CQC report explained · a residential care home
What the CQC found at 17 Norton Avenue
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Inspectors found enough staff, suitable risk plans, safe medicines systems, clean premises and appropriate recruitment checks.
- Effective?
- Outstanding
- People received care based on their individual needs and professional advice. Inspectors found excellent links with health professionals, well-trained staff and creative support that achieved very positive health and independence outcomes.
- Caring?
- Good
- Staff were kind, compassionate and respectful. People were supported to communicate their views, make choices and maintain their dignity and independence.
- Responsive?
- Good
- Care plans were accurate, personalised and up to date. People were supported with activities, relationships, complaints and planning for their future care.
- Well-led?
- Good
- The home had a registered manager and an open culture. Quality checks, feedback and incident reviews were used to make improvements.
What inspectors found, July 2018
Choices Housing Association Limited - 17 Norton Avenue was rated Good; inspectors found Outstanding effectiveness and improvements since the previous inspection.
The inspection was unannounced and took place on 6 June 2018. One inspector spoke with relatives, staff and a visiting professional. They observed care, reviewed three people's records, five staff files and management records.
The home supported up to six people and four people lived there at the time. Inspectors found people were safe, treated kindly and supported with personalised care. Medicines, staffing, infection control and risk management were found to be safe.
Effectiveness was rated Outstanding. Inspectors highlighted strong health care support, well-trained staff, creative help with eating and drinking, and support that improved people's independence and quality of life.
The overall rating was Good. The previous rating was Requires Improvement and the provider had previously breached the law. Inspectors found the promised improvements had been completed and there were no current breaches.
Strong health support
The home worked closely with health and social care professionals. Inspectors saw this led to improved health, comfort, access to treatment and quality of life.
“The service had excellent links with health and social care professionals.” from the report
Effective staff training
Training was tailored to people's individual needs. Staff also received supervision, appraisals and regular competency checks.
“Staff were supported to develop the skills and knowledge to provide effective care.” from the report
Choice and independence
Staff used communication aids and practical equipment to help people make choices and do more for themselves.
“People were supported to make choices in all aspects of their care and support.” from the report
Kind and respectful care
Inspectors observed calm, compassionate support. Staff knew people's preferences, worries and communication methods.
“We observed that staff were kind and compassionate in their approach when supporting people and spent time with people giving them the reassurance they needed.” from the report
Improved medicines safety
The home had strengthened stock checks, administration records and staff competency checks since the previous inspection.
“The systems and processes in place were operated safely to ensure that people received the medicines they needed.” from the report
Inspectors raised no specific concerns in this report.
- 01How have the improved medicines stock checks and administration systems been maintained since this inspection?
- 02How are people's risk assessments and care plans reviewed when their health or behaviour changes?
- 03How will you support my relative to communicate choices if they cannot communicate verbally?
- 04What individual training and competency checks would staff receive for my relative's health needs?
- 05How are people and relatives currently involved in reviewing care plans, activities and weekly choices?
This was an unannounced inspection of the care, premises and management of the home, covering all five CQC questions. This explanation was written from the published report of 28 July 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
What inspectors found, March 2017
Rated Requires Improvement; inspectors found unsafe gaps in risk planning, medicines, health monitoring, dignity and care records.
This was an unannounced inspection on 27 January 2017. Inspectors spoke with people, staff and managers, reviewed care and management records, observed care, and considered relatives’ feedback.
The home was not consistently safe, effective, caring, responsive or well-led. Risks were not always assessed properly. One prescribed cream was unavailable for seven days, and one person was served food that posed a choking risk.
Inspectors also found gaps in health monitoring, care records, dignity and communication. The home had enough staff, staff understood safeguarding, people could access health professionals, and people were supported with activities and relationships.
The overall rating changed from Good at the August 2014 inspection to Requires Improvement. A new management team had identified several problems and started making changes, but inspectors could not yet tell whether these changes were effective.
Staffing and safeguarding
There were enough staff to provide prompt care, and recruitment checks were in place. Staff knew how to recognise and report abuse.
“Safe staffing levels were maintained and staff were recruited in a safe manner that protected people from the risk of avoidable harm.” from the report
Mental capacity safeguards
The report says the Mental Capacity Act and Deprivation of Liberty Safeguards were followed. Decisions were made in people’s best interests when needed.
“Care records showed that a DoLS application had been made for each person in response to their individual restrictions.” from the report
Activities and relationships
People were supported to take part in activities inside and outside the home, and to maintain important relationships.
“People told us and we saw that they were encouraged to participate in leisure and social based activities that met their individual preferences.” from the report
Staff knowledge and privacy
Permanent staff knew people’s likes and interests. People could access their bedrooms and their privacy was respected.
“We saw that people's bedrooms were decorated in a manner that reflected their interests and needs.” from the report
New management action
The new management team had identified many of the problems and begun introducing new systems. Staff spoke positively about the changes.
“Staff had confidence in the new management team and spoke positively about the changes that were being made to improve people's care.” from the report
Risk and choking information
seriousImportant risk information was not always formally assessed or available to staff. One person was served an unsuitable diet because staff had not understood the person’s current dietary needs.
“We saw the person was served an unsuitable diet at lunchtime on the day of our inspection.” from the report
Medicine availability
seriousOne prescribed cream was unavailable for seven days. The report says the person’s skin was red and sore on several days when the cream could not be given.
“One person's medicine administration records (MAR) showed that they had not had one of their prescribed creams administered for a seven day period.” from the report
Care records
seriousCare plans were not always accurate or up to date. This could lead to new or temporary staff giving unsuitable or inconsistent care.
“This placed the person at risk of receiving unsafe and inconsistent care that was not responsive to their needs.” from the report
Dignity and communication
needs fixingA person was not supported to clean food from their face, and information was shared in front of other people. Pictorial communication tools were not available to support everyday choices.
“However, we found that people's dignity was not consistently promoted.” from the report
Health monitoring
needs fixingA person had not been weighed for about four months despite a monthly plan. Advice about low fluid intake was also not acted on as required.
“This advice had not been incorporated into the person's eating and drinking care plan and we saw that action had not been taken when their fluid intake fell below their recommended target.” from the report
Management oversight
seriousThe provider did not tell CQC that the registered manager had left. Improvement plans had started, but some had not been implemented or tested for effectiveness.
“The provider had not informed us of this change which is reportable to us by law.” from the report
- 01How do you now make sure prescribed medicines, including creams, are ordered early enough and are always available?
- 02How are choking risks, dietary instructions and other significant risks recorded and checked before staff provide care?
- 03How do you ensure temporary and permanent staff read and understand updated care plans before supporting someone?
- 04What pictorial or other communication tools are now available for people who cannot speak or read, and how are these used in care reviews?
- 05What changes have been made since the inspection, and how have you checked that they are working?
This was an unannounced comprehensive inspection covering all five questions; the previous Good rating was from August 2014. This explanation was written from the published report of 7 March 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of 17 Norton Avenue
3 rated inspections over 3 years: the service has held its Good rating throughout.
- July 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: OutstandingCaring: GoodResponsive: GoodWell-led: Good
- March 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 4 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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