Archived: Normanhurst EMI Home

Normanhurst EMI 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 personal care and accommodation for up to 18 older people who are living with dementia or require support with their mental health needs. At the time of the inspection there were eleven people living there.

At the last inspection in August 2017 the overall rating for Normanhurst EMI Home was Requires Improvement as more work was needed to ensure their quality assurance system identified areas where improvements were required. Such as the provision of relevant training in moving and handling and record keeping. At this inspection we found these areas had been addressed and the overall rating had improved to Good.

The registered manager of Normanhurst EMI Home is also the registered manager for Normanhurst Care Home and was present during 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 Nursing Home and Normanhurst Care Home.

An effective quality assurance system enabled management to audit the care plans and other records, such as medicines, accidents and incidents, cleaning and infection control, to identify trends and take action when needed. People and relatives told us the staff were very good; they offered the support and care people needed and involved them in discussions about driving forward improvements at the home.

Risk had been assessed and staff supported people to remain independent, active and safe, as they moved around the home using walking aids and with staff assistance. Staff had completed relevant training, including medicines, infection control and safeguarding. They demonstrated a good understanding of people’s needs, how to protect people from harm and what action they would take if they had any concerns. Supervision and staff meetings kept staff up to date with current best practice and they were aware of their roles and responsibilities. Robust recruitment procedures ensured only suitable staff were employed and there were enough staff working in the home to provide the care people needed.

Care plans were written and agreed with people and their relatives, if appropriate. They included physical and mental health needs with risk assessments and clear guidance for staff to follow to ensure they had the care they needed. Staff were aware of people’s preferences and wishes. They explained clearly how people made decisions about the care provided and we observed staff listened to people and acted on their requests.

Staff had an understanding of the Mental Capacity Act 2005 and consistently asked if people needed support or assistance. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS applications had been requested when required to ensure people were safe.

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 that people had different communication needs and were able to explain how they supported people to communicate.

People said the food was good; they enjoyed a cooked breakfast most days and asked for another meal when they did not like the meal they had chosen. Staff offered alternatives and people were enjoyed these. Staff ensured people had enough to eat and drink and contacted their GP if they had any concerns. Visitors to the home were made to feel very welcome and people were supported to keep in touch with relatives and friends.

Normanhurst EMI 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 patio and garden. The home was situated near the sea-front in Bexhill on Sea

The service 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 also owned Normanhurst Care Home and Normanhurst Nursing Home.

Normanhurst EMI Home was last inspected in June 2016 where the overall rating for this service was Requires Improvement. Two 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 a lack of systems to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberties Safeguards (DoLS) were being consistently followed and ensuring staff were aware of their responsibilities. 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 14 and 17 August 2017 was to see if improvements had been made and the breaches of regulation made. We found that significant improvements had been made and the breaches of regulation met. However, we identified areas that required improvement and that needed to be further developed and embedded into practice.

This inspection found that mental capacity assessments were completed in line with legal requirements. Staff had received training in the mental capacity act and further training was being undertaken. Reference to people’s mental capacity recorded the steps taken to reach a decision about a person’s capacity. However, there were some areas of practice that were undertaken automatically to keep them safe without discussion or a rationale documented. This included the use of covert (hidden) sensor mats in bedrooms and some corridors and no call bell facility available to people when in their bedroom.

The provider had not correctly displayed their CQC rating on their website and the information on the website was misleading. This was immediately rectified during the inspection process.

We recommend that the provider ensures that they understand all legislation in respect of providing care and treatment.

Since the last inspection systems and processes to assess and monitor the quality of the service to drive improvement had been developed. However, further development was required in certain areas to ensure that risk was mitigated and people’s health and well-being was protected. This was in respect of infection control measures and the monitoring of unexplained bruising.

At the last inspection improvements were needed to the meal service. This inspection found people were supported to eat and drink in a safe and dignified manner. The meal delivery ensured people’s nutritional and hydration needs had been met and offered a wide range of choice and variety of nutritious food.

Improvements were needed in respect of the recruitment processes and this inspection found that pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

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.

Risk assessments that guided staff to promote people’s comfort, nutrition, skin integrity and the prevention of pressure damage were in place and accurate. There were behavioural management plans in place for those people who lived with behaviours that were challenging. Equipment used to prevent pressure damage was set correctly and people identified at risk from pressure damage had the necessary equipment in place to prevent skin damage.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles.

People were protected against the risks of unsafe medicines management. The staff were following current and relevant medicines guidance.

Staffing deployment ensured people received the support required and their health and social needs were met. There was an on-going training programme that included essential training such as safeguarding and service specific training such as dementia care. 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.

The home was clean and well presented. Risks associated with the cleanliness of the environment and equipment had been identified and managed effectively. Emergency procedures were in place in the event of fire or evacuation.

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

The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse. They said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and, they would be happy to talk to them if they had any concerns.

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

Normanhurst EMI Home provided accommodation over three floors, with a passenger lift to support people in getting between each floor. Lounges and a separate dining room were provided on the ground floor. The home was situated close to the sea-front in Bexhill on Sea.

Normanhurst EMI 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 registered manager was also the registered manager for Normanhurst Care Home, which was next door to Normanhurst EMI Home. The providers for the service were Mr David Lewis and Mr Robert Hebbes. They owned Normanhurst Nursing Home and Normanhurst Care Home.

Normanhurst EMI Home was last inspected on 3 January 2014. No issues were identified at that inspection.

During their audits of service provision, the provider had not identified a range of areas. Their audits had not identified that people did not consistently have care plans developed in relevant areas or that some documentation was not completed, to ensure people received consistent care. The provider had also not identified that parts of the home environment did not follow guidelines on supporting people who were living with dementia or a disability. There was a lack of audit of staff supervisions, to ensure relevant areas were identified. The provider had not identified that although care staff provided activities to people, they had not been trained in this area. 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. People’s assessments in relation to the Mental Capacity Act 2005 were not decision specific and did not ensure the requirements of the Act were followed. 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 in some way, for example by the use of restrictions such as stair gates.

Some areas for supporting people with meals did not consistently follow guidelines on for people who were living with dementia. There were a wide range of meals offered to people. People commented favourably on the meals service. Where people needed support with their food and drinks, they were helped in the way they needed.

A few areas of risk for people such as personal evacuation plans (PEEPs) did not identify all areas of risk. Other areas of risk were identified and regular checks were maintained in relation to ensuring people’s safety.

Staff fully engaged with people when they supported and cared for them. Staff were responsive to people and consistently supported people in the way they needed, including supporting them in remaining as independent as possible.

Staff supported people in taking their medicines safely, this included when people needed skin creams applying or where people were prescribed medicines on an ‘as required’ basis. There were appropriate systems for the storage of medicines. Staff had effective systems for liaison with external healthcare professionals where people needed support.

Staff showed a clear understanding of how to protect people from risk, including risk of abuse and followed relevant guidelines to reduce risk to people. People said there were enough staff on duty to meet their needs.

We found two 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.

We saw that care plans were detailed and personalised and that these reflected the assessed needs of people. Staff were clear about what abuse was and what to do if abuse was suspected. There were sufficient numbers of staff with the appropriate skills to meet the needs of people using the service. We found that there was an effective complaints system available.