Normandy House is registered to provide accommodation and support for up to six people with learning disabilities and complex needs. On the day of our visit, there were five people living at the service.

Our inspection took place on 18 April 2017 and was unannounced.

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.

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service. People had risk assessments in place to enable them to be as independent as they could be whilst remaining safe. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient numbers of staff who had the right skills and knowledge to meet people’s needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Systems were in place to ensure people’s medicines were managed in a safe way and that they received their medication when they needed it.

Staff received support and training to perform their roles and responsibilities. They were provided with on-going training to update their skills and knowledge. Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were provided with a balanced diet and adequate amounts of food and drinks of their choice. The service had developed positive working relationships with external healthcare professionals to ensure effective arrangements were in place to meet people’s healthcare needs.

People were looked after by staff that were caring, compassionate and promoted their privacy and dignity. We saw that people were given regular opportunities to express their views on the service they received and to be actively involved in making decisions about their care and support.

Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported. There was an effective complaints system in place which was used to drive future improvement within the service.

There were effective systems in place for responding to complaints and people and their relatives were made aware of the complaints processes. Quality assurance systems were in place and were used to obtain feedback, monitor service performance and manage risks.

Normandy House provides personal care and accommodation for up to six people who have learning disabilities and may also be living with dementia. The home is located in a residential area of Milton Keynes. On the day of our inspection there were five people living in the service.

We carried out this inspection on 21 March 2016, to check that improvements had been made following our focused inspection on 14 July 2015. This inspection was unannounced.

There was no registered manager in post during our inspection; however the service had a new manager who was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Although there were systems in place in respect of the Mental Capacity Act 2005 (MCA) these were not always used appropriately to ensure that decision specific assessments were completed for people.

Care plans were based upon people’s individual needs and preferences. We found that they were reviewed and updated regularly, to ensure they reflected the most up-to-date information regarding people’s care needs. However, records did not show that people or their relatives were full participants within the formal review process, which meant that their input into the care planning process was not always well documented.

Quality monitoring systems and processes were in place but were not always used as effectively as they could have been. The manager required time to embed their proposed changes so as to drive future improvement.

People felt safe in the service. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report potential abuse. Systems in place were not followed to ensure that appropriate action was taken to keep people safe from abuse or neglect. Potential safeguarding incidents were reported to relevant external agencies. Risk assessments ensured that staff understood how to manage risks to promote people’s safety.

Robust recruitment checks took place in order to establish that staff were safe to work with people. There were adequate numbers of staff on duty to support people safely and ensure people had opportunities to take part in activities of their choice. Systems and processes in place ensured that the administration, storage, disposal and handling of medicines were suitable for the people who lived at the service.

Staff were provided with an induction programme when they commenced employment and they also received on-going training, based on the needs of the people who lived at the service. They benefitted from additional support within regular supervision sessions which enabled them to discuss any concerns and training and development needs.

People were able to access snacks and fluids throughout the day. Meals were based upon their preferences and catered for specialist dietary requirements. People had access to health care professionals to make sure they received appropriate care and treatment to meet their individual needs.

Staff were friendly, kind and compassionate towards people. They engaged with them in a friendly manner and assisted them as required, whilst encouraging them to remain as independent as possible. Staff treated people with dignity and respect and understood their specific needs and wishes. Advocacy services were accessed to enable people to have a voice when this was appropriate.

People were supported to undertake activities both inside and outside of the service to keep them engaged. The service also had a complaints procedure in place, to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The service was led

Normandy House is a care home that provides personal care and accommodation for up to six people who have learning disabilities. The home is located in a residential area of Milton Keynes.

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.

During our inspection in March 2015, we found that risks to people’s safety had been not been adequately assessed. As a result, staff had no formal guidance to protect and promote people’s safety. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found that people were not always involved in maintaining and updating their care plans. This meant that records were not always accurate or reflective of people’s current needs. Although there were internal systems in place to monitor the quality and safety of the service, it was evident that these were not always used as effectively as they could have been. This was in breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make, and stating that improvements would be achieved by 10 July 2015.

This report only covers our findings in relation to the outstanding breaches of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Normandy House’ on our website at www.cqc.org.uk.

This inspection was unannounced and took place on 14 July 2015.

During this inspection, we found that risk assessments were now in place for the people living at the service. These were based upon their current needs and aimed to support people to take risks whilst ensuring their safety.

We also found that improvements had been made to the systems in place within the service, to ensure that appropriate standards of record keeping and quality assurance checks took place.

While improvements had been made we have not revised the rating for these key questions; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe and well-led at the next comprehensive inspection.

Normandy House is a care home that provides personal care and accommodation for up to six people who have learning disabilities. The home is located in a residential area of Milton Keynes.

The inspection took place on 19 March 2015.

There was no registered manager in post during our visit; however the service has a manager who is in the process of registering with the Care Quality Commission (CQC). 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 felt safe and were protected by staff providing their care.

Staff were knowledgeable about the risks of abuse and there were suitable systems in place for recording, reporting and investigating incidents.

However, risks to people’s safety had been not been assessed and staff had no written guidance to protect and promote people’s safety.

Staff numbers were based upon the amount of care that people required, in conjunction with their assessed dependency levels.

Standard recruitment policies and procedures were followed.

Systems and processes in place for the administration, storage and recording of medicines were not always adequate.

People were not always supported by staff that had been provided with appropriate knowledge and skills to carry out their roles and responsibilities. Although staff received support, the manager who was new in post, had not been able to undertake formal supervision for staff.

Staff knew how to protect people who were unable to make decisions for themselves. There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.

People’s nutritional needs had been assessed and they were satisfied with the support they received with their meals and drinks.

People’s physical health was monitored including health conditions and symptoms, so that appropriate referrals to health professionals could be made.

People had good relationships with staff and were happy with the support they received from them.

Staff enabled people to make choices about their care and daily lives and understood how to respect their privacy and dignity.

People were not always involved in maintaining and updating their care plans. Although staff documented their actions on a daily basis, records were not always accurate and reflective of people’s current needs.

The service had an effective complaints procedure in place. Staff were responsive to people’s concerns and when issues were raised these were acted upon promptly.

The provider had internal systems in place to monitor the quality and safety of the service but these were not always used as effectively as they could have been.

We found the service was in breach of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three people and they were able to tell us that they were happy living at Normandy House. One person showed us their room which had been decorated with their choice of furnishings and colours.

As some people at Normandy House were not able to talk to us about their care, we spoke with relatives and family members. One person told us that “the staff are fantastic”. Another person said that they were pleased with the care that their relative was receiving.

We saw that the provider had a safe and effective system in place for the management of medicines, and that there were sufficient members of staff to provide the care that people needed.

We were concerned that not all records had been kept up to date when people’s needs had changed, and that some staff had been provided with informal training but we could not find any records which demonstrated that their competency had been assessed.

We saw that adequate food and drink was provided by staff in the way that best met people’s requirements.

We saw all the people who lived at Normandy House. Not all of the people who used the service were able to talk with us due to communication difficulties. We observed care and support being carried out by staff who engaged very well with all of the people, and were respectful of their needs such as privacy and dignity.

People told us that they were happy at Normandy house and that they had no complaints.

Normandy House was very clean, warm and homely.

We spoke with two people who used the service. They told us they were happy at Normandy House and that they felt safe. We saw that when people returned from their day centre activities they appeared relaxed and happy to see the staff. Comments included, "I like it here," and "The staff are nice."