Norbury Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Although some improvements were observed we found insufficient progress around the management of medicines and oversight of risk. Care records were not always clear or robust in identifying support needs or mitigating risk and monitoring systems did not provide adequate oversight of the service. This meant some aspects of the service were not always safe and there was an increased risk that people could be harmed. This was a breach of regulation 12 of the HSCA 2008 (Regulated Activities) Regulations 2014. Staff were recruited safely and received training relevant to their role. However further training in some areas was planned to ensure staff had the skills and confidence to support people safely. There were sufficient staff at the service, however we found that staff could be better deployed at key times throughout the day to ensure consistent and safe support was provided. Improvements were required to ensure the environment was safe and to ensure people were protected from the risk of infections.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe. One person told us, “I’d tell [staff name] if I had a problem. I wouldn’t change anything.” Relatives spoken with told us they felt their family members were safe but there were some issues around support with nutrition, staff competency, missing items and communication. One relative told us, “[Person] has lost the ability to eat hard foods so [person] has soft foods. Last week staff offered [person] a Bourbon biscuit. I complained and they said staff had been told. This has happened a couple of times.”

Staff were able to recognise possible signs of abuse and knew how to report such concerns. Staff told us they received safeguarding awareness training and demonstrated knowledge of whistleblowing procedures. All staff we spoke with felt comfortable raising issues and were satisfied leaders would act on concerns. A staff member told us, “I would be the first one to raise a concern and go and see the manager or above.” There was a commitment from the management team to provide staff with the skills and knowledge to keep people safe from abuse and neglect. While the staff we spoke to could tell us how they kept people safe our assessment found that some elements of care did not meet the expected standards.

We could not be confident people were safeguarded from abuse and avoidable harm. Risks to people were not always being managed safely. This placed people at increased risk of harm. We noticed a number of bedroom gates in place across the home. The service was not fully adhering to the principles of the Mental Capacity Act with some people not having the relevant consents for gates in place. However, best interest decisions for people who did not have capacity were in progress and a review of gates was being undertaken. We observed some kind and caring interactions between people and staff throughout both visits.

The provider did not have effective oversight to identify and manage risks in relation to safeguarding people from abuse and improper treatment. People’s care records and risk assessments did not always accurately reflect their needs or detail how the service was working within the principles of the Mental Capacity Act (MCA). Some progress had been made since our last visit with Deprivation of Liberty Safeguards (DoLs) applications being submitted and relevant capacity assessments or best interest decisions underway. Records showed safeguarding concerns were reported promptly to the local authority, but some notifications were not always submitted to CQC. Missing notifications were immediately submitted by the provider. Staff had completed safeguarding training and the provider’s safeguarding policy guided staff about different types of abuse and how to raise a concern to ensure people were protected.

Risks to people were not always safely managed. Overall relatives felt their family member’s risks could be better managed. One commented, “I told the nurse [person] was chesty and they got a doctor, and it was Covid. It might have been nice if they had noticed.”

Staff spoken to were aware of the risks associated with people’s care needs and could describe the support people needed to manage those risks. However, staff were not always aware of people’s moving and handling risks particularly where mobility was decreasing, and care plans did not always provide sufficient guidance for staff on how to care for people safely.

During our site visits we observed some practices which did not always promote people's safety. We observed an unsafe moving and handling practice for one person. This was raised with a senior member of staff and action taken. We observed a COSHH product stored in a communal area placing people at risk of ingesting unsafe substances. This was brought to the attention of the staff during the visit and immediately rectified. One person did not have their legs elevated safely in line with their assessed needs and another was not supported safely during transfer from chair to wheelchair. Staff took action when this was brought to their attention by the inspector. We observed doors being wedged open and items stored in one stairwell which posed a risk to people in the event of a fire. These were actioned immediately by the deputy manager.

People were at potential risk of harm as the provider had not always identified, mitigated, or safely managed risks to people. Where risks to people were known, risk assessments and care plans were not always up to date, detailed or accurate. For example, the mobility section of the care plan for one person did not have up to date information on their decreasing mobility or how they should be supported safely. Some people had conflicting information within their care records, which also put them at risk of not being supported safely. For example, there was conflicting information in some care records relating to diet and fluid levels for people at risk of choking. Records of support carried out were not always recorded. For example, where a person required regular repositioning to aid pressure areas or checks on their wellbeing there were gaps in the records of support provided that were not being identified by checks or audits. It was therefore unclear whether support had been provided at the required frequency. We found people at risk of weight loss were placed on food charts, but these had not always been completed properly. Therefore, it was unclear whether the people were receiving adequate nutrition or supported appropriately. The provider did not have sufficient oversight of people's mealtime experiences to ensure all people were appropriately supported and wait times were not excessive.

We received mixed views from people and relatives about staffing levels and staff competency. People’s comments included, “I would say they have enough staff. They are very efficient, but they don’t have long to chat. They look after me lovely” Another told us, “There’s enough staff. There’s not a lot to do, but I’m used to it.” One relative told us, “Some of the staff know what they are doing.”

Staff commented on the number of changes in management but overall were positive about the new senior team in place and the support provided. One member of staff told us, “We get somewhere, and then a new manager comes in and its back to square one and all change.” Another said, “Getting support but I will feel more comfortable when we have a permanent manager. If I have any worries I just go to them and it gets sorted out.” We received mixed feedback from staff about staffing levels which have been reduced to reflect the number of residents living at Norbury Court. One staff said, “Less residents but more staff would give more time to residents like emotional support. Can only happen when we have more staff.”

There were occasions when people at risk of falls were left unattended due to poor staff deployment. This meant there was an increased risk of falls. Some people who needed encouragement and prompting with their meals were not always receiving this as staff were too busy or not appropriately deployed. During both our visits we saw some nice interactions, but staff were often busy with care tasks and many of the interactions we observed were task orientated particularly on the weekend. Staff had very few opportunities to spend any meaningful time with people and we saw limited activities available across both visits. On both our visits the weather was hot, and the temperature of the building was not helped by some radiators also being on. We noticed staff consistently checking on people and encouraging fluid intake. Drinks were available in rooms and communal areas. Records of fluid intake had also improved from last visit.

We found staffing levels were sufficient to meet people's needs. However, at the time of our visit we noted staff were not always suitably deployed across all units to provide appropriate levels of support and maintain the safety and wellbeing of residents. Records provided showed evidence of supervision taking place and observations to help staff to develop within their role. However, the matrix in place did not reflect a full year and some staff were yet to receive a supervision for the period reviewed. Staff were provided with training around the needs of people including dementia and pressure area care. However, the training was not always effective in enabling staff to be competent in providing appropriate care. The provider had identified and booked further training for staff in some areas including moving and handling. Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. Further work was underway to track renewal dates of Disclosure and Barring Service (DBS) checks for staff.

People and relatives spoken to raised no concerns about infection control at the service. We observed people to be clean, tidy and appropriately dressed. However, we noticed some rooms and some communal areas had malodours and required a deep clean. We did not receive any concerns from staff about the environment or equipment within the service. Infection control audits were taking place and most of the issues we found had been highlighted by the provider in their recent audit. However, delayed timescales for replacing items such as damaged flooring was impacting on overall cleanliness and infection control.

We did not receive any concerns from staff about the environment or equipment within the service. Infection control audits were taking place and most of the issues we found had been highlighted by the provider in their recent audit. However, delayed timescales for replacing items such as damaged flooring was impacting on overall cleanliness and infection control.

Although there had been improvements in this area since our last visit, we still found areas of concern. We found strong malodours in some areas of the service, with some seating and flooring stained. Some areas required a deeper clean and many areas were still poorly maintained making cleaning difficult. On both visits we saw staff transport dirty laundry without using appropriate laundry bags or appropriate Personal Protective Equipment (PPE). This increased the risk of cross infection.

Although improvements had been made, the systems used by the provider to monitor infection, prevention and control practice were not fully robust and did not ensure people were always protected from the risk of infection. An environment plan was in place to address some of the maintenance and redecoration issues, but this appeared behind schedule. An infection control policy was in place and staff had received training in infection control. However, staff were observed on both visits not following current guidance on the safe transfer of dirty laundry. This meant the risk of cross contamination was increased.

When people were prescribed medicines at specific times, there was not always records to show they had their medicines at the correct times. This meant there was a risk their medicines would not work properly, and they might experience unnecessary symptoms. When people had their drinks thickened to prevent choking, the records for staff to follow were contradictory, therefore there was a risk drinks might be made to the Medicines Optimisation Team Assessment Report incorrect consistency. We found people’s topical preparations, for example patches, were not being applied following the manufacturer’s instructions, so there was a risk people might have experienced unnecessary side effects. We also found medicines to be given before or after food were not given following

Staff were not always following the medicines policy. We found waste medicines were not stored safely as detailed in the home’s policy and according to national guidance. Staff told us risk assessments for the storage of topical preparations had not been completed, this placed people at risk of harm due to unrestricted access. Staff told us the local GP service attended the home weekly to review people who lived at the home. When medicine incidents took place, appropriate action was taken to investigate and prevent recurrences.

People’s medicines allergies were accurately recorded on their medicines administration record. When people had their medicines via a feeding tube, this was not always clearly documented on their medicines administration record so there was a risk they might be given their medicine orally which could be detrimental to their health. When people had their medicines covertly, hidden in food and drink, the medicines policy had not always been followed. We also found staff did not always follow the supporting information to ensure the medicines were given safely when hidden in food and drink. Several people were prescribed ‘when required’ medicines, person centred information to support staff to safely administer these medicines was not always available so there was a risk people might not have got their medicines when they needed them.