About the service:

Norwood Grange Care Home is owned and managed by Country Court Care Homes Limited. It is purpose built to provide accommodation and care for up to 35 people. The home provides care for people living with dementia and mental health needs. At the time of the inspection 31 were using the service.

People’s experience of using this service:

People told us they felt safe at Norwood Grange and they were consistently treated with kindness, dignity and respect.

People’s care records contained guidance for staff about how to support people safely and minimise risks to people. Staff were trained in their responsibilities for safeguarding adults and knew what action to take if they witnessed or suspected any abuse.

Some improvements were required in recruitment processes to provide further assurances staff were suitable to work in the care service.

The service had systems in place to ensure people received their medicines as prescribed. Staff supported people to maintain their health by making appropriate referrals to community health professionals and acting on any advice they were given.

There were enough staff on shift to keep people safe and we observed staff respond to people in a timely manner throughout the day. Staff told us they thought there were enough staff to meet people’s needs.

People received personalised support from staff who knew them well. People’s likes, dislikes and social histories were recorded in their care records. This helped staff care for them in a personalised way.

Staff were competent, knowledgeable and skilled. They received regular training, supervisions and appraisals which supported them to conduct their roles effectively.

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.

People were happy with the food provided at Norwood Grange. The service catered for people's special dietary requirements and staff monitored food and fluid intake levels of people who were assessed to be at risk.

A range of activities were provided for people living at Norwood Grange which considered people’s interests and wishes.

The provider had an effective complaints procedure in place. Information about how to complain was displayed in the entrance to the home. People and their relatives knew how to complain if they needed to.

The provider and registered manager understood the regulatory requirements and monitored the quality and safety of the service on a regular basis. Some improvement was needed to ensure CQC were informed of all notifications required under legislation.

Staff told us they enjoyed their jobs and they worked very well together.

Rating at last inspection:

At the last inspection the service was rated Good (report published 7 October 2016)

Why we inspected:

This was a planned comprehensive inspection based on the rating awarded at the last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. We plan to complete a further inspection in line with our re-inspection schedule for those services rated good.

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

The inspection of Norwood Grange Care Home took place on 24 August 2016 and was unannounced. At the last inspection on 19 May 2014 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were superseded on 1 April 2015 by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Norwood Grange Care Home, owned and managed by Country Court Care Homes Limited was purpose built to provide accommodation and care for up to 35 older people in single occupancy bedrooms. The service provided care for older people who were living with dementia and / or have mental health needs. At the time of the inspection there were 34 people that used the service. The property was a large extended house in its own grounds and had accommodation and facilities on two floors. There was car parking for eight cars to the front of the house and an enclosed secure garden to the rear.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for the last two years. 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 were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and group basis so that people avoided injury or harm.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet people’s needs and we saw that the staff named on the rosters were actually those that were on duty. Staffing levels were determined by careful and regular calculation of people’s dependency levels using a dependency tool. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable and skilled to care for and support vulnerable people. We found that the management of medicines was safely carried out.

We saw that people were cared for and supported by qualified and competent staff that were regularly supervised and had their personal performance appraised. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected. Staff had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The registered manager was able to explain how the service worked with other health and social care professionals and family members to ensure a decision was made in a person’s best interests where they lacked capacity to make their own decisions.

People received the nutrition and hydration they required to maintain their health and wellbeing. The premises were suitable for providing care to older people. Although the environment was not yet entirely dementia-friendly, it was half-way developed so as to meet the needs of those people that were living with dementia. More was yet to be done.

We found that people received compassionate care from kind staff. The staff were aware of and knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at this time.

Norwood Grange is a care home which was providing residential care for 27 people at the time of our inspection. We spoke with groups of people who were sitting in communal areas and with two people individually. We also spoke with six members of staff, two relatives, the home manager and the operations manager.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood their role in safeguarding the people they supported. People who lived in the home said, “I feel safe and happy here” and “Everybody is kind and nice.”

People were protected against the risks associated with the unsafe administration of medicines. At this inspection we observed staff dispense and administer medication to people safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, relevant policies and procedures were in place. Appropriate staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded as required.

We found there was an effective recruitment procedure in place to ensure people employed were of good character and had the skills and experience necessary for the work they performed. All staff had completed Disclosure and Barring Service (DBS) checks which helped to safeguard people who lived in the home.

Is the service effective?

Care files we checked confirmed that initial assessments had been carried out by the staff before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people who were to live there. People’s health and care needs were assessed with them, and their family and friends were involved in the formulation of their plans of care. Specialist mobility and equipment needs had been identified in care plans where required.

We found people were provided with a choice of nutritious food. Some people required specialised diets for health or personal reasons. We found the service provided food and drinks specifically requested by people. People told us, “I enjoy my food” and “I eat everything so that's a good sign.”

Two visitors confirmed they were able to see their relative in private and that visiting times were flexible.

Is the service caring?

We found people were treated with respect and dignity by the staff. During our inspection we observed staff speaking with people who used the service in a friendly and caring way. We observed care and support was provided to people when requested.

Four care workers we spoke with demonstrated a good understanding of people’s needs and were able to give examples of how they promoted people’s independence. Staff were skilled and confident in recognising the diversity, values and human rights of people who used the service.

People we spoke with told us staff were, "very nice" and "lovely." A relative said, “I visit my family member nearly every day and the staff are absolutely marvellous. I have never seen anything here that worries or concerns me.”

Is the service responsive?

Staff told us the care and support provided was flexible to the person’s needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed.

One relative told us, “My family member has never looked so well and laughed as much as they do now. That’s because the staff know how to deal with people who have different and varying needs. Staff are skilled and people who live here respond really well to them.”

People were able to join in with a range of activities. An activity worker was employed and we observed the activity worker encouraging people to join in with a selection of activities. We also saw care workers spending time with people on a one to one basis, playing games and painting nails. It was very evident that people enjoyed and benefitted from this.

People knew how to make a complaint if they were unhappy. Relatives spoken with said they had no worries or concerns about the home but if they did they could talk to any of the staff and they would listen and sort it out."

Is the service well-led?

The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision. We saw evidence the service had taken advice provided by other healthcare professionals so that the quality of the service would be improved.

There was a system in place to make sure the manager and staff learnt from events such as incidents, complaints, concerns and investigations. This helped to protect people from the risk of harm and helped to ensure that lessons were learned from mistakes.

The service had a quality assurance system. Records seen by us showed that shortfalls identified in the manager’s audits had been addressed. For example, an audit of the medication was completed each month. We found areas of concern which were identified in April 2014 had been actioned.

People who used the service, their relatives, friends and other healthcare professionals involved with the service had completed a satisfaction survey. We saw the majority of comments made were positive and that most people rated the service highly.

People with dementia are not always able to tell us about their experiences. We observed that people were supported by the staff in promoting their independence and they were involved in their care. We observed staff explaining their actions to the people and gaining consent. People were happy and co-operative with the staff.

We spoke with five people and they told us that they were treated with respect and that their opinions were sought so that they were involved in decisions and that they had choice. Their comments included: “they (the staff) come and ask you what you would like to eat” and “when I don’t feel very well and I want to stay up I can”.

All the relatives we spoke with were very satisfied with the quality of care their family member had received. Their comments included: “she (family member) gets good personal care and she is joining in with the activities” and “very good care”.

People told us that they felt "safe" and that they had no worries or concerns. They all said that if they had any concerns or worries they would speak to a family member or staff.

Staff spoken with told us that they felt supported and received regular supervision sessions.

The service had an effective system to regularly assess and monitor the quality of service that people received.