Norwood House provides accommodation and personal care for up to 71 older people. There were 41 people living in the home when we inspected on 1 November 2018. The home was situated in a rural area of Middleton Moor on the periphery of the village of Saxmundham in Suffolk.

Norwood House 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. This comprehensive inspection took place on 1 November 2018 and was unannounced. Our last inspection at Norwood House in February 2018 was the third comprehensive inspection since 2016 where we had rated the home requires improvement overall. At the inspection in February 2018 we found nine breaches of the regulations. We were concerned that there were insufficient staff deployed on shifts and that people were not always treated with dignity and respect because staff were task focussed and care was hurried. We could not be confident that people always received the care and support they needed because care plans were not all reflective of people's current support needs.

We were also concerned that staff did not have a good understanding of how to safeguard adults from abuse and harm and the provider had not ensured they carried out their responsibilities to comply with the requirements of the Mental Capacity Act (MCA) 2005. In addition, notifications of events and incidents were not always submitted in accordance with statutory regulations. Due to the failure to make and sustain the necessary improvements we rated the key question of 'well-led' inadequate at that inspection.

Following the last inspection, we met with the provider to discuss the necessary actions improvements and seek their assurances that appropriate action would be taken.

You can read the reports from our previous comprehensive inspections, by selecting the 'all reports' link for Norwood House on our website at www.cqc.org.uk

During this inspection, we reviewed actions the provider told us they had taken to gain compliance against the breaches in regulations identified at the previous inspection in February 2018. Shortly after our inspection in February 2018 the registered manager at that time left employment at Norwood House. A new manager commenced in the role of general manager at Norwood House in April 2018. They successfully applied to register with the Care Quality Commission as a registered manager in October 2018. 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.

At this inspection we found improvements had been made. Work had taken place since our last inspection to improve the safety, effectiveness and quality of the service. At this inspection in November 2018 we found two breaches of the regulations of the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. This was in relation to the safe recruitment of staff and also the lack of a call bell system which enabled people to seek staff assistance from their bedrooms. We also made a recommendation in respect of the ongoing close monitoring of staffing levels and a recommendation about end of life care. We also found that the work to improve the service was in its early stages but clearly underway and the new management team which consisted of the recently registered manager and a new deputy manager were committed to ensuring the required improvements took place. At this inspection we found further improvements were required to ensure a consistent delivery of safe care and treatment that could be evidenced in the longer term. You can see what action we told the provider

Norwood House provides accommodation and personal care for up to 71 older people. There were 41 people living in the home. The home was situated in a rural area of Middleton Moor on the periphery of the village of Saxmundham in Suffolk.

Norwood House 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. This inspection took place on 21 and 23 February 2018 and was unannounced.

There was a registered manager in post 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.

At our last comprehensive inspection in November 2016 we rated the home requires improvement. We recognised that whilst improvements had been made some of these were on going and not yet fully implemented, sustained and embedded into practice. We also found that further improvements were needed to ensure people are provided with their medicines safely at all times. Improvements were needed to show how people were provided with person centred care which was tailored to meet their specific needs. We also recommended that the service seek training for staff which was specific to the needs of the people using the service.

Prior to the inspection in November 2016 we carried out an inspection in April 2016. At this inspection we also rated the home requirements improvement, inadequate in well led and found that there were four breaches of the regulations. This inspection is the third comprehensive inspection since 2016 where we have rated the home requires improvement overall. We have also found nine breaches of the regulations. Due to this and the failure to make and sustain the necessary improvements we have rated the key question of ‘well led’ inadequate. You can read the reports from our previous comprehensive inspections, by selecting the 'all reports' link for Norwood House on our website at www.cqc.org.uk

We found that people were not always kept safe as there were insufficient staff deployed on shifts and whilst staff knew people well and were kind, they were not able to meet their care needs as they did not have sufficient time. People told us that staff were kind and caring but they often had to wait for care to be delivered due to the home being short of staff.

Notifications of events and incidents were not always submitted in accordance with statutory regulations. Registered managers and providers are required to submit to CQC statutory notifications in accordance with regulatory requirements however we found a number of safeguarding incidents that had occurred at the home which we had not been notified of.

Staff did not have a good understanding of how to safeguard adults from abuse and harm and who to contact if they suspected any abuse however they knew how to access this information should they have needed to.

The provider had not ensured they carried out their responsibilities to comply with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Where people could not always make decisions themselves, mental capacity assessments had not been completed.

People received support from staff that were mostly kind and caring. However, people were not always treated with dignity and respect because staff were task focussed and care took place in a manner that was not centred on people as individuals and was at times hurried.

Care plans were not all reflective of people’s current support needs; the information within them was not always detailed. We could not be confident that people always recei

Norwood House provides accommodation and personal care for up to 71 people, the majority living with dementia.

There were 43 people living in the service when we inspected on 15 November 2016. This was an unannounced inspection.

There was no 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. A new manager was employed in the service since September 2016, they were in the process of completing their registered manager application.

At our comprehensive inspection of 11 April 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which were: Regulation 9 Person centred care, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 20 Duty of candour. At our focused inspection of 14 September 2016 we found that improvements had been made in Regulation 20 Duty of Candour.

You can read the report from our last comprehensive and focused inspection, by selecting the 'all reports' link for Norwood House on our website at www.cqc.org.uk.

This comprehensive inspection was undertaken to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection of 11 April 2016 had been made.

In the short time that the manager had been working in the service there had been significant improvements made. However, some of these were ongoing and not yet fully implemented, sustained and embedded in practice. The manager was fully aware of the improvements they still needed to make and had plans in place to implement these. Improvements had been made in the service’s quality assurance processes which were used to identify shortfalls and address them. There was now a system in place to manage complaints and these were used to improve the service.

Some improvements had been made in the safe management of medicines. However these were ongoing and further improvements were needed to ensure people are provided with their medicines safely at all times. There were systems in place to store, obtain, dispose of and administer medicines safely and to maintain records relating to medicines management.

Some improvements had been made in people’s care panning documents. However, these were not yet fully implemented and further improvements were needed to show how people were provided with person centred care which was tailored to meet their specific needs. Further improvements were needed in how staff responded to people’s needs.

Staff had been provided with training relating to their work role. However, the manager was in the process of assessing the training received by staff and what they needed to meet people’s needs effectively. We have recommended that the service seek training for staff which is specific to the needs of the people using the service.

Improvements had been made and the service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People were provided with the opportunity to participate in meaningful activities. People were treated with respect and care by the staff working in the service.

Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse. Where incidents had occurred actions had been taken to reduce future risks.

There were sufficient staff numbers to meet people’s needs safely. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fi

Norwood House provides accommodation and personal care for up to 71 people, some living with dementia. There were 50 people living in the service when we inspected on 14 September 2016.

We undertook an unannounced focused inspection of Norwood House on 14 September 2016. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection of 11 April 2016 had been made. The team inspected the service against one of the five questions we ask about services: is the service well-led? This is because the service was not meeting some legal requirements.

We undertook this focused inspection to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Norwood House on our website at www.cqc.org.uk.

Following our last inspection we issued a warning notice in which we told the provider the areas they needed to improve on relating to the Duty of Candour. This included the actions they should have taken following an incident including investigating it, keeping the person, or their representatives where appropriate, informed of the investigation outcomes and providing an explanation and/or apology for the incident. The purpose of this focused inspection was to check that the provider had made the required improvements. We found that the provider was working to the requirements of Regulation 20 Duty of Candour and the appropriate improvements had been made.

We have changed the rating for well-led from inadequate to requires improvement, this is because the provider has made the improvements required as identified in our warning notice in relation to the Duty of Candour. The overall rating for the service has not changed. We will follow up on other areas of improvement identified at our last inspection in a comprehensive inspection in due course.

There was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was a new manager in post who had started working in the service 5 September 2016.

Norwood House provides accommodation and personal care for up to 71 people, the majority living with dementia.

There were 54 people living in the service when we inspected on 11 April 2016. This was an unannounced inspection.

The registered manager had recently left 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.

Improvements were needed to ensure that people were provided with their medicines when they were prescribed.

Staff were trained in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). However, people’s care plans did not sufficiently identify which areas of their care they could consent to and which areas they needed assistance with. DoLS referrals had not been kept under review to ensure any restrictions met people’s current needs.

Improvements were needed in people’s care records to identify people’s specific conditions and how they impacted on their daily living. Some care records had not been kept up to date and were contradictory in parts. Improvements were needed in how people's anxiety and incidents were used to plan and provide people's care.

A complaints procedure was in place. Records of complaints were not all complete.

The service’s quality assurance system was not robust enough to independently identify shortfalls and address them. The service was not up to date with their responsibilities under the Duty of Candour.

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

There were systems in place to safeguard people from abuse.

Staff were trained and supported to meet the needs of the people who used the service. Improvements were ongoing to ensure staff were provided with regular supervision meetings. Staff were available when people needed assistance, care and support. The recruitment of staff was safely completed to make sure that they were suitable to work in the service.

People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner. People were provided with the opportunity to participate in activities which interested and stimulated them.

Prior to our inspection, the service had notified us of an incident that had occurred in the service. During our inspection visit we looked at the actions taken to reduce the risks of similar happening again and the action the provider had taken as a result of this. We are in the process of considering our regulatory responsibilities and action. If we do take further action we will report on this.

We had received some information of concern and therefore decided to carry out a responsive review of the service. During our inspection we spoke with ten people who used the service and two relatives. We also spoke with the manager and eight staff.

Norwood House provided a service for people with dementia. On the day of our inspection 43 people were resident. We looked at the care records for five people who used the service. We also looked at how they consented to their care, how their care and health needs were met, how they were safeguarded from harm, how staff were supported and supervised and quality assurance.

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?

The service had ensured that staff were provided with the knowledge and skills to keep people safe and protect them from harm. Staff we spoke with told us that they were aware of the action they would take if they suspected abuse was or had taken place.

We found that the service had suitable arrangements in place to gain people's consent and assess their mental capacity to make decisions before acting on their behalf. Deprivation of Liberty Safeguards (DoLS) were in place for people who needed them, to protect their best interests.

The monitoring of people’s health and well-being through the review of care plans, risk assessments and daily records ensured people were provided with care and support that ensured their welfare and safety.

Is the service effective?

People's assessments showed that their care, support and treatment was planned and delivered in a way that ensured that their needs were being met. People were fully involved, where possible, in choices and decisions about their lives. This made their care more effective as it enhanced their wellbeing and independence.

Is the service caring?

We saw good interaction between staff and people who used the service. Staff spoke to people respectfully; they were considerate, courteous and kind. Staff had a good knowledge of people's likes and dislikes and spent time with them. This showed that people were cared for by staff who were thoughtful and caring.

Is the service responsive?

Regular checks on the dependency levels of people who used the service were undertaken. There were sufficient staff on duty to respond to people's needs appropriately.

We saw from the records viewed that the service worked well with other agencies. A range of health, mental health and social care professionals from the community were involved in people's care. This showed that people received their care in a joined up way.

Is the service well-led?

Regular care reviews and discussions about people's quality of life at Norwood House were discussed with them and their families. This ensured that people's changing needs and preferences were always taken into account.

Management systems were in place to ensure that staff had the necessary skills and abilities to do the job and that they were supported in their role.

The service was well-led as it was continually improving in its care provision.

We talked with six people who used the service to gain their views and experiences about the service they were provided with. They told us their needs were met and staff treated them well. One person told us, “The staff are brilliant. I love it here.” Another person said, “I have got to be here so I make the most of it. It’s not so bad. Bit like a home from home except it’s not. People are nice here and the staff are good.”

All six people told us that they were satisfied with the service provided. One person said, “I love it here. Everything is just as it should be.”

People we spoke with confirmed they were consulted about the care and support that they were provided with and understood the care and treatment choices available to them. One person told us, “They (staff) are good. They tell me what is going on and when I need to go to hospital. They remind me to take my medication and tell me what it is for.”

We looked at four people’s care records which provided information for staff on how to meet people’s individual health and care needs. We saw that people’s choices and preferences were reflected in their care records and written in a way that promoted independence.

People said they were given a variety of meals that were, “Tasty,” “Always warm,” and, “Appetising.” One person said, “The food is nice. I enjoy what we have.” People confirmed that if they didn’t want what was on the menu they could have something else. One person told us, “I don’t like big dinners. I prefer baked beans on toast or omelette. So sometimes that is what I have.”

We saw that the service provided enough qualified, skilled and experienced staff to meet people’s needs. We looked at staff records and spoke with three members of staff who told us they were being appropriately supervised and supported. Staff were knowledgeable about the people they supported and how to meet their needs.

We saw that the provider had records in place that were accurate and fit for purpose.

During our inspection we observed that the interaction between staff and people using the service was friendly, respectful and professional. We saw that staff sought people’s agreement before providing support or assistance.

We spoke with people who use the service, relatives of people who use the service, three members of staff and two visiting professionals. We saw the staff respond to the choices that people made during our inspection. This included the drinks and meals that they wanted and whereabouts in the service they wanted to be.

People told us that they felt that the support they received from the service met their needs. A relative said, “I think they do a wonderful job under the circumstances."

People with whom we spoke said that they felt safe whilst living at Norwood House. The relatives of people who use the service told us that they were happy to raise any concerns with the manager or deputy, and that they felt listened to.

People were complimentary about the approach of the staff who supported them. One person said, "The carers are superb, lovely people." During our visit we saw that staff were attentive to people's needs. They responded to verbal and non verbal requests for assistance promptly.

We saw evidence of audit checks by senior members of staff. We also saw evidence of the regular review, and amendments to, care plans and risk assessment. This showed us that the service responded to the changing needs of people who used the service as and when required.

People told us that they were happy living at Norwood House. 'The girls are very good. They are kind'. People told us they liked their rooms and thought the food was good. People told us that they were happy living at Norwood House. 'The girls are very good. They are kind'. People told us they liked their rooms and thought the food was good.