This comprehensive inspection took place on 22 May 2018 and was unannounced.

The last comprehensive inspection was in July 2016. The service was rated requires improvement in the key question 'Is the service Effective?’ because we found a breach of regulation regarding premises and equipment. Overall the service was rated good. A focused inspection was carried out in April 2017 when we found the provider continued to breach the regulation regarding premises and equipment and in addition was breaching the regulation in regards to person centred care. We served a requirement notice for the breach related to person centred care and a warning notice on the provider for the breach of regulation in regards to the premises asking them to make the necessary improvements. We also asked the provider to complete an action plan to show what they would do and by when to improve the rating of the key question of 'Is the service Effective?’' to at least good.

At this inspection we found the provider had made improvements and had met the regulation in regards to the premises. However, we found three additional breaches of regulations, and a repeated breach for the regulation in regards to person centred care and the service continues to be rated requires improvement

Norwood Green Care Home 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.

The home is part of Four Seasons Limited a national organisation that provides care to people in the UK. Norwood Green Care Home is registered to provide nursing care to 92 people with dementia, mental health needs and general nursing care. The home accommodates people across three separate units, each of which have separate adapted facilities. There is a central kitchen on the ground floor and a large communal garden. At the time of our inspection there were 88 people living in the home.

There was a registered manager who joined the service in November 2017 and registered with the Commission in May 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.

The provider sent us an action plan in April 2017 that stated the bathrooms would be refurbished by June 2017. We found in this inspection that all bath and shower rooms were refurbished to a good standard. We had received no action plan about addressing the concern about person centred care. We found a continuing breach of this regulation because people were still not receiving their choice of bathing or showering in accordance with their care plans.

People, relatives and visitors told us that people were not supported to get up when they wanted to, that they were not receiving showers when they wanted them and that planned activities were sometimes cancelled. They expressed that there were not enough care staff in the home. We found that the registered manager was assessing staffing need using an electronic system. However, people were not always being supported in line with their care plans and this indicated that staffing levels were not sufficient to provide a person centred service.

We found a number hazards in the service that had not been identified and addressed through checks and audits. These included an overgrown garden that was not safe for people to use as there were trip hazards. There were security hazards that included an unlocked garden gate, an open exit door and a stairway that people could have access to from the ground floor and that were not risk assessed. There was unsecured lift equipment. The registered manager addressed these concerns when we pointed

This inspection took place on 24 April 2017 and was unannounced. We last inspected the service in July 2016 and found a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not maintain satisfactorily all parts of the premises and most bath and shower rooms were not fit for purpose. The provider sent us an action plan dated 11 August 2016 and told us they would carry out a “full replacement of all shower rooms and replacements for 3 bathrooms.” At this inspection we found that, although some work had started in some shower rooms, this had not been completed and only one shower room was available for use by people using the service.

In March 2017 we received information from the local authority’s Environmental Health team and the Clinical Commissioning Group’s (CCG) infection control lead, following an outbreak of norovirus that affected people using the service and staff. The reports included a number of recommendations and actions for the provider to take to improve infection control in the service. At this inspection we found the provider had responded to the reports and had taken appropriate actions to improve infection control.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Norwood Green Care Home’ on our website at www.cqc.org.uk.

Norwood Green Care Home provides accommodation, nursing and personal care for up to 92 older people, some of whom were living with dementia. The service is provided by Four Seasons (No 7) Ltd, a private company managing over 300 care homes in the UK.

The service had a manager who was registered with the Care Quality Commission (CQC). 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.

We found that the provider was continuing to breach Regulation 15 and was also in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People using the service did not receive care and support in line with their preferences and their care plan.

The provider had not carried out works to upgrade the bathrooms and shower rooms and most people using the service had not had access to a bath or shower since our last inspection in July 2016.

The provider had taken appropriate action to implement recommendations made by the Clinical Commissioning Group (CCG) and the local authority to improve infection control in the service.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 12 and 14 July 2016. The visit on 12 July was unannounced and we told the provider we would return on 14 July to complete the inspection. The last inspection of the service was in August 2014 when we judged the service as Good for all of the areas we inspected.

Norwood Green Care Home provides accommodation, nursing and personal care for up to 92 older people, some of whom were living with dementia. When we visited, 85 people were using the service. The service is provided by Four Seasons (No 7) Ltd, a private company managing over 300 care homes in the UK. The service had a manager who was registered with the Care Quality Commission (CQC). 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.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not maintain satisfactorily all parts of the premises and most bath and shower rooms were not fit for purpose. You can see what action we told the provider to take at the back of the full version of the report.

People using the service and their relatives told us people were cared for safely. Nurses and care staff were familiar with the provider’s safeguarding procedures and were able to tell us what they would do if they had any concerns about someone’s safety or wellbeing.

People received the medicines they needed safely.

The provider deployed sufficient numbers of staff to meet the care needs of people using the service. They had systems to ensure new staff were suitable to work with people using the service, although these were not always implemented consistently.

People using the service and their relatives told us staff were well-trained to meet people’s care needs.

The staff told us they felt well supported by the provider and managers in the service.

Managers and staff were working within the principles of the Mental Capacity Act 2005 and any conditions on authorisations to deprive a person of their liberty were being met.

Most people told us they enjoyed the food provided in the service.

People had access to the health care services they needed.

People using the service and their relatives told us the staff who cared for and supported them were caring and that they always treated people with respect.

We saw the staff caring for people were polite and kind.

The staff spoke a range of languages and they told me that at least one member of staff could speak the first language/preferred language of everyone who lived there.

People using the service and their relatives told us they received the care and support they needed.

Each person had a care plan that included an assessment of their health and social care needs.

People told us the provider arranged activities and outings and most people said they enjoyed these.

People also told us their family members and friends could visit them and they told us they looked forward to and enjoyed these visits.

The service had a manager who was registered with the Care Quality Commission. People using the service, their visitors and staff spoke positively about the manager.

Throughout the inspection, the atmosphere in the service was open, welcoming and inclusive.

The provider had systems to monitor quality in the service and to make improvements.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

There was a registered manager at the service at the time of our inspection.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

This was an unannounced inspection. Prior to this inspection, the service was last inspected by the Care Quality Commission on 5 November 2013 and at the time was found to be meeting the regulations we looked at.

Norwood Green Care Centre provides accommodation for up to 92 people who require nursing or personal care. There are three units within the home. Two of the units are for people living with the experience of dementia. The third unit is for people that have general nursing care needs. There were 84 people using the service when we visited.

People told us they felt safe and we saw there were systems and processes in place to protect them from the risk of harm.

People’s needs were assessed and care plans were developed to address the identified needs. Risks were assessed and reviewed regularly and appropriate management plans were in place where risks were identified to ensure people’s safety. Staff spoke confidently about understanding people’s needs and treating each person as an individual. There were sufficient numbers of staff to meet people’s individual needs.

People were involved in making decisions about their care and how they wanted to be cared for. Staff had undertaken training on the Mental Capacity Act 2005 and were aware of their responsibilities in relation to Deprivation of Liberty Safeguards (DoLS).

Recruitment practices were robust and being followed. People received effective care from staff who were trained and supported by the manager.

People were involved in the assessments of their health and care needs and in developing and reviewing their care plan. Life history information, including individual preferences, had been obtained and this allowed staff to have a better understanding of people’s needs.

Suitable arrangements were in place to ensure people’s nutritional needs were met according to their choices and preferences.

People had access to health and social care professionals to meet their needs and staff monitored their health and wellbeing. Where people required equipment to maintain their safety and independence, this was provided.

People’s care records had been reviewed regularly so any changes to their care were identified and records were kept up to date. People and their families said they would be confident to raise any concerns that arose and we saw that complaints were investigated and responded to in accordance with the complaints procedure.

There were effective systems in place to monitor and improve the quality of the service provided. A programme of audits was carried out and where shortfalls were identified, actions plans were in place to make improvements. People's views were sought both on an informal and formal basis.

This was through talking to people and their representatives on a day to day basis, during their reviews of care, through the use of surveys and quarterly meetings. The staff described the service as having an open and transparent culture. The manager demonstrated good leadership skills and was supportive to people using the service, relatives and staff.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with fourteen people using the service, two relatives, three friends of people using the service and fifteen staff.

People's needs were assessed and care plans developed that ensured people's needs were met effectively. Any identified risks to people's welfare were assessed and plans put in place to minimise these while enabling people to maintain their independence. People's healthcare needs were monitored and met with the support of healthcare professionals.

People told us they were well looked after. Comments from people using the service included, “They are nice people, I get on well with them all”, “they are very good and very kind, the staff are excellent” and “it’s lovely here and everyone is nice”. A relative said they were “completely satisfied with the care (their relative) is getting”.

People were monitored and supported with their dietary and nutritional needs.

Equipment was available to meet people’s needs, regularly risk assessed and appropriately maintained to make sure it was safe for people to use.

Staff received training and supervision to ensure they were appropriately supported in their job.

Overall people’s personal records were accurate and fit for purpose.

We talked with eight people using the service. We also used a number of different methods to help us understand the experiences of people using the service because many had complex needs which meant that they could not tell us their experiences. This included talking to the relative of one person, speaking with a health care professional and using the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us that staff treated them with respect and that they had choices in all aspects of their daily lives. We observed staff speaking with people in a gentle and courteous manner.

On the dementia units we observed staff engaging and interacting with people to promote their well being. One person said “it’s home from home and that it is a family within a family.” Another commented “no problem, superb each and everyone (staff) is very good.” A relative told us that staff were “well mannered, caring and professional”.

We observed people being administered their medicines by staff. The health care professional told us that staff were good at monitoring people’s condition and the side effects of medication.

People we spoke with said they were confident to report any concerns or complaints to the manager and the staff.

People said that staff were available when they needed them and that they were well cared for. They said staff were kind and caring and that they could raise any concerns they had with them.

Visitors said the care was of a good standard and when they had raised any concerns these had been addressed promptly by the manager.

People told us they made choices as to whether they wanted their bedroom door kept open or closed. They also said they were able to give consent to the care and support they received. Visitors told us they had been involved in care planning and review meetings for their relatives and that the staff communicated any changes in their relative’s condition to them.

Only a small number of people were able to discuss their experiences with us. We were able to observe people on all three units being assisted at the lunch time meal, and with activities. We spoke to the staff and to a small number of visitors.

Those people who were able to say, told us that they were quite happy with the home.

We were informed by one visitor that they could not fault the care provided and found the staff to be excellent. They had been able to discuss their relative’s care, and make decisions on the person behalf, and said that any concerns they had ever raised had been addressed.

We observed staff supporting people with individual activities, including looking at a newspaper, completing a word puzzle, looking at picture cards, and having nail polish applied. In one unit, staff had been assisting people to make pizzas. Televisions and music were on in the lounges, but we did not see them being used to entertain or engage anyone. In one instance, the DVD was changed a number of times within a short period. Music was also being played quite loudly in one lounge, making it difficult to hear what was happening in the corridor.

In the two units, specifically for people with dementia, a large number of people remained in bed and others walked around the corridors. We saw very limited interaction from staff with the people who remained in their rooms or with the people who were walking around. The care staff we saw working with people on a one-to-one basis, were doing so in a pleasant and friendly manner and were trying to engage the person. We observed little contact with people from the senior staff on each of the units.

One lounge is available for people’s religious needs to be met and we saw two people using this facility. Staff were available to translate for a person who indicated they would like to speak to us.