Norman Hudson Care Home is registered to provide residential and nursing care for up to forty-two people some of whom may be living with dementia. The home is located in Huddersfield.

At the last inspection, the service was rated Good.

Staff had opportunities to update their skills and professional development. Staff demonstrated an understanding of the Mental Capacity Act (MCA) 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We spoke to the registered manager around one staff file where employment dates had not been recorded in the recruitment process. This was acted on and completed by day two of our inspection.

Care records contained clear information covering all aspects of people's individualised care and support and staff had a caring approach to working with the people who used the service.

Staff were confident in supporting people with medicines and knew people well.

There was a clear management structure and staff clearly understood their roles and responsibilities. There was an open and transparent culture in which staff felt valued and able to approach the registered manager. Staff told us they felt valued and enjoyed their job. The management team continued to improve and work with relatives at the home if they had any concerns or complaints. The home had received many compliments in relation to the care and support they provide.

Further information is in the detailed findings below

This inspection took place on 26 June 2015. The inspection was unannounced.

Norman Hudson Care Home is registered to provide residential and nursing care for up to forty-two people some of whom may be living with dementia. The home is set out over three floors with all communal living areas, including two lounges and two dining areas situated on the ground floor. There is also a decorated and furnished like a pub for people who live at the home to enjoy. There are safe gardens to the rear of the home.

At the time of our inspection, the Nominated Individual for the company was progressing his application to the Care Quality Commission for registered manager status.

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.’

People told us they felt safe and staff knew how to maintain people’s safety. Accidents were analysed to try to reduce risks. Systems were in place to make sure staff were recruited safely.

We found the home to be clean.

Systems for managing medicines were safe.

Staff training was up to date. Systems for supporting staff were in place.

Staff treated people with kindness. One person told us ‘Staff are really good, they are always trying to help me and I get on well with them.’ Staff demonstrated a good understanding of the need to treat people with respect and dignity.

People’s choices were respected and their views were sought through a residents association and residents meetings.

People received a nutritious diet and found the food enjoyable. Close monitoring of people’s nutritional needs was in place and any weight loss was identified and responded to.

Person centred care plans were in place.

People had access to meaningful activities.

People felt able to tell staff if there was something they were not happy with and we saw that concerns and complaints were managed well.

Improvements had been made to the environment and to facilities to support the orientation of people living with dementia.

Robust processes were in place for auditing the quality of service provision. People who lived at the home, their families and staff were involved in decision making about the home.

The person named as manager on this report has left the service and a new manager is in post.

When we inspected Norman Hudson Care Home in June 2014 we found the service to be in breach of regulations 17(Respecting and involving people who use services), 9 (Care and welfare of people who use services), 11 (Safeguarding people who use services from abuse), 13 (Management of medicines), 22 (Staffing) and 10 (Assessing and monitoring the quality of service provision) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We judged that people who used the service experienced poor care that had a significant impact on their health, safety or welfare or there was a risk of this happening. The matter needed to be resolved quickly. As a result of this the Commission made a decision to set compliance actions in relation to these regulations. This meant that we told the provider they had to make improvements.

In addition to this, and because of a history of non-compliance with regulations the Commission took the decision to take further enforcement action against the provider. This action was taken under regulation 9 (Care and Welfare) and regulation 11 (Safeguarding people who use services from abuse).

The provider made representations against this enforcement action and has kept the Commission informed of the actions they have taken to achieve compliance with the regulations.

This visit was made to see if the provider had achieved compliance with the regulations under which the enforcement action was taken.

This inspection was made over two days. On the first day two Adult Social Care Inspectors, an Expert by Experience and a Specialist Advisor went to the home and one Adult Social Care Inspector returned on the second day.

We looked at care records for five people and observed care. We spoke with two people visiting their relatives and eight people who lived at the home. Not all of the people we spoke with were able, due to complex care needs, to tell us about their experiences.

We spoke with ten members of staff including the nurse in charge and the registered manager. The registered manager is also the Nominated Individual for the service.

We found that improvements had been made and that people who lived at the home were receiving the care and support they needed. We also found that systems were in place to make sure people who lived at the home were safe.

Visiting relatives said:

“I can’t fault the care that they give now, it has improved. (my relative) is well looked after in terms of their health"

“I think (my relative) is more settled generally, things have improved lately. I can see it in the other residents too.”

“I think that the staff have the skills to keep people safe”

“Things have improved in the last six months. I used to think that there was a bit of an atmosphere but this has definitely got better. I think they have separated some of the residents and made another lounge. This has helped to improve things.”

All of the people the Expert by Experience spoke with said they felt safe living at the home.

When we inspected this service in November 2013 we found that care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare.

In addition we found there were not enough staff available to meet people's needs. We judged that both of these issues had a major impact on people who used the service and issued warning notices to the provider informing them that improvements had to be made.

We also found that people who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We judged that this had a moderate impact on people who used the service, and told the provider to take action.

The provider responded and told us that they had taken action to improve the service. We made this visit, over two days, to see what actions had been taken and to assess improvements in the three areas outlined above.

We found better arrangements were in place to make sure that people received the care and support they needed from staff at the home and other healthcare professionals. However, we found a number of issues relating to the delivery of care within the home and, whilst we felt the provider had taken sufficient action to meet with the warning notice, we have said further improvements were needed.

We found staffing was better organised and recruitment of new staff was ongoing.

We found insufficient action had been taken to protect people who used the service from the risk of abuse.

These were some of the things people who used the service or their relatives told us during our visit:

“Some of the staff are really lovely.”

“My mum really enjoys the food; they have two cooked meals a day.”

“I find my relative’s clothing is not folded it is just thrown in the drawers and it’s like it on most occasions I look.”

“Recently they have improved up to a point but it’s superficial. For example the environment has improved but care hasn’t always.”

“You seem to have to ask for everything before it is done.”

“It can be a bit boring sometimes.”

“The food is a bit mundane and there’s not a great deal of choice.”

“I have no complaints about the staff or care I receive.”

This inspection was undertaken following the Care Quality Commission receiving information of concern relating to the care of people living at Norman Hudson Care Home.

Many of the people we met during out inspection were unable, due to complex care issues, to tell us about their experiences at the home. In view of this we used other methods to understand the experience of living at the home. These included observation of care and looking at care records. Two of the people we spoke with told us that they often have to wait for staff to assist them in meeting their needs.

We spoke with one person's relative on the telephone who told us that they had concerns about the care their relative received.

We found the service were failing to make sure that people's care and welfare needs were met. This included failure to access to medical attention in a timely manner.

We found that safeguarding procedures were not being followed.

We found there were not enough staff available to meet the needs of the people living at the home.

We found that Statutory Notifications to the Care Quality Commission were not always being made as required under the Health and Social Care Act 2008.

This inspection was undertaken to follow up on issues highlighted during our inspection visit on 20 June 2013. Due to the focussed nature of this inspection we did not, on this occasion, speak with people who lived at the home or their relatives.

We found that work had been done and systems put in place to demonstrate that staff had respect and consideration of the people who lived at the home. This included looking after people's personal belongings.

We saw that work had begun to redecorate and refurbish several areas of the home including people's bedrooms. This meant that the provider was working toward making sure that the premises were safe and suitable.

During our visit we spoke with six people who lived at the home and one person who was visiting their friend at the home. Many of the people we spoke with were living with dementia and were not able to tell us their opinions of the care and support they received. We did however observe that people who lived at the home appeared comfortable with, and trusting of, the staff on duty.

One person told us they felt that the staff attitudes towards them were mixed. Some staff they described as very good but said others were not. They told us that their room was comfortable and that the food was good.

A visitor told us that they had seen some nice interactions between staff and people who lived at the home.

We found a number of issues which indicated that staff did not always consider or respect the privacy and dignity needs of the people who lived at the home. This included lack of care and respect toward people's personal possessions and personal space.

We found that maintenance was poor in some areas and in some areas, posed a risk to the safety of the people who lived at the home.

Staff were knowledgeable about how to keep people safe and understood examples of issues that might not be in the people's best interests. There were good processes in place for managing complaints.

There were enough staff available to meet people's physical needs but we saw that staff did not always engage with people to meet their recreational needs.

When we visited the service in August 2012 we found that they were not compliant with the regulations relating to care and welfare of people who use the service (outcome 4) and meeting nutritional needs (outcome 5). We said that improvements must be made.

We made this visit to see if the service had achieved compliance.

We found that improvements had been made and that people who lived at the home were receiving the care and support they needed and that their nutritional needs were being met.

Whilst we were at the home we observed that the staff were very busy and that this had an impact on some aspects of care, in particular the timely administration of medication. Staff told us that this was not always the case but not necessarily unusual.

We spoke with six of the people who lived at the home. These are some of the things they told us:

"Staff are very nice but they are always too busy to spend time with us"

"I am ok but people who need more help sometimes have to wait a long time"

"I'm bored, I need something to do"

Some people told us that staff were kindand "friendly" but one person said " Some staff are better than others, some you've got to watch"

Three people told us that they sometimes have to wait for support in meeting their needs and one person said "There is a lack of attention to detail"

We had mixed responses when we spoke to people who live at the home. One person said the home was alright but some staff "don't like to smile"

Another person said that they get help when they need it, that staff are kind but don't have time to sit and chat and that they would speak to the manager if there was something they were not happy about. This person also said that if they don't fancy the meal on the menu the cook will always provide an alternative that they like.

One person said they didn't like the home and that staff ignore them.

Staff told us that they enjoy working at the home.

We didn't speak to any relatives but saw some of the home's quality questionnaires from December 2011. People indicated a satisfaction with the home, one person wrote that they were "made to feel welcome by the whole team"

The inspection involved three visits. The first, carried out by two inspectors started at 9pm on 9 June 2014 and lasted for 3 hours. The second visit took place during the day on 11 June 2014. This was carried out by three inspectors and a specialist advisor. The third visit was made on 19th June 2014 because we had received more information of concern. During the inspections we spoke with the manager, the deputy manager,two company directors (one of whom is also the Nominated Individual), one agency nurse, one permanent nurse and twelve care assistants. Over the three visits we spoke with a number of people who lived at the home. Not all of the people we spoke with were able, due to complex care needs, to tell us about their experience of living at the home. We also spoke with two visiting relatives and one relative who contacted us with concerns.

We looked around the premises, observed staff interactions with people who lived at the home, observed lunchtime and looked at records. There were 28 people living at the home at the time of our inspection.

It should be noted that the person named as manager on this report is no longer employed at the service. The new home manager is currently applying to become the registered manager for the home.

When we visited Norman Hudson Care Home in February 2014 we found the care and welfare needs of people who lived at the home were not being met. We asked the provider to make improvements. We also found that procedures were not in place to keep people who lived at the home safe. We issued a warning notice to the provider in this regard. We went back on this visit to check whether improvements had been made.

Before this visit we had received information of concern about care and welfare of the people living at the home, staffing levels, and staff training and competencies. We looked at these areas during our visit.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Staff did not respond appropriately when we told them about an incident we had observed where one person who lived at the home hit another person. Medicines were not managed safely and the provider had failed to make sure appropriate procedures had been followed during an outbreak of diarrhoea and vomiting. We found that staff did not always demonstrate respect for people who lived at the home.

Is the service effective?

We found the health and wellbeing needs of the people who lived at the home were not always met. Poor organisation and deployment of staff meant that people did not always have their needs met in a timely fashion. One relative told us that due to poor communication from the home and problems with the care and support their relative received they were looking for a new care home.

Is the service caring?

We saw some staff supporting people in a kindly and respectful manner. However we saw other staff not being respectful of the privacy and dignity needs of the people who lived at the home. We saw that the provider had failed to ensure people's comfort when the heating system was broken and people were living in an uncomfortably warm environment. Some visitors we spoke with told us they were happy with the care their relative received.

Is the service responsive?

We saw that work was being planned to support people in meeting their social and recreational needs. However we saw that some people had not had their interests and preferences recorded and for one person they had been recorded but were incorrect. One relative told us that communication from the home was poor. The provider failed to respond immediately to some of the issues we raised over the course of our visits.

Is the service well led?

We saw that the Nominated Individual was working shifts as a nurse at the home to provide leadership and guidance to staff. However we found that not all staff were following the good practice procedures put in place by the Nominated Individual. Audits had failed to identify issues within the home and care records were not being audited to make sure people received the support they needed.

Where we have concerns we have a range of enforcement powers we can use to protect the safety and welfare of people who use this service. When we propose to take enforcement action, our decision is open to challenge by a registered person through a variety of internal and external appeal processes. We will publish a further report on any action we have taken.