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.

Norwood House is situated in Scarborough. The home accommodates up to 20 older people or people living with dementia in one adapted building. They do not provide nursing care.

Inspection site visits took place on 25 and 27 September 2018. At the time of this inspection, the service was providing support to 9 people.

At the last inspection in January and February 2018 the provider was found to be in breach of six regulations. These were Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 15 Premises and equipment, Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper persons employed.

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: Is the service Safe, is the service Effective, is the service Caring, is the service Responsive and is the service Well-led to at least good.

There was a manager in post but they had not yet registered with CQC. At the time of writing this report, an application for the manager to register had been submitted. 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.

Recruitment processes had still not been established and operated to ensure new staff were recruited safely. One to one supervisions had not taken place in accordance with the providers supervision policy. We have made a recommendation about staff supervisions. A plan was in place to ensure all staff were provided with an annual appraisal.

Risks to people had been assessed and recorded although we found some shortfalls in relation to choking risks. Appropriate checks were in place to ensure the environment and the premises were regularly maintained. Risks in relation to windows, bed safety rails and fire safety were in place and regularly reviewed.

Medicines had been stored and administered safely. Assessments of staffs’ competencies in this area had been conducted to ensure they had the skills and knowledge to manage and administer medicines.

The service was generally clean and tidy although further redecoration was needed in some areas where walls were scuffed or marked. A cleaning schedule was in place to ensure the service followed good infection control practice. Malodours were evident in some bathrooms.

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. Information was not appropriately recorded in relation to best interest decisions. We have made a recommendation about the recording of best interest decisions

People were provided with a variety of meals that they told us they enjoyed. Where people required specialist diets, all staff were not always aware of their needs. Food monitoring charts had not always been completed sufficiently to enable staff to effectively monitor people’s nutritional intake.

People told us staff were kind and caring and treated them with dignity and respect. Where possible, people’s independence was promoted although people were not always presented with information in a format they could understand. We have made a recommendation about accessible information.

Care plans contained person-centred information which focused on the individual. Pre-admission assessments had been completed prior to a person movin

Norwood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Norwood House can accommodate up to 20 people and is registered to provide care and accommodation for older people, some of whom may be living with dementia. It does not provide nursing care. During our inspection 12 people were using the service most of whom had some degree of cognitive impairment, such as dementia.

This inspection took place on 11 January, 1 February and 26 February 2018. The inspection was due but was prompted, in part, by the death of a person who used the service who had fallen from a window. The first day of inspection was unannounced; the second and third days were announced. At the time of our inspection, a registered manager was in post but was taking a period of leave. 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. As a result of the absence of the registered manager the service was being overseen by an interim manager.

At the last inspection undertaken on 22 December 2015, we rated the service as Good.

At this inspection, 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.

Robust systems and process were not in place to ensure the safety of people who used the service in the event of a fire. Regular testing of fire-fighting equipment and safety checks of the environment had not taken place. Fire drills had not been completed with all staff to ensure the procedure would work at different times of the day. This was promptly rectified with all staff attending drills and evacuation practises.

The registered manager and provider had not assessed or properly managed environmental risks. Environmental risk assessments had not been completed and deficits within the service had not been identified and rectified by the provider. For example, we found that combustible materials were stored in a fuse box and wheelchair and bedrail risk assessments were not completed. This put people at risk of avoidable harm. Many of the windows at the service were sealed shut and others opened too widely. Single glazed windows were not adequately protected.

Recruitment procedures were not established and operated effectively to ensure that new staff were of good character. Appropriate checks had not been completed.

Staff were knowledgeable about the people who lived at the service, however, the provider had not ensured staff training was appropriately facilitated and up-to-date. The person delivering training was not qualified to do so, therefore training was invalid.

There was a sufficient number of staff on duty. The deployment of staff was adequate for the number of people who used the service. Staff responded to people’s needs in a timely manner.

People were not supported to have maximum choice and control of their lives and the policies and systems in the service did not support this practice. The registered manager and the provider failed to adhere to the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We found people were unlawfully deprived of their liberty as DoLS assessments hadn’t been requested when required.

Medicines were

This inspection was undertaken on 22 December 2015, and was unannounced. The service was last inspected on 2 September 2014 and found to be compliant with all of the regulations that we assessed.

Norwood House is registered to offer personal care and accommodation for up to a maximum of 20 people. The home specialises in care for people who are living with dementia.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and knew what actions to take if they suspected abuse had occurred. Staff who had been recruited safely were deployed in suitable numbers to meet the assessed needs of the people who used the service. People’s medicines were stored safely and administered as prescribed.

People were supported by staff who had been trained to carry out their roles effectively; they had the skills and abilities to communicate with the people who used the service. Consent was gained before care and support was delivered and the principles of the Mental Capacity Act were followed within the service. People were supported to eat a balanced diet of their choosing. When concerns were identified relevant professionals were contacted for their advice and guidance.

People told us they were supported by kind and caring staff who knew their preferences for how care and support should be delivered. During observations it was clear caring relationships had been developed between the people who used the service and staff. People’s privacy and dignity was respected by staff who understood the need to treat sensitive information confidentially.

People were involved with the initial and on-going planning of their care. Their levels of independence and individual strengths and abilities were recorded. People were encouraged to maintain relationships with important people in their lives and to follow their hobbies and interests. The registered provider had a complaints policy which was made available to people who used the service. When complaints were received they were used to develop the service possible as required.

Staff told us the registered manager was approachable, supportive and listened to their views regarding developing the service. A quality assurance system was in place to ensure shortfalls in care, treatment and support were identified. Time based actions plans were developed to improve the service when required. The registered manager understood their responsibilities to report accidents, incidents and other notifiable incidents to the CQC. The registered manager worked closely with the local commissioning teams and an independent care group to ensure best practice was implemented within the service

A single inspector carried out this inspection. The focus of the inspection was to answer: is the service safe? We wanted to check that the provider had taken action to improve this area which was none compliant at our last inspection.

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

Is the service safe?

At this visit we looked at the shortfalls that were found with the safety and suitability of the premises. We found that improvements had been made and action had been taken to address the issues that were found in June 2014. A member of staff we spoke with said “We have taken action to make sure the home environment is safe and pleasant for people.”

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

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

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

The service had policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DOLS). There was no one currently using the service who had a DOLS in place. The provider knew how to request an assessment if this was required. Staff received safeguarding and MCA training. This meant staff were aware of procedures they must follow in order to ensure people were safeguarded.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks.

People were protected from the risk of infection because staff followed good infection control practice and these practices were monitored regularly.

Some areas of the home were ‘cluttered’ with unused equipment and some items accessible to people which would pose a risk to their health and safety.

There were sufficient care workers to respond to people's health and welfare needs. One person said "There are always enough staff around, I don’t have to wait" Another person said "Staff are busy but they do have time to spend with me."

Is the service effective?

An assessment was completed prior to people being admitted to the service which detailed people's needs. Care plans covering areas such as personal care, mobility, nutrition, daily and social preferences and health conditions were completed. We saw corresponding risk assessments in place. We could see that people's care had been reviewed and their plans amended

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere.

One person said “The staff are very nice we’re like a family”. And another person said “I have no worries about the care my relative gets.”

Is the service responsive?

People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the manager to address any shortfalls or concerns.

Is the service well-led?

The service had a developing quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff told us the manager was supportive and promoted positive team working.

This inspection was a follow up to an inspection carried out in September 2013.

We reviewed the care and support plans of people who lived at the service and found that they reflected the individual’s needs but were not always person centred.

One person told us “I like it here although no meetings take place". Another person said that they had not lived at the service long but they were"settling in well". We observed staff and people using the service communicating in a relaxed and friendly manner.

There was no fire risk assessment available and no personal emergency evacuation plans for people who used the service as required under the Regulatory Reform (Fire Safety) Order 2005. We issued an immediate compliance action requiring the manager to produce these documents within 24 hours to ensure the safety of people who used and worked at the service.

We had some concerns during our inspection. There was no evidence of any risk assessments linked to infection control and the means by which the service would prevent and monitor those risks.

Following concerns from a previous inspection the manager confirmed that actions had being taken to make improvements.However,the records used to check if areas of the service were safe were not effective because they were not always current.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spent time observing care to help us understand the experience of people who could not talk with us. We spoke with staff and checked care records.

At the time we visited we observed positive interactions between people who used the service and staff. People were relaxed and comfortable in their surroundings. We saw there were sufficient members of staff to support people with their care in a timely way.

We found that people were cared for in a clean, hygienic environment. The décor and furnishings we saw were in keeping with the style of the home and offered people a home-like ambience.

However, we identified that improvements were needed to care planning to make sure that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We found that effective systems to regularly assess and monitor the quality of service that people received had not been developed.

We visited Norwood House and spoke with two people who lived there and a relative who visited the home on the day of inspection. People told us they were happy with the care and that the staff were kind and supportive.

People’s consent to care was gained and we saw evidence that people received the care they needed. For example we saw up to date plans of care which considered individual physical, emotional and mental health care needs. We saw risk assessments and that all documentation was kept up to date to ensure people had their changing needs met. We saw that the home consulted with specialists to make sure people had the benefit of expert advice.

People were protected from harm and the risk of harm through staff training and risk assessments. The service referred safeguarding incidents to the local authority and to CQC as required to ensure people were protected. Staff also had training in mental capacity and deprivation of liberty safeguards.

Staff were suitably recruited to ensure they could offer the appropriate care to people. They had received training and supervision to support them in their role for people's benefit.

The home had a complaints procedure, we saw that the home dealt with complaints appropriately and people told us that they knew how to complain.

People did not make comments however, observations on the day of the visit provided evidence that staff involved people in decisions about their day to day care. For example, people were asked about where they wanted to go, what they wanted to do, who they wanted to sit next to and what they wanted to eat. Staff gave people time and engaged with them in a friendly and encouraging way to preserve their dignity and involve them as much as possible the way they spent their time. Staff were observed interacting with people in a way which suggested care needs were well understood and that staff had appropriate training. For example, a member of staff accompanied a person as she moved around the home and assisted her with orientation in a helpful and kind way. Another member of staff talked with a person about her family as she carried out her nail care.