This inspection took place on 11 December 2018 and was unannounced. At our last inspection of the service in March 2018, the service was rated as Requires Improvement. We found the provider's arrangements for assessing risks for people were not always completed, medicines were not always administered safely and systems to monitor the quality of the service provided were not always effective. There were breaches of Regulations 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. At this inspection, we found that improvements made were sufficient to rectify the breaches and the overall rating has improved to Good.

Normanton Village View Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to 72 people across four separate units, each of which have separate adapted facilities. The service specialises in providing care to people living with dementia with varying dependency needs. At the time of our inspection there were 43 people using the service, and three of the four units were in use.

There were two registered managers in post who shared responsibility for the service. 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.

Records and observations of care provided did not support there were always enough staff deployed in the service to provide people's care in a timely manner. Following our inspection, the registered manager told us they were developing a staff dependency tool to enable them to ensure sufficient staff were always deployed across the service to meet people's needs.

Staff had a good understanding of their role in keeping people safe and protecting people from the risk of abuse. Risk assessments were in place and regularly reviewed to manage potential risks within people's lives, whilst also supporting their independence. Accidents and incidents were analysed to ensure lessons were learnt to reduce the risk of future harm for people.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out so only suitable staff worked at the service.

Medicines were managed and administered safely and as prescribed. Staff followed safe infection control procedures to protect people from the risk of acquiring health related infections.

Staff induction training and on-going development training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people's needs were met. Staff were well supported by line managers and had regular one-to-one supervisions.

People's needs were assessed to ensure care provided met with their needs and they were supported to maintain their health and well-being. People who were at risk of poor nutrition, were supported to ensure they had sufficient amounts to eat and drink. People and relatives were positive about the quality of the meals provided.

People's consent was gained before any care was provided. People were supported to have maximum control and choices of their lives and staff supported them in the least restrictive way possible.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people's likes and dislikes and staff were knowledgeable about peop

We carried out a comprehensive, unannounced inspection on 22 March 2018. The previous comprehensive was undertaken in September 2017. At this inspection the provider had breached six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. These breaches related to staffing, safe care, consent, dignity and respect, person centred care and good governance. The service was rated as 'Inadequate'. At the present inspection we found the provider had made some improvements against breaches. However, we found further improvements were required to ensure the provider was able to consistently deliver good care for people. You can read the report from our last comprehensive inspection and our focused inspection, by selecting the 'all reports' link for Normanton Village View Nursing Home on our website at www.cqc.org.uk.

Following the last inspection in September 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well-led to at least good.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this time frame. At this inspection the service demonstrated to us that some improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Normanton Village View Nursing home is a 'care home' with nursing and is registered to provide accommodation to people who require personal or nursing care for up to 72 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is provided across two floors which are split into four separate units. At the time of our inspection there were 38 people living in the service, many of whom were living with dementia.

There was 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.

Risks to people had been assessed and staff demonstrated they understood how to support people safely. However, we found inconsistencies in people's care records. Some records lacked clarity in providing guidance for staff on the measures they needed to take to keep people safe. People's care records did not always reflect people received care to meet their assessed needs and keep them safe. Records lacked the detail and guidance staff needed to intervene when people became distressed or anxious in order to keep them safe.

People did not always receive medicines administered covertly (disguised in food and drink) as prescribed. Other aspects of medicines were, in the main, managed safely.

The provider had made improvements to systems and processes to monitor the quality of the care provided. However, these systems were not always effective in bringing about improvements that were embedded into staff working practices to ensure people received consistently good care.

People did not always receive the support they needed to eat their meals. Further improvements were needed to ensure people experienced a positive dining experience.

Staff did not always demonstrate the awareness they needed to ensure people's right to be treated in a dignified manner was protected.

Staff had completed training to enable them to recognise the signs and symptoms of abuse and felt confident in how to report concerns.

People were protected from the risk of unsuitable staff because

This inspection took place on 4 and 5 September 2017 and the first day was unannounced.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with Care Quality Commission (CQC) about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks.

The provider is registered to provide accommodation for up to 72 older people living with or without dementia; the home covered two floors and was split into four separate units, two on each floor. There were 55 people using the service at the time of our inspection.

At our last inspection on 7 June 2016, we asked the provider to take action to make improvements in the area of consent. We received an action plan setting out when the provider would be compliant with the regulation. At this inspection we found more work was required in this area and the regulation was not complied with.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

A registered manager was registered with the CQC; however, they had recently stopped working at the service. A representative of the provider was present both days of the inspection and told us they would be applying to register as manager for the service. 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.

Risks were not always managed so people were protected from avoidable harm. Staff did not always follow safe medicines management and infection control practices.

Sufficient staff were not always on duty to meet people’s needs. Staff understood their duty to protect people from the risk of abuse but did not always know how to report any concerns to external organisations.

Staff were recruited through safe recruitment practices.

Staff felt supported but did not always receive appropriate induction, training and supervision. People’s rights were not fully protected under the Mental Capacity Act 2005.

People told us they received suffic

The inspection visit took place on 07 June 2016 and was unannounced. This meant the staff and provider did not know we would be visiting.

Normanton Village View provides nursing and residential care for up to 80 people. At the time of our inspection there were 45 people using the service and one person in hospital.

The service had a registered manager in place at the time of our 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.

People and their relatives had been involved in planning the care and support they received from the service. Their needs had been identified, assessed and reviewed on a regular basis.

People received care in a dignified manner that protected their privacy. People were protected from the risk of abuse as staff understood what constituted potential abuse or poor care and knew how to report concerns.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Mental Capacity Assessments were carried out where key decisions were required and the principles of the MCA had been adhered to. Applications had been made to the supervisory body for consideration under DoLS; however the provider was no able to consistently demonstrate that people were supported to make decisions about their care in accordance with MCA.

People received care and support from staff that had appropriate training and who received regular reviews from the registered manager about their performance.

People were encouraged to undertake activities that interested them and to make choices everyday choices about how they spent their time and what they wanted to eat and drink.

Staff had been employed following recruitment checks. We saw that staff had a police check to ensure they were safe to work with people. However we found in some recruitment records that gaps in employment and references were not verified.

The registered manager and registered provider continuously assessed and monitored the quality of the service and actions plans were in place where areas of improvement had been identified. However these audits did not identify the issues we found during the inspection visit.

Feedback was obtained from people who used the service and their relatives. Records showed that systems for recording and managing complaints, safeguarding concerns and incidents and accidents were managed well. However we found that people’s resuscitation records were not correctly completed and people’s care plans did not always contain the sufficient and up to date information.

You can see what action we told the provider to take and the end of this report.

Prior to our inspection we reviewed all the information we had received from the provider. On the day of our visit we spoke with 13 people that used the service, and three visiting relatives for their views and experiences. Some people who used the service were not able to tell us their experience of the care they received due to illness or disability. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We also spoke with the registered manager, senior manager, deputy manager, care staff including domestic and nursing staff. We looked at some of the records held in the service, including the care files for six people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

We found there were insufficient numbers of experienced and skilled staff available at all times, to meet people’s assessed needs, and safeguard people’s health and welfare needs.

The cleanliness of the service, including the cleaning of equipment required improvements to ensure people, visitors and staff were fully protected from the risks of cross contamination.

The service adhered to the Deprivation of Liberty Safeguards. This meant people’s human rights were protected.

Is the service effective?

Whilst the provider assessed people’s needs, people’s plans of care lacked personalised information.

Some people had behavioural needs associated with their dementia. We were concerned that staff did not have the required support, information and guidance from appropriate healthcare professionals.

Is the service responsive?

People received opportunities to participate in activities such as arts and craft. However, these were not always planned for appropriately, and activities were not based on people’s known interests and hobbies.

The provider had a complaints procedure available for people and their relatives. We saw what action the provider had taken in response to complaints and concerns raised.

We saw information was available on independent advocacy services.

Is the service caring?

We found staff spoke to people politely and on the whole used people’s preferred names. However, our observations of staff engagement with people, showed the quality of care and interaction was poor. People did not always receive care and support that was dignified and respectful.

Is the service well-led?

The registered manager had recently returned from a period of absence. People who used the service, relatives and staff told us they found the registered manager to be supportive and approachable and that their leadership was good.

The provider had asked people who used the service, and relatives through a satisfaction survey for their views about the service provided.

We saw accidents and incident were recorded and analysed to look for lessons learnt to reduce further incident. Checks were in place that monitored the safety of the service.

There were 70 people using the service on the day of our visit. People that were unable to give their views due to their level of dementia appeared comfortable with the support they received. People using the service that were able to give their views told us, “the staff are all very good, very polite and respectful.” And “the staff are very respectful, very agreeable and pleasant.”

Visitors told us, “I have no worries about the care here; the staff are very good, they are so friendly and always let me know if there are any problems.” And, “I honestly can’t fault the place, my relative receives very good care, it’s such a weight off my mind because I know they are well looked after.”

We observed care practices throughout the day and saw that staff were responsive to people’s needs and wishes. We also observed a positive and friendly relationship between the staff team and visitors.

Records seen demonstrated that arrangements were in place to ensure that people who were unable to give valid consent were supported in their best interests.

The care plans seen reflected people’s individual needs and took into account equality and diversity issues such as individual preferences and choices, religion and dietary needs.

Aids and adaptations were available and suitable to meet people’s needs, including adapted cutlery, hoisting equipment, mobility aids, lifts, toilets and bathing facilities.

People using the service said they were happy with the support they received from the staff team. Comments included, “ the staff are lovely, they come and check I’m alright and often persuade me to come and sit in the communal area’s , which I do sometimes.” Another person said, “they are all very nice, always seem happy to help me.”

People confirmed that staff treated them respectfully and ensured their dignity and privacy was maintained. We saw some good examples of people being treated with dignity and respect. Staff were polite and helped people in an unhurried way.

People that we spoke to appeared relaxed and comfortable and were able to move freely and safely around the communal areas of the home.

Comments from visitors were positive regarding the care and support provided to their relative. One visitor told us, “I have peace of mind now that my relative is here, I know that they are looked after well. “ Another visitor told us that their relative had recently moved into the home, they said, “ so far everything seems good, the staff are friendly and always welcoming. “ This person confirmed that their relative always looked clean and well groomed when they visited. They said, “they seem to have settled in well and I would know if they weren’t happy.“

One visitor to the service explained “my relative has been here for seven years. I am happy with the care and all of the staff. The staff understand their needs”. This person also told us “my relative can’t really talk, but the staff stop and chat to me. I am also looked after when I visit”.

Another visitor told us “my relative is physically getting better here. The staff are friendly and they make an effort”.

One person using the service said “sometimes the carers are busy, I think there could be more carers”. Another person mentioned that “sometimes I wait for about ten minutes to be seen to”.

One person using the service said “I think I get all of the medication I need. They are always prompt”.

We received the results of two surveys carried out by the Derby local involvement network (LINk). One person said that they are "Happy - comfortable, better off here than I am at home, the nurses take good care of me." The other person said "The people, the staff are wonderful and the food is good" and "They really do care".

We spoke to some people using the service during our visit. We were told that one person "feels well looked after. I go out with staff or friends, visiting the dentist later today". A relative we spoke to said that they were "very happy with the care".

We received the results of two surveys carried out by the Derby LINk. When asked what aspects they liked the most about living at Normanton Village View one person said "The food, good choice, the cook and the nurses." The other person said that one important aspect of living at the service was "good food".

During our visit one person told us that they "don’t eat a great deal due to condition but staff offer alternatives". A relative that we spoke to said they "have observed staff assisting with feeding and drinks are available."

We carried out an unannounced inspection of the service on 15 and 16 April 2015.

Normanton Village View Nursing Home provides accommodation for up to 80 people who require nursing or personal care. On the day of our inspection 40 people were using the service and two people were in hospital.

There was a registered manager in place. 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 last inspection on 2 September 2014 we asked the provider to take action to make improvements to protect people living at the home. The provider was not meeting four Regulations of the Health and Social Care Act 2008. These were in relation to people’s care and welfare, cleanliness and infection control, staffing and supporting workers. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. While we found that the actions we required had been completed and these regulations were now met, the provider needed more time to fully embed these improvements.

People told us that they felt safe living at Normanton Village View Nursing Home. We were aware that the commissioners of the service that funded some people had concerns about the safety of people due to a high number of safeguarding incidents. We found the service had worked with commissioners to investigate concerns and had taken action where required to manage and reduce further risks. This included a review of some people’s needs and additional training for staff. The service had developed a new system to record accidents and incidents including safeguarding incidents, to enable them to better analyse patterns and trends and to look at lessons learnt to protect people further.

The risk management plans to support people with behaviours that presented a risk to themselves or to others had improved since our last inspection. Staff had more detailed information about how to meet people’s needs and keep people safe. Staff had also received awareness training in managing behaviour that staff spoke positively about and that they felt was of benefit. Where risks had been identified with people’s healthcare needs these had been assessed and planned for.

People and their relatives told us they felt there were sufficient staff available to meet their needs and that they had seen improvements with the deployment of staff. This included staff being more visible within the communal lounges. People said that their requests for assistance were responded to by staff in a timely manner.

The registered manager regularly assessed people’s dependency needs and had involved commissioners where people’s needs had changed.

People and their relatives did not raise any concerns about how their medicines were managed or administered. We found people received their medicines as prescribed by their GP. Where people received medicines covertly this had been assessed and authorised appropriately. However plans of care did not include the information that staff administering medicines required so that they could do so consistently safely.

People and their relatives were positive about the experience and knowledge of staff that supported them. The provider had recruited another deputy nurse who was qualified in mental health who would further benefit the service with their knowledge, experience and skills. Whilst staff had received additional training in dementia care we found that all staff still had limited awareness of dementia care. The registered manager was aware of this and had made arrangements for staff to receive further training. We spoke with a consultant psychiatrist who supported some people within the service. They told us they were planning to provide staff with additional support and guidance about the needs of people living with dementia.

The systems to support staff had improved and staff had received appropriate supervision and support to review their practice and training needs. Further improvements had been planned to ensure staff received consistent and regular support.

The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards legislation was adhered to but further improvements were required with regard to MCA assessments to ensure people’s human rights were fully protected.

People told us they received sufficient amounts to eat and drink and that they were happy with the food choices. We observed people were supported where required with their meals and drinks and snacks were frequently offered.

Healthcare professionals involved with the service said that referrals were made in a timely manner and that their recommendations were followed. Improvement around staff communication was highlighted as an area of improvement by some healthcare professionals and staff employed at the service.

People and their relatives spoke positively about the staff’s care and attitude. We observed staff to be kind, caring and compassionate. On the whole positive engagement was observed where people’s care and wellbeing, dignity and respect were maintained.

Whilst information recorded in care files had improved since our last inspection further improvements were required to ensure information was personalised. People told us how activities, hobbies and interests were supported. The provider was in the process of recruiting an additional activity coordinator. We saw people received opportunities to pursue their hobbies and interests but found the environment required further improvements to support people living with dementia.

The registered manager was praised by people that used the service and staff and had made a positive contribution in bringing about positive changes within the service. They were aware of the continued shortfalls required and showed a commitment in achieving improvement.

The provider had systems in place that monitored the quality and safety of the service. Some improvements were required to ensure these checks were consistent and robust.