Norton Lodge

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 3 breaches of the legal regulations in this key question. These related to safe care and treatment, premises and equipment, and staffing. Risk assessments were not always completed to mitigate risks to people. Medicines were not always safely managed and maintained. Not all care plans contained relevant, up to date information, which placed people at risk of not receiving the care and support required to meet their needs. The environment was not always clean, and people were not always protected from the risks associated with infection prevention and control. Staff were not effectively deployed; we identified situations where inadequate staffing levels placed people at risk. Safeguarding referrals were not always escalated in a timely manner.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some relatives told us their loved one were safe; however, one person living in the service expressed concerns about other people entering their room and the absence of staff nearby to provide assistance.

Staff informed us they could raise issues with the manager; however, they were not always acted upon. Staff we spoke to raised concerns regarding a negative culture amongst staff teams, particularly between day and night staff.

The processes in place to provide a good learning culture were not effective. We did not see evidence of regular supervision for staff to ensure positive feedback was received and any shared learning provided. Lessons learnt were not always recorded.

People had access to the GP when needed, with weekly visits from the GP. Relatives told us referrals were made when required, however there was sometimes a delay.

Staff confirmed the GP visited weekly and they would make appointments if necessary. However, extra staff were not always available to support people to appointments, which resulted in a staff member on shift supporting someone to their appointment, leaving the home a staff member down.

We were unable to obtain feedback from partners for this quality statement, so unable to score.

Preadmission assessments were completed, however they lacked details. Care plans were not always devised in a timely manner to ensure people’s needs were assessed and could be met safely. We observed that one person did not have a care plan in place. This was raised with the manager, who ensured it was completed, however some sections still remained blank.

People and their relatives told us they felt safe. One relative said, “I feel they [person] is kept safe and well looked after.” However, one person told us, “Staff do answer call bells however sometimes beeps for a long time but unsure if that’s just when someone doesn’t answer and turn it off.”

Some staff were aware of how to raise a safeguarding; however, one staff member told us, “I think I would raise a concern but think I would think about it for a while.” Staff were not all aware of the whistleblowing policy.

We observed altercations between 2 people living in the service, and there were no staff within the vicinity to provide support. We also observed 1 person almost falling while trying to mobilise without support. Accident, incidents, and safeguarding concerns were recorded; however, these were not always analysed effectively to ensure risks could be prevented. Actions following these incidents were not always documented. We identified numerous times where assistive technology that had been implemented was not consistently working.

Accident, incidents, and safeguarding concerns were recorded; however, these were not always analysed effectively to ensure risks could be prevented. Actions following these incidents were not always documented. We identified numerous times where assistive technology that had been implemented was not consistently working.

Relatives told us they were not involved in the development of care plans or risk assessments. One relative told us, “[person] had pressure sore, so the home organised a new bed.”

Staff told us they did not always receive a handover, so were not always aware of concerns. There was a handover on the computer system, however, staff did not always have the time to read this.

We observed people who were high risk of falls not wearing the correct footwear. Risks were not always managed. People were left without access to call bells, preventing them from being able to request or receive support they needed or wanted. We observed incidents between people living at the service, with no staff visible to mitigate the risks.

We were not always assured that risk assessments about care were person-centred and regularly reviewed with the person. We observed instances where people who required risk assessments to manage their risks did not have them in place. Peoples’ care records did not evidence that people had been consulted about their risk assessments or their reviews. We were not assured processes were in place to ensure staff had proper handovers. This meant there was a risk that information about people’s risks was not always shared with staff providing the support.

We observed one person experiencing a leak in their room. We discussed this with the manager, and it was rectified, however, the leak had been present for at least 3 months. One person told us they had been told not to use the tap in their sink due to it being unsafe, as the water was too hot.

Staff raised concerns about the cleanliness of the home and the lack of cleaning staff. Staff told us they were expected to clean but they didn’t have the time.

We observed hole in a person’s rooms with water coming through. This was raised with the manager and was covered; however this had been raised 3 months earlier and had not been rectified. We observed water temperatures in people’s bedrooms being too hot, which presented a scalding risk. We observed one person’s wardrobe was not attached to the wall. We raised this with the manager, who actioned this immediately.

There were processes in place to audit the environment, identify maintenance tasks, and carry out required works, but these were not adhered to. We identified that fridge temperature checks were not routinely taken. When concerns regarding the safety of the environment, including water temperatures, had been identified, actions were not taken to remedy the concerns. There were delays in ensuring the environment was safe. There were insufficient domestic staff deployed to ensure the home was clean and free from malodours. This resulted in the premises being unclean, and poorly maintained.

People and relatives told us there were staff available when needed, but sometimes they had to wait. One relative told us, “Staff do look rushed but they are lovely.”

Staff told us there were not enough staff and they were struggling to do their jobs. They were not always able to support people with a bath or shower due to staffing issues. Staff told us they sometimes had to support people with personal care after breakfast as they could not do it before. Not all staff felt they could meet the needs of the people living within the home. One staff member told us, “We don’t have adequate staffing to support people and meet their needs.”

There was not an appropriate staffing level and skill mix to ensure people received consistently safe, good quality care that met their needs. We observed people being supported with breakfast 1 hour before lunch. We also observed people sitting in the lounge for long periods of time without support, and people who smoked waited for over an hour for their cigarettes because the nurse was unavailable. We observed incidents between people with no staff visible to provide support. Additionally, we observed an agency member of staff working within the home with no induction. They had been provided with a piece of paper listing the names of people to support.

The dependency tool, used to ensure there was appropriate numbers of staff to meet people’s needs, had recently been reviewed and it was identified that there was not enough staff within the home. Management informed us they were trying to recruit new staff, however despite being aware of the staffing shortage, staffing levels had not increased. Staff often worked overtime, or agency staff were used. Staff recruitment files did not contain evidence of inductions into the service, and we were told this was due to staff having these files at home. Therefore, we could not be assured that all staff received a thorough induction before commencing employment.

Relatives told us they felt the home was clean. However, evidence from people’s surveys identified that some people were not happy with the home environment.

Staff were concerned about the lack of cleaning staff, which impacted their ability to maintain effective levels of hygiene in the home.

There was no effective approach to assessing and managing the risk of infection, in line with current relevant national guidance. People were not fully protected from the risk of infection because premises and equipment were not kept clean and hygienic. We observed an unclean environment, including, walls and doors marked with fluid residue, broken windowsills and unclean equipment, such as bath chairs. Roles and responsibilities around infection prevention and control were not clear, as there was a lack of domestic staff. The manager’s walk arounds were not effective, as they had failed to identify shortfalls in cleanliness.

Not all staff had received training in relation to infection prevention and control. The environment was unclean and cleaning schedules in place evidenced that some rooms had not been cleaned for numerous days, including bathrooms, communal areas and people’s bedrooms. There were not enough domestic staff to maintain the cleanliness of the home.

People told us they received their medicines when they were required.

Staff told us they had received training in relation to the administration of medication. However, they told us that some staff made frequent mistakes, but nothing happened to address this. Staff were not happy about the introduction of paper MARs (medicines administration records), as they found it harder to record the information and there was duplication. However, the manager explained that this was temporary measure due to errors and lack of training with the previous system, and that all staff would eventually be trained on the electronic system.

The system in place for the recording of medication was not always effective. We found gaps in the administration of medication and poor recording of medicines given as and when required. Some people needed to have their fluids thickened and were prescribed a thickening powder to be added to their fluids to prevent them choking. The records did not demonstrate this was being given with all drinks. Some people were prescribed medicines to be taken ‘when required’ or with a choice of dose, but the protocols to support the safe administration of these were either not in place or were not personalised. There was no information for staff to follow to assist them when deciding the most appropriate dose to administer when there was a choice, which meant people may not get their medicines consistently and at the time they were needed. Medicines, including creams, were not always safely stored. We found highly flammable creams left in people’s rooms with no risk assessments in place. Fridge temperatures were not always recorded, and the temperature frequently fell below the recommended temperature for safe storage of medication.