Norman Hudson Care Home

Updated 27 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Norman Hudson Care Home is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Norman Hudson Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered CQC to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A regional manager, who had been working at this home since December 2022, was in day-to-day control of running the service.

This inspection was unannounced.

We visited the location on 22 March 2023 and 23 March 2023.

What we did before the inspection

We reviewed information we received about the service since the last inspection and liaised closely with local authority partners and professionals who worked with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people who lived at the home, 9 relatives, the home manager, the chief operating officer, project manager, activities coordinator, administrator, 2 nurses, 7 care assistants as well as ancillary staff. We observed care in communal areas, including mealtimes on both days.

We reviewed a range of care records, including 5 care plans, medicine records, staff rotas and other documentation to support how the service is run.

Updated 27 May 2023

About the service

Norman Hudson Care Home is registered to provide residential and nursing care for up to 42 people. At the time of the inspection there were 27 people living in the home, the majority of whom were living with dementia. The home is situated across 3 floors, with communal areas on the ground floor.

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

We were not assured medicines were administered as prescribed and robust recording was not in place. Medication running balances did not always match stock held, ‘as required’ medicines were missing protocols and the medication fridge temperature was operating outside a safe range. The missing protocols were put in place between days 1 and 2 of our inspection. The provider’s audits had identified some, but not all the issues we found on inspection.

Staff were unable to describe safe and appropriate action would be taken in the event of an emergency requiring evacuation. The provider told us they would address this with staff. It was not clear how an unsuccessful fire drill had been followed up in January 2023. Safeguarding records, complaints, accidents and incidents did not show how events the provider had marked for further investigation had been followed up. Staff understood safeguarding responsibilities and both people and their representatives said they were protected from harm.

The nominated individual told us they did not produce visit reports as this oversight came from ‘Gold Command’ (quality assurance) meetings. The provider told us these meetings were documented in emails, but did not present these records. An action plan for previous inspection findings was shared with us. Daily walkarounds were not fully effective and the allocation of ‘chart champions’ had not improved daily recording. Some items of lifting equipment had not been thoroughly examined as required by the Health and Safety Executive.

Electronic and paper based care planning systems were in the home, but staff were not enabled to access the electronic records, which were the most up-to-date. This was partly addressed during our inspection as the provider printed the electronic records. IT equipment needed to make the electronic care planning system operational was due to be installed shortly after our inspection. Electronic care plans were sufficiently detailed records.

The recording of people’s dietary needs was not consistent. People had a positive mealtime experience as staff worked hard to offer people a range of options, which was particularly important where people initially refused what they were offered. Relatives told us they were kept up-to-date around key developments in their family member’s health.

Some caring interactions had improved at this inspection. We saw examples of kind interactions, but other examples were seen where staff were not fully skilled. Dementia training which the provider had arranged with the local authority had to be delayed in February 2023 due to unforeseen circumstances and was rearranged for May 2023. People said the staff were caring and relatives said they had observed improvements. People were more meaningfully engaged with a programme of activities. Activities were also sourced externally and people enjoyed this provision.

Feedback from relatives was generally positive. However, they provided mixed feedback about the responsiveness of the provider’s communication, whilst also saying they felt well informed about incidents in the home. The provider acted openly with relatives around shortfalls found at our previous inspection. A culture review completed by a consultant in December 2022 highlighted concerning issues around the provider’s management of the home. A new management team had been introduced, although further changes were expected in the months after our inspection. The provider said they would ensure there was a suitable handover to the new management team.

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 service supported this practice. However, we have asked the provider to investigate the control people have over morning and night routines. We have made a recommendation about the use of best interests decisions, as needed, for this aspect of people’s care.

Work had been carried out to improve the living environment and this was ongoing, as some work still needed to be done. Ideas for improvements to the premises were shared by the provider, which included plans to make the home more dementia friendly.

Infection control measures were not robust at this inspection. The premises were found to be cleaner, but some equipment in the home needed a deep clean.

There was an improved skills mix of staff on day and night shifts. Shifts were fully staffed in line with people’s assessed needs. Staff files demonstrated the provider carried out safe recruitment checks. Staff were receiving an improved level of formal support through induction, high training completion levels and examples of supervision for some, but not all staff.

We identified two incidents at this inspection which should have been reported to the Care Quality Commission. We have dealt with this outside the inspection process.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 3 February 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of some regulations. However, we found the provider remained in breach of regulation concerning people’s safety and systems to ensure sufficient oversight of the service.

Why we inspected

The inspection was prompted due to concerns identified at our last inspection in December 2022 around safeguarding, management of risk, premises and equipment, staffing arrangements, staff recruitment and leadership in the home. A decision was made for us to inspect and examine those risks. We carried out an inspection which looked at all five of our key questions.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement, based on the findings of this inspection. We have found evidence the provider still needs to make improvements. Please see all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last inspection, by selecting the 'all reports' link for Norman Hudson Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and governance of the home.

We have made recommendations about ensuring best interests decisions are in place where needed and assessing how best to support people living with a mental health diagnosis.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.