The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We carried out an unannounced comprehensive inspection on 26 September 2016. The overall rating was ‘requires improvement’. We issued a requirement notice and told the provider to take action in relation to how people's confidentiality was promoted and to how their money personal money was stored. Improvements were also required to ensure staff used people's care plans to help plan and deliver people's care in line with their needs, wishes and preferences, and opportunities for social engagement required further development. In addition, the management of people's medicines required strengthening, and further action was required to ensure the newly designed systems and processes which had been implemented to monitor the quality of the care, were embedded into practice. Following the inspection, the provider sent us an action plan, telling us how they would make improvements.

We carried out a comprehensive inspection in December 2017 and looked at whether improvements had been made for issues raised from the inspection in 2016. At the time, we found that people’s confidentiality was respected, people’s money was looked after safely and people had comprehensive care plans in place.

However, in December 2017, we found that people still did not have much opportunity to remain physically or cognitively active and that improvements were still required regarding medicines management. We also found the environment had not been assessed to ensure it was safe for all people living there and that people were not always protected from the risk of infection. We found people did not always have access to sufficient numbers of staff, people were not always treated with dignity and respect and their privacy was not always promoted. People’s needs or preferences regarding the end of their life, food and mealtimes and the décor and environment had not always been sought or respected. People had not always been involved in developing the service and the provider had not effectively monitored the service to ensure improvements were made to its quality and safety. The provider had not ensured that the culture of the service was positive, inclusive or person-centred and staff told us they did not feel valued by the provider. The provider had a limited understanding of the regulations which underpin the running of the service.

Following the insp

We carried out an unannounced comprehensive inspection on 26 September 2016. The overall rating was requires improvement. We issued a requirement notice and told the provider to take action in relation to how people’s confidentiality was promoted and to how their money personal money was stored.

Improvements were also required to ensure staff used people’s care plans to help plan and deliver people’s care in line with their needs, wishes and preferences, and opportunities for social engagement required further development. In addition, the management of people’s medicines required strengthening, and further action was required to ensure the newly designed systems and processes which had been implemented to monitor the quality of the care, were embedded into practice. Following the inspection, the provider sent us an action plan, telling us how they would make improvements and during this inspection we looked to see if action had been taken.

Norfolk Villa Residential Home is a service which provides care and accommodation for up to 19 older people, some of whom are living with dementia. Accommodation and facilities at Norfolk Villa Residential Home are situated on two floors, with access to the upper floor via stairs and/or a stair lift. There is a lounge, dining room and outside patio area, as well as some shared bathrooms, shower facilities and toilets. On the day of the inspection 15 people were living at the service.

The provider had responsibility for the management of the service and has no requirement to have a registered manager. A registered manager is a person who is registered with the Commission and has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, in 2016 the provider had sought support with the running of the service, by employing an acting manager from a health and social care consultancy firm. The acting manager is referred to as the manager throughout the report.

We carried out an unannounced comprehensive inspection on 05 December 2017 and 08 December 2017.

People continued to live in a service which was not effectively assessed and monitored by the provider to ensure its ongoing quality and safety. Despite, the provider employing a consultancy firm to manage the service on their behalf, the provider did not have effective systems and processes in place to monitor the ongoing standard of the service, and to help ensure the service met regulations.

The provider had a limited understanding of the regulations which underpin the running of the service, in particular, the regulation relating to good governance. The continued rating of requires improvement since 2015 demonstrated the provider did not continuously learn and improve the service.

People lived in a service which did not continuously and positively adapt to changes in practice and legislation. For example, the provider and manager did not know about the CQC’s changes to the Key Lines of Enquiry (KLOEs). They were also not aware of the Accessible Information Standard (AIS). The AIS is to ensure services fully meet people’s information and communication needs, in line with the Health and Social Care Act 2012. Both of these came into effect from 01 November 2017.

People lived in a service which did not have a positive, inclusive and person-centred culture. The provider told us the ethos of the service was to offer a homely and family ordinated service. Whilst, these values were seen to be embedded into staffs practice, staff told us they did not feel the provider demonstrated these values.

The provider had not always notified the Commission of significant events which had occurred in line with their legal obligations. For example, the approval of Deprivation of Liberty Safeguard (DoLS) applications.

Staff spoke highly of the manager, and felt respected, supported and valued by them. The manager was open and transparent, and wor

We carried out an unannounced comprehensive inspection of this service on 29 February 2016, 02 March 2016, 15 March 2016 and 20 April 2016. Breaches of legal requirements were found. We served a Warning Notice on the registered provider. Warning notices are part of our enforcement policy and tell the provider where they were not meeting their legal requirements. They had to have put this right by 31 August 2016. This was because care was not always safe, personalised and consistent and, the systems in place to monitor the quality of the service were ineffective. People were not protected from risks associated with their care, and risk assessments were not reflective of people’s current risks. People were also at risk of not receiving their medicines as prescribed. People’s records were not well maintained to evidence the care given. We also asked the registered provider to submit monthly progress reports to the Commission so we were able to monitor improvement and action being taken.

We undertook this comprehensive inspection on the 22 September 2016. We undertook this inspection to confirm that the service now met legal requirements. The inspection was unannounced.

The service provides care and accommodation for up to 19 older people, some of whom are living with dementia. On the day of the inspection 14 people were living at the service.

Accommodation and facilities in Norfolk Villa are situated on two floors, with access to the upper floor via stairs. There are some shared bathrooms, shower facilities and toilets. Communal areas include a lounge, a dining room and an outside patio area.

There was a registered provider; the service did not require a registered manager in post. The registered provider had sought the advice and expertise of a consultancy firm and they had employed an acting manager. The acting manager is referred to as the manager throughout the report. 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.

At this inspection we found improvements had been made to the systems and processes in place to support good governance. We found people were safe, and care provided appropriate to people's needs. However, we continued to have minor concerns regarding medicine management and although care plans and risk assessments were in place, these required greater personalisation. Our findings were already incorporated into the manager’s plan for the next 6 months.

Medicine management had improved significantly however we found verbal orders from doctors were being taken by staff over the telephone which could be misunderstood and had the potential to cause risk to people. We also found hand written entries on people’s medicine charts were not always checked by a second person which might cause errors in the medicine they received. Clarity was required where people were on a variable medicine dose so the rationale for giving a certain dose was clear and consistent. The staff immediately put systems in place to address this during the inspection.

Staffing levels met people’s needs, were flexible, and staff had received training to meet people’s needs. Staff had a good knowledge of people’s care plans and had been involved in developing these alongside people where they wished to be involved. Staff were supported and learning and recent changes to the processes in place were being embedded through staff meetings and supervision.

People’s human rights were respected. People were central to decisions about their care and treatment and their consent was asked for prior to any interventions. The Mental Capacity Act (2005) was better understood and staff knew when restrictions in place might amount to a deprivation of liberty.

People enjoyed a healthy diet. There were systems in place to ensure essential information regarding allergies and preferences were known. People’s weight was monitored and

The inspection took place over three days, 29 February 2016, 2 March 2016 and 15 March 2016. The first day of the inspection was unannounced.

The service provides care and accommodation for 19 older people, some of whom are living with dementia or who may have physical or mental health needs. On the days of the inspection 17 people were living at the care home.

Accommodation and facilities in Norfolk Villa are situated on two floors, with access to the upper floor via stairs. There are some shared bathrooms, shower facilities and toilets. Communal areas include a lounge, a dining room and an outside patio area.

There was a registered provider; the service did not require a registered manager in post. 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.

At the last inspection on 12 and 17 September 2015, we asked the provider to take action to make improvements as we found care was not always safe, personalised and consistent. We found people’s consent was not always obtained prior to care being given; risk assessments did not always reflect people’s needs; there was no proper and safe management of medicines; staff did not always have the knowledge, experience and skills to support people; and the systems in place to monitor the quality of the service were ineffective. The provider sent us a plan detailing the improvements which would be made to meet the legal requirements in relation to the breaches. The provider told us they would make all improvements by the 28 February 2016.

At this inspection we found some improvements had been made, but we continued to have concerns in several areas.

People’s medicines were not always managed, administered and stored safely. We found essential checks were not routinely completed to ensure the right people received the medicine they were prescribed. We found that there were gaps in the medicine records which meant we could not be sure people had received their prescribed medicine.

People’s care records were not always reflective of people’s needs and did not always show whether people were involved in writing them. The records of people’s care were not always complete and lacked essential details to ensure care given was appropriate and as desired by the person. People’s end of life needs were not always planned with them and their end of life care planning was inconsistent. However, we saw these were being improved during the inspection.

People’s individual risk assessments were not reviewed regularly to ensure they reflected people’s current risk in relation to their health needs. People were not involved in planning how to mitigate the risks they faced while living at the service. People’s care plans and records did not reflect risks which had been identified by the service.

Not all staff had been trained in the MCA and the associated Deprivation of Liberty Safeguards (DoLS). When people did not have the mental capacity to make decisions about their care and treatment, assessments were not always evident and there was a lack of guidance in place for staff about how to support people to make decisions. However, we observed staff asking for people’s consent before providing personal care.

Good leadership and governance was not always evident. The provider had developed new audits but not all of these were effective and had not identified the issues raised during the inspection. However, the provider was working in collaboration with external services to improve the quality of care and during the inspection process, presented a plan to CQC to help ensure all aspects of people’s care was of a high quality.

There were activities which occurred at the home which people liked participating in and enjoyed. However, activities were not always personalised to people’s specific needs or interests and were infrequent.

Staff were recruited safely. Staff were recei

We met 12 people who used the service, spoke to one relative, two visiting professionals, talked with the staff on duty and checked the provider's records. One person using the service said, “The best place in town!” We looked at the “views and comments” form completed by people living in the home for further information.

We saw people’s privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated staff respected the people they cared for. One person living in Norfolk Villa said, “They always knock on my door before they come in.” One visiting professional said, “They have been very good at supporting the person I visit.”

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. There were enough staff on duty to meet the needs of the people receiving care at the home and some people were able to say they felt safe living at Norfolk Villa. Safeguarding procedures were in place and staff had completed training and understood how to safeguard the people they supported.

Staff training records contained all mandatory courses as required, for example staff had completed training in safe handling of medicines and manual handling. This meant the provider could demonstrate that the staff employed to work at the home had the skills and experience needed to support the people who received care in the home.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The DoLS apply to care homes and hospitals. No application had needed to be submitted.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their care plans where possible. Specialist dietary, mobility and equipment needs had been identified in care plans when required.

The people we spoke with told us that they felt that staff were kind and caring. People told us that they were happy with the care and support that had been delivered and their needs had been met.

The visitor and professionals we spoke with were able to confirm that they were able to see people in private and that visiting times were flexible.

The staff spoken with had a clear understanding of the care and support needs of the people living in the home. The relative spoken with said, “Can’t fault the care they give mum.” Staff had received training to meet the needs of the people living at the home.

Is the service caring?

Those people who were able to talk with us said that they were supported by kind and attentive staff. We saw that the staff showed patience when supporting people.

People using the service had completed questionnaires on their satisfaction of the service provided. Residents meetings were held to discuss any shortfall identified.

Is the service responsive?

There were regular activities arranged within the home and a local retailer had visited and set up a shop in the home so people were able to purchase items. One person said, “It is like having a shopping mall in the home- it is great!” We looked at how complaints had been dealt with and we found that the responses had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support care provision and service development.

The service had recently been visited by the commissioning authority and the information from the registered provider showed the home was continuingly improving and had taken on board the recommendations suggested. This included the employment of a consultant who was assisting with the further development of records and care plans for people.

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities.

We (the Care Quality Commission) carried out this inspection to follow up on compliance actions made at our previous inspection in January 2012.

We talked with six people who lived at the home. They told us “It’s marvellous here, staff are always popping in to ask how I am keeping” and “They are the loveliest group of staff”.

We spoke with six staff who told us that us that they had sufficient training in all areas to help them do their jobs well.

People told us that staff always asked for their consent before providing care. We looked at the care provided and records relating to three people. Records relating to people’s care were not detailed or personal to each person. This may affect how care is provided.

Medication systems were not robust and people may not have received pain relief medication when it was prescribed.

People using the service and staff on duty felt there were sufficient staff on duty to meet their needs. Staff had not followed their training to ensure the safety of people using the service and staff.

Some parts of the home were not safe for people using the service and some areas of the home were not clean.

Auditing systems undertaken by the management of the home were in place to monitor the service. Some parts of the auditing had not identified shortfalls in the quality of care provided.

The CQC, Care Quality Commission pharmacy inspector visited the home on two days 10 November 2011 and again on 6 December 2011 as a follow up as part of the same inspection. During our first visit to the home on 10 November, we spoke with two people who told us that they get given their medicines when they need them. They told us that staff are kind and helpful, and reported no problems with their medicines.

People can look after their own medicines if it is safe for them to do so, but there was no-one in the home who does this at the moment.

During our first visit we watched medicines being given and found that medicines were removed from the labelled containers in which they are supplied, before the time of administration. Sometimes medicines were removed by one member of staff, and put in lidded named pots for a different person to give later in the evening or the next morning. This is not good or safe practice as medicines should only be removed from labelled containers at the time of that they are given. The staff in the home explained to us that a new system had already been ordered and was due to start a few days later.

When the pharmacy inspector visited again on 6 December, we found that there had been many improvements to medicines management. We watched some people being given their medicines at lunchtime and found that they were now being administered using a safe method.

We visited Norfolk Villa with an expert by experience. The Care Quality Commission (CQC) describe an expert by experience as "people who have in-depth experience of using services, and have been trained in their expert role by voluntary organisations."

During the visit we spoke with 10 people who live at the home, four visitors and one healthcare professional.

People told us they felt “well cared for” and “in good hands.” People also said they felt in control of their daily routine and care. People also appreciated that staff did not “take over” or rush their care. People were also complimentary about the additional care given by the provider.

Relatives were also pleased with the care provided and said staff acted on their concerns and were very good at reporting any incidents or changes.

People told us the response times to call bells was very good. However, a tour of the building showed that not all call bells had been adjusted so that people could reach the bell from their chair or bed. Staff explained that some people had been given mobile call bells. However, one person, who was being nursed in bed was still unable to reach their mobile call bell.

People liked the activities when they happened at the home and had attended some religious services at the home in the past. People also said that they were very satisfied with the quality, quantity and choice of food available. Meals are seen as a social occasion.

The home has been extended to include an annexe which staff referred to as the cottage. People told us they liked living at Norfolk Villa. A relative said “there are never any nasty smells and it’s always clean. A tour of the home showed some areas of decor were looking in need of minor repair. Small patches of floor coverings were frayed, torn or rucked in two communal corridor areas, the dining area and three bedrooms and this was causing a potential trip hazard. There was also a step leading to the cottage which was not easy to see.

The people we spoke with said they thought that an increase in staffing especially during the early morning would be of benefit. One person said “They could do with more staff at times, they do the best with what they’ve got.”

We inspected the service on the 12 and 17 September 2015. The inspection was unannounced.

We last inspected the service on the 14 April 2014 and found no concerns.

Norfolk Villa Residential Home provides residential care without nursing for up to 19 older people. People living at the service may be living with mild dementia. There were 18 people living at the service when we visited.

There was a registered provider; the service did not require a registered manager in post. 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.

Not all people had care plans in place. Care plans that were in place did not detail people’s individual care needs sufficiently to ensure staff knew what care to deliver, and these were not regularly reviewed to help ensure they reflected people’s needs. People were not always involved in planning their care and enabled to make choices about how they wanted their care to be delivered. The matron, registered provider and staff were knowledgeable about people and their needs.

Not all people had risk assessments. Where there were risk assessments, these had not been regularly reviewed and were not always clearly linked to people’s care plans. Risks associated with people’s individual needs were not formally recorded to help ensure people were protected and staff had the full information to meet people’s needs.

People’s medicines were not always administered safely, records did not always demonstrate medicines had been given. Some staff were recording people had taken their medicines when they had not.

Not all staff followed safe infection control practices. Protective clothing was not always worn and we found some bedrooms and bathrooms were not clean. Equipment such as commodes were not clean and hygienic.

Most people who lived at Norfolk Villa had mental capacity to make their own decisions about their care but staff’s understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) was limited. Where people did not have capacity we did not see evidence of assessments having occurred and there was no clear guidance for staff about how to support people to make decisions.

There were sufficient staff to meet people’s needs safely. There was a training programme in place but some staff had not completed the provider’s essential training. Some training such as moving and handling was out of date. Staff were recruited safely. Staff understood how to keep people safe from harm and felt any concerns would be taken seriously.

People received a good diet but their nutritional needs had not always been assessed and their likes and dislikes were not always known by the staff. The kitchen staff did not have information about dietary needs such as those who required a low phosphate diet or had diabetes. Allergies were not consistently communicated to the cook. People were not involved in developing the menu and there was a lack of choice available on the menu.

People could see their GP and other health professionals as required. Any concerns about people’s health were addressed quickly by the staff and referrals made to external services when required.

Staff conversation and engagement with people was minimal during the inspection. Activities were limited but very much enjoyed when they occurred. Care records did not always detail what people enjoyed doing or their past histories so staff did not know what activities might interest them. People had their faith needs met.

People and those who mattered to them had their complaints and concerns responded to appropriately when they had raised issues.

There was a management structure in place and during the inspection process, roles and responsibilities of management were being reviewed. Staff told us they did not always feel listened too, supported and valued. The team were not working cohesively to provide high quality care.

There were not robust systems with regards quality monitoring processes in place. There were no audits in place to identify the concerns we found during this inspection. The registered manager had not submitted the legal required notifications to CQC to inform us of incidents or deaths relating to people living at Norfolk Villa.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.