Archived: Norton Street

Norton Street is a residential care home registered to provide personal care for up to 31 people. The service consisted of 8 separate terraced houses on residential streets close to the registered office address. The provider had opened additional houses as part of this location since the last inspection; The Care Quality Commission (CQC) had accepted the provider’s application to increase the maximum number of people they could provide support to from 25 to 31 people. There were 25 people using the service at the time of our inspection, whose primary support needs related to their mental health.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided. 2 people were receiving support with personal care at the time of our inspection.

People’s experience of using this service and what we found

Risk assessments and associated guidance were not clear about people’s current needs. They contained conflicting, old and repetitive information. This had been identified through local authority audits and a CQC monitoring call in August 2022, but action to improve the risk assessments and guidance was still at the information gathering stage.

There were enough staff on duty to meet people’s needs and they had been safely recruited. Staff had the training to carry out their role. Staff were supported through staff meetings and supervisions. However, some felt there was sometimes a blame culture when issues had been identified. Staff wore the appropriate personal protective equipment. Staff worked in partnership with other professionals. People received their medicines as prescribed. Equipment was checked and serviced as per current guidance.

A quality assurance system was in place and action plans produced from these. However, audits continued to state care plans were complete, up to date, reviewed and checked, despite actions plans identifying they needed reviewing. Incidents and accidents were recorded and investigated to identify actions to reduce the risk of a re-occurrence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 July 2019).

At our last inspection we recommended that the provider reviewed their processes for checking the required pre-employment information is received prior to appointing members of staff. At this inspection we found improvements had been made and all pre-employment checks were in place.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of medicines. This inspection examined those risks and we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Norton Street on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk assessments and associated guidance not reflecting current needs and the governance and quality assurance system at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Norton Street is a residential care home registered to provide personal care for up to 25 people. The service consisted of six separate terraced houses on residential streets close to the registered office address. The provider had opened an additional house as part of this location since the last inspection; CQC had accepted the provider’s application to increase the maximum number of people they could provide support to from 20 to 25 people. There were 17 people using the service at the time of our inspection, whose primary support needs related to their mental health.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided. One person was receiving support with personal care at the time of our inspection.

People’s experience of using this service and what we found

We found the service needed to improve how they managed risks relating to the safety of the houses where people lived. The registered manager sent us evidence that action had been taken or was planned to addresses the shortfalls we found. Although we did not identify concerns about the staff recruited, the provider needed to strengthen their recruitment processes in relation to the records they kept. We recommended the provider reviews their recruitment procedures.

Staff assessed people’s care needs and developed detailed plans to help staff meet those needs. Staff involved other health professionals in people’s care as needed and encouraged and supported people to live healthy lifestyles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received support from staff who knew them and understood their needs and preferences. The person we spoke with told us they felt comfortable discussing their care with staff and felt involved in any decisions about their support.

Care plans were detailed and person-centred. Staff provided people with support to take part in activities and helped prevent people becoming socially isolated. The service had not received any complaints. Whilst people told us they would feel comfortable raising a complaint, we made a recommendation that the provider reviews their complaints policy/procedure to ensure it contained all required information.

Since our last inspection, the manager had registered with the CQC as is a requirement of the provider’s registration with us. Staff told us they were well supported and felt listened to. The registered manager had identified areas of the service that could be improved, including the decoration in some people’s houses. They told us they were confident the provider would give them the resources to do this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report published 22 December 2016)

Why we inspected

This was a planned inspection, scheduled based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Norton Street is registered to provide personal care and accommodation for 20 adults with enduring mental health needs. Accommodation is provided in six terraced houses in the Old Trafford area of South Manchester. The service is situated close to local shops and transport networks into Manchester and surrounding areas. At the time of our inspection there were 18 people residing at Norton Street.

At the time of our inspection there was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law, as does the registered provider.

There was a manager at the service who had recently been promoted within the service and was in the process of applying to CQC to be the registered manager. However, we noted no application to register the manager had yet been received. We will continue to monitor this.

The manager and staff understood their obligations under the Mental Capacity Act 2005 and Mental Health Act 1983 and worked within these legislative frameworks. Staff had received training in both subjects and were fully informed of any changes at team meetings to ensure they continued to provide care within the law.

At the last inspection we saw two properties that were in need of redecoration, refurbishment and repair. At this inspection we found improvements had been made to all six properties, ensuring they were at a satisfactory standard for people.

Staff were extremely caring and always ensured they treated people with dignity and respect. They had an excellent understanding of the care and support needs of every person receiving a service at Norton Street. People had developed very positive relationships with staff and there was a friendly and relaxed atmosphere.

We found that medication arrangements were safe. Some people told us they managed their own medication and these were securely stored in their bedrooms. Support plans included an assessment of the person’s needs for support with any medicines they were prescribed.

Support plans showed that people had access to their GP and other health and social care professionals such as psychiatrists, a dietician, district nurses, social workers and community psychiatric nurses (CPN). This showed us that people were supported by staff to maintain their health and wellbeing.

The support staff we spoke with demonstrated an excellent knowledge of people's care needs, and significant events in their lives, and their daily routines and preferences.

Staff had received a range of training, which covered key courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who had mental health disorders and the use of Mental Health Act 1983 (amended 2007).

People and the staff we spoke with told us that there were enough staff on duty. We found that on the whole there were sufficient staff on duty to meet people's needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. This meant staff hired were suitable to work with vulnerable people.

The manager also completed a monthly manager's audit. This audit looked at the following areas: care planning, recovery, key workers, activities, meetings, medication, environment, food menus, and training. We found these audits were detailed, comprehensive and followed up on any actions identified. This meant the provider had adequate oversight of the care and support provided to ensure people’s care and support was safe and effective.

People were encouraged and supported to be as independent as possible, and the service had employed a recovery team to develop this area of practice. The service also devised goal orientated care plans to identify achievable targets which encouraged and motivated people to develop skills and abilities. Activities were in place to provide stimulation for people and people took part in activities in their chosen community activities.

We checked equipment and maintenance records relating to the fire alarm, fire extinguishers, gas installation, electrical wiring, portable appliance tests, water quality checks. All records were found to be in a satisfactory order.

We looked at the care records for three people living at Norton Street. Within the three care records we found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. . Although care plans and risk assessments were in place they were not consistently being reviewed.

We saw in all the care records we looked at, people had nutrition care plans and risk assessments in place.

The four houses we visited, we noted the environment was clean, however the d'cor was dated particularly the bathrooms and kitchen areas. Furniture in the lounge of one house was dated.

The manager provided us with an action plan following our last inspection which outlined the quality monitoring systems they planned to implement. As part of our inspection the manager provided us with a copy of a recent audit of care plans.

The Operations and HR director provided us with a copy of the action plan they planned to implement at Norton Street to ensure work planned to improve the environment was completed.

The eight people we spoke with told us that they liked the staff that provided their support. They said that staff listened to their views and took action when it was needed. The people we spoke with were confident that staff would take action if they had any concerns about their personal safety. A system was in place to identify and report allegations or suspicions of abuse and staff had been trained in this area.

Care plans provided evidence that risks to the safe delivery of care had generally been assessed and managed well. However, one person who was at risk of weight loss, did not have a nutritional risk assessment for the prevention of unintentional weight loss.

Although the provider had a system in place to monitor, review and improve the service provided, it had not been effective in ensuring that living environments were maintained to an appropriate standard. Hazards in the environment potentially placed people using the service at risk of burns from hot water pipes and trips from frayed carpets on stairways. Further improvements were needed to the decor of people's living environments.