This inspection was carried out on 15 September 2015. Norfolk House is a purpose built care home with nursing, situated on the outskirts of Weybridge in Surrey. Some of the people using the service are living with dementia. The service can accommodate up to 76 people, over three floors, and all rooms have en-suite facilities. On the day of the inspection there were 58 people living at the service.
On the day of our visit there was not a registered manager in post. 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. There had not been a registered manager at the service since January 2015. A new manager had started at the service, they told us that they were in the process of submitting their application to us. They had only been at the service for one week.
There were not sufficient numbers of staff deployed around the service to meet people’s needs.
Risk assessments for people were undertaken. Each risk assessment gave staff information on how to reduce the risk but they were not in any detail. These included risks of poor nutrition, choking and falls.Staff had a good understanding of people’s risks. Not all of the information around risks had been kept together to ensure that staff had all of the information in one place.
Staff had knowledge of their responsibilities under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. However MCA assessments had not always been completed appropriately for people.
Staff did not always have the most up to date guidance in relation to their role. The service clinical training had not been completed by all of the nurses.
There were complete pre-employment checks for all staff. This included full employment history and reasons why they had left previous employment. This meant as far as possible only suitable staff were employed.
There were up to date policies for staff in relation to people’s medicines. Peoples medicine charts were completed clearly and accurately. Peoples medicines were managed safetly and they had them when they needed them.
One to one meetings were undertaken with staff and their manager however appraisals had not taken place for all staff. Staff did say that they felt supported.
People’s personal history, individual preferences, interests and aspirations were all considered in their care planning. Care plans were reviewed every month to help ensure they were kept up to date and reflected each individual’s current needs. However there wasn’t always a plan of care around every idenfied need. For example in relation to challenging behaviour.
There was a programme of activities in place which people said they enjoyed. However there were times at the weekend when no activities took place.
There were instances of staff not being as caring as they could be. There were times when people had no meaningful conversations with staff. Other people and relatives felt that staff were kind and considerate. People were treated with kindness and compassion by staff throughout the inspection. One person said “I have fun with the carers, staff are caring in every way.”
People and relatives said they felt their family members were safe. Staff understood what it meant to safeguard people from abuse and how to report any concerns.
Staff gave examples of where they would ask people for consent in relation to providing personal care. We saw several instances of this happening during the day.
People and relatives said that the food was good. People were encouraged to make their own decisions about the food they wanted. People’s food and nutrition was carefully monitored and maintained.
People had access to health care professionals as and when they required it. We saw several examples of visits from health care professionals on the day of our visit.
People and relatives had the opportunity to be involved in the running of the service. Residents and relatives meetings were held and the minutes showed discussions about the décor of the service.
There was a complaints policy which people and relatives had knowledge of and knew how to access this.
Audits of systems and practices were carried out and were effective. Where concerns had been identified these were being addressed. Incidents and accidents were recorded and there was an analysis of this. For example in relation to falls.
Staff said they felt supported or motivated in their jobs. Regular staff meetings took place and staff contributed to how the service ran. Meetings were minuted and made available to all staff.
Annual surveys were sent to the people, relatives and staff which were used as a way of improving the service.
During the inspection we found 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 the report.