and accommodation for up to 31 older people and people living with dementia. At the time of the inspection there were 25 people living there. Some people had complex needs and required nursing care and support, including end of life care. Other people needed support with personal care and assistance moving around the home due to frailty or medical conditions, such as diabetes and stroke and, some people were living with dementia.

A registered manager had not been in place since May 2018. A manager had been appointed and was applying to register at the time of the inspection. 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. The providers for the service are Mr David Lewis and Mr Robert Hebbes. They also own Normanhurst Care Home and Normanhurst EMI Home.

We carried out a comprehensive inspection at Normanhurst Nursing Home in June 2016 when we found the overall rating was Requires Improvement, with four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because improvements were needed in the quality assurance process as a number of areas for improvement had not been identified and audits had not been completed for some aspects of the services.

At the last inspection on 31July and 01 August 2017 we found that improvements had been made. However, medicines practices needed to improve further, to ensure people’s health and well-being was protected and the quality assurance process needed further development. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the overall rating was Requires Improvement.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and confirm it had improved. We found improvements had been made. However, the quality assurance system was not effective as it had not identified all areas where improvements were needed, such as medicine records and nutrition. Additional work was needed to ensure all areas of the service provided were monitored and that this was part of everyday practice to drive improvements. This is the third time the overall rating for this service is Requires Improvement.

Staff understood the Mental Capacity Act 2005 and consistently asked people if they needed assistance. People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had completed relevant training, including moving and handling, infection control, medicines and safeguarding. They had a good understanding of people’s needs, how to protect people from abuse and the action they would take if they had any concerns. Robust recruitment procedures ensured only suitable staff were employed and there were sufficient staff working in the home to provide the care people needed. Supervision and staff meetings kept staff up to date with current best practice and they understood their roles and responsibilities.

Staff supported people to be independent, make choices and plan the support they received with staff. People told us staff provided the care they needed and staff treated them with respect. Care plans were based on people’s assessed needs and had been agreed with people and/or their relatives. They included risk assessments and clear guidance for staff to follow to reduce risk as much as possible.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff were aware people had different communication needs and explained how they supported people to communicate.

People said the food was good, staff assisted people if required and referrals were made to healthcare professionals if there were any concerns about a person’s diet. Relatives and friends could visit at any time and were involved, if appropriate, in planning and reviewing people’s care.

Normanhurst Nursing Home had accommodation provided over three floors. A passenger lift was available to support people in getting between each floor. A lounge and separate dining room were provided on the ground floor and there was a wheelchair accessible garden. The home was situated near the sea-front in Bexhill on Sea

There was a a registered manager. 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. The providers for the service were Mr David Lewis and Mr Robert Hebbes. They also owned Normanhurst Care Home and Normanhurst EMI Home.

Normanhurst Nursing Home was last inspected in June 2016. At this comprehensive the overall rating for this service was Requires Improvement. Four breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. This was because audits of service provision had not identified a range of areas that needed to be improved. This included no audit of the training needs of staff to ensure they could meet peoples’ needs safely. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by August 2017.

This inspection on 31July and 01 August 2017 was to see if improvements had been made and embedded into practice. We found that many improvements had been made. However medicine practices need to be improved further to ensure medicines were given as prescribed and ensured peoples’ health and well-being was protected. We found multiple signature omissions for the month of July 2017, along with medicines being out of stock for essential medicines for up to five days. There were also some irregularities in respect of GP instructions and staff documentation.

Quality monitoring systems and daily documentation completed by staff needed further development to ensure best practice in all areas, for example, medicines and fluid intake charts.

We recommend that the service seeks advice from a reputable source to ensure that staff use the appropriate equipment for people with variable mobility.

The provider was meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were completed in line with legal requirements. Deprivation of Liberty Safeguards had been requested for those that required them. The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the MCA 2005 and DoLS.

People received care that person specific to reflect both their health and social care needs. Care plans had been reviewed and there was acknowledgement from the management team that there was still work to be done to ensure that all reflected peoples personal preferences. There were plans to review the organisational documentation that would streamline peoples care plans to ensure that they were easy for staff to use and access. Risk assessments that guided staff to promote people’s comfort, nutrition, skin integrity and the prevention of pressure damage were accurate. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Equipment used to prevent pressure damage was set correctly and people identified at risk from pressure damage had the necessary equipment to prevent skin damage. There were activities for people to participate in as groups or individually to meet their social and welfare needs.

Staffing numbers and the deployment of staff ensured that people were safe and supported to spend their day as they wished. There had been a consistent usage of agency staff as many permanent staff have left. However new staff were being recruited and the organisation were committed to further recruitment.

People were complimentary about the food at Normanhurst Nursing Home and the dining experience was an enjoyable experience for people. People were supported to eat and drink in a safe and dignified manner. The meal delivery ensured peoples nutritional and hydration needs had been met and offered a wide range of choice and variety of nutritious food.

The home was clean and well presented. Risks associated with the cleanliness of the environment and equipment had been identified and managed effectively.

There were arrangements for the supervision and appraisal of staff. Staff supervision took place to discuss specific concerns. Staff confirmed that they had regular supervision and yearly appraisals.

People we spoke with were complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff were respectful to people and there was plenty of chat and laughter heard.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by the Normanhurst Nursing Home all had registration with the nursing midwifery council (NMC) which was up to date.

We found a breach of the HSCA 2014 Regulations. You can see what action we told the provider to take at the back of the full version of the report.

Normanhurst Nursing Home had accommodation provided over three floors. A passenger lift was available to support people in getting between each floor. A lounge and separate dining room were provided on the ground floor and there was a wheelchair accessible garden. The home was situated near the sea-front in Bexhill on Sea

Normanhurst Nursing Home had a registered manager. 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. The providers for the service were Mr David Lewis and Mr Robert Hebbes. They owned Normanhurst Care Home and Normanhurst EMI Home.

Normanhurst Nursing Home was last inspected on 31 July 2014. No issues were identified at that inspection.

During their audits of service provision, the provider had not identified a range of areas. This included people not always being left with access to their call bells and audit of time taken by staff to respond when call bells were used. The provider had not audited the training plan to ensure all staff were trained in areas to meet people’s individual nursing and care needs. Recruitment systems were not audited to ensure that all staff folders included all required information and the provider’s policies were consistently followed.

Some staff had not been trained in their responsibilities under the Mental Capacity Act 2005 (MCA). Systems for ensuring people’s consent were not clear. Deprivation of Liberties (DoLS) applications were made, however there was a lack of best interest decisions documentation where people needed to have their liberties restricted, for example by the use of bed rails.

Assessments and care plans for people who had specific needs relating to living with dementia and need for engagement with activities required improvement. Some staff did not always fully engage with people who were frail and living with dementia. Other staff were responsive and consistently supported people in the way they needed.

Systems for supporting people with 'as required' (prn) medicines were not person-centred. In all other areas, registered nurses supported people in taking their medicines safely and ensured there were appropriate systems for storage of medicines.

There were fully established systems for ensuring people received the nursing and treatment care they needed. This included appropriate care of people’s wounds, and end of life care. There were effective systems for liaison with external healthcare professionals, where appropriate.

The registered manager was new in post and was developing a range of areas including audit of accidents and development of systems for staff supervision.

There were a wide range of meals offered to people. People commented favourably on the meals. Where people needed support with their food and drinks, they were helped in the way they needed.

People said they were supported by kindly, caring staff. They said there were enough staff on duty to meet their needs, and they felt safe in the home.

Staff said they were supported by the provider’s induction and training programme. Staff showed a clear understanding of how to protect people from risk, including risk of abuse.

We found a number of breaches of the HSCA 2014 Regulations. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service and staff members 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.

Is the service safe?

People received appropriate care that met their needs based on a thorough assessment. People were cared for in an environment that identified and minimised risk.

Staff had the adequate training to quickly recognise and respond to emergency situations and could provide care and treatment which promoted people's safety and welfare.

The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had attended relevant safeguarding training and were aware of how to access support when needed.

People using the service were being cared for safely by suitably qualified staff who were competent to carry out their role. Staff members followed a thorough induction and on-going training process which enabled them to deliver care safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to nursing homes. Where people needed to be prevented from leaving the home to maintain their safety, we saw that the provider did this in the least restrictive way. Deprivation of Liberty had been granted where appropriate. We saw that the necessary policies and procedures were in place and that they were being followed accordingly.

Is the service effective?

People told us that they were happy with the care they received and felt settled in the home. It was clear during our visit that staff knew people well and understood their care and support needs.

Staff had received training to meet the needs of people living at the home.

Positive written feedback from people using the service demonstrated that the service was effective.

Is the service caring?

We found that people's routines were flexible and they were encouraged to make decisions about what they wanted to do. We saw that their choices were respected.

We saw that staff gave encouragement and support where needed to people using the service.

We observed staff members interacting with people in a positive way. We saw staff assisting people with activities and joining in with hobbies. The general environment of the home was welcoming and relaxed.

People we spoke with were satisfied with the care and support that they received from the service.

Is the service responsive?

The care records that we looked at during our inspection confirmed that people's preferences, interests, aspirations and needs had been identified and recorded.

People's preferences were recorded and acted upon and people were actively encouraged to pursue interests and hobbies. People were involved in various activities within the home and trips out.

The provider had a complaints procedure in place and had an awareness of their responsibilities for recording and dealing with complaints.

The provider responded to the views and comments of people who used the service and put improvements and changes into place appropriately.

Is the service well-led?

The provider had robust quality assurance processes in place. Staff were supported with regular team meetings and we saw evidence of staff receiving supervisions.

A member of staff told that they felt supported in their role and the manager was approachable. We observed that managers were knowledgeable of staff members’ training and development needs.

We saw evidence that managers consulted staff before implementing changes to the home and their views had been taken into consideration.

People that we spoke with told us they were happy living at the home. One person told us, 'I'm very happy, you won't find anything wrong here.' Another person said, 'it's not like home, but it is ok here and staff are kind.'

We looked at the care plans and saw that people were consulted before care was delivered. We saw that people's care was delivered in line with their assessed needs and their individual care plan. We saw that staff knew people well and were kind and respectful when providing care.

We saw that the provider had appropriate arrangements in place to manage medicines safely.

We spoke with staff and looked at staff files. We saw there were effective recruitment and selection processes in place.

The manager had an effective system in place to regularly assess and monitor the quality of service that people received. There was evidence that actions had been taken when concerns were raised.

We looked at the medicine administration record (MAR) charts and found some of the records were not complete. We looked at the supporting documents and found that these did not always match the prescribed medication on the MAR chart. The system in place for the recording of medicines was not safe.

We looked at the policies and procedures for ordering, storage and administration of medicines. We found that these were generic and did not meet the needs of the people who used the service.

We spoke with the care manager and the two nurses on duty. They said they had recognised some of the shortfalls with regard to managing medicines and had started to put systems in place to address them.

We spoke with three people who used the service. They said they were comfortable and the staff were very good. They made no specific comment about medication.