CQC report explained · a residential care home
What the CQC found at Norfolk Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People felt safe and relatives trusted staff. Risks were regularly reviewed, staffing levels were considered sufficient, and medicines were generally managed safely, although 'when required' medicines guidance was not always clear.
- Effective?
- Good
- People received suitable food, drink, training and healthcare support. Inspectors found improvements since the previous inspection, but some mental-capacity and best-interest decisions about shared bedrooms had not been recorded.
- Caring?
- Requires improvement
- Interactions were often positive, but staff did not always protect privacy and dignity. Inspectors also heard mixed views about how some staff treated people and saw decisions that affected other people negatively.
- Responsive?
- Good
- Care plans were current and gave staff useful guidance. Activities and trips had increased, and people were supported to maintain relationships, but some people were unoccupied for long periods.
- Well-led?
- Good
- Management and quality systems had improved considerably since the previous inspection. The provider was no longer in breach of Regulation 17, and staff and relatives described strong leadership and support.
What inspectors found, July 2022
Rated Good overall, but Caring Requires Improvement because privacy, dignity and the effect of some decisions on others were not always handled well.
This was an unannounced inspection on 11 and 17 May 2022. One inspector and an Expert by Experience visited, spoke with people, staff, relatives and health professionals, and checked care records, medicines, staffing and management records.
Inspectors found people were generally safe and received effective, responsive care. Risks were assessed, medicines were well managed, staff were trained, care plans were detailed, and people were supported with food, healthcare, activities and contact with relatives.
The main weakness was caring. Staff did not always protect people's privacy, and some decisions made for one person negatively affected others. Some people also spent long periods without activities. The overall rating was Good, with Safe, Effective, Responsive and Well-led rated Good, but Caring rated Requires Improvement.
Improved management
Staff, relatives and external professionals all reported considerable improvement since the current manager took up post. The provider had audits and action plans to monitor quality and learn from incidents.
“Without exception, staff and relatives said there had been considerable improvement in the service since the current registered manager had taken up post.” from the report
People felt safe
People said they felt safe, relatives trusted the staff, and risks were reviewed when people's needs changed. Staff knew how to report safeguarding concerns.
“People told us they felt safe with staff when receiving care.” from the report
Good care planning
Care plans were up to date and included people's needs, preferences and interests. Staff also worked with health professionals and followed their advice.
“People's care plans were up to date and accurate.” from the report
More activities
Activities and trips had increased in recent months. Staff knew people's interests and supported them to maintain relationships and join in social events.
“People's opportunities for activities had increased in recent months and everyone had opportunities to go out of the home on local trips.” from the report
Privacy and dignity
needs fixingStaff were heard discussing people in front of others and giving directions to people using a toilet from a nearby lounge. This meant private information was not always kept private.
“We heard staff speaking to each other about people in front of others.” from the report
Mixed experiences of care
needs fixingSome people gave positive feedback, but others raised concerns about how some staff behaved when people objected to something. The manager said these comments would be investigated.
“If I tell the carers that I don't like them doing something they get angry.” from the report
People left unoccupied
minorAlthough activities had improved, inspectors saw many people without activities for long periods. Some people said there was not enough to do.
“However, many people were unoccupied for long periods of time.” from the report
Best-interest records
needs fixingMental-capacity assessments and best-interest decisions had not been completed for some decisions about shared bedrooms. This created a risk that decisions were not properly recorded or least restrictive.
“This meant there was a risk of decisions being made that were not in people' best interests or in the least restrictive manner.” from the report
Infection-control practice
needs fixingStaff did not always sanitise their hands between changing disposable gloves. Used gloves were also put in an open-top bin in one area.
“Staff did not always sanitise their hands between changing disposable gloves, and used gloves were being disposed of in an open top bin in one area of the home.” from the report
- 01How do you make sure private information is not discussed where other people can hear it?
- 02What action have you taken about concerns that some staff became angry when people objected to care?
- 03How do you ensure people have regular activities and are not left unoccupied for long periods?
- 04Have all mental-capacity assessments and best-interest decisions about shared bedrooms now been completed and recorded?
- 05What steps have been taken to make sure staff sanitise their hands between changing gloves and dispose of used gloves safely?
This unannounced inspection looked at all five key questions, including the premises, care and infection-control arrangements, and found that several ratings had improved from Requires Improvement while Caring remained Requires Improvement. This explanation was written from the published report of 1 July 2022 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.
What inspectors found, November 2019
Norfolk Lodge rated Requires Improvement; inspectors found avoidable safety risks, inconsistent care and weak quality checks, despite some safe medicines practice and an open culture.
This was an unannounced inspection on 23 October 2019. One inspector and an Expert by Experience spoke with people, relatives and staff, observed care, and checked care, medicine and management records.
The home was not always safe. Some risks were not properly assessed or reduced, including unsafe storage of toiletries and denture cleaner, fire exit key arrangements, and inaccurate malnutrition and falls assessments. Staff practice was also mixed, with some people not treated with enough kindness or respect.
People generally received enough food, drink, medicines and healthcare. However, mealtimes, activities, access to the garden and support for people living with dementia needed improvement. The home was rated Requires Improvement in all five areas, and this was a deterioration from Good at the previous inspection in March 2017.
Medicines
Inspectors found that medicines were stored, audited and given safely. Staff had training and their competence had been checked.
“Medicines were managed safely. People told us they received these when they needed them and the records we looked at confirmed this.” from the report
Safeguarding
People said they felt safe. Staff understood how to report abuse, and safeguarding concerns had been investigated with the local authority when needed.
“Systems and processes were in place to protect people from the risk of abuse.” from the report
Healthcare
Staff supported people's health needs and worked with GPs and other professionals, including dieticians and speech and language therapists.
“Staff were vigilant to people's health needs and records showed that people had access to various healthcare professionals such as GPs, dieticians and speech and language therapists when required.” from the report
Open culture
People, relatives and staff said the manager was approachable. People and relatives felt able to raise concerns without anxiety.
“There was an open culture within the home.” from the report
Privacy and independence
Staff knocked before entering rooms, protected privacy during personal care and encouraged some people to eat independently.
“People's privacy and dignity was supported.” from the report
Risk assessments
seriousSome risks were not assessed accurately or reduced enough. Inspectors found unsafe storage and concerns about fire exit keys, as well as incorrect malnutrition and falls assessments.
“Risks to people's safety had not always been assessed or mitigated as much as reasonably practicable to protect them from avoidable harm.” from the report
Quality monitoring
seriousThe home's checks did not identify important problems with mealtimes, fire safety and unsafe storage. This led to a breach of Regulation 17.
“The governance systems in place had not been fully effective at monitoring or improving the quality of care people received.” from the report
Mealtimes
needs fixingSome people waited for their food, meals were left on the counter and hot food was served too early. Pureed meals also needed to look more appealing.
“The lunchtime meal experience for people needed improving.” from the report
Activities and stimulation
needs fixingStaff were often too busy to engage with people beyond care tasks. People living with dementia had limited opportunities for activities and could not always go outside when they wanted.
“There is very limited interaction between the staff and the residents with dementia. The opportunities to do things are limited.” from the report
Respectful treatment
needs fixingInspectors saw mixed treatment. Some staff were compassionate, but other actions and language were disrespectful and the person-centred culture was not fully established.
“A person-centred culture had not been fully embedded within the home and requires improvement.” from the report
- 01What action has been taken to make sure malnutrition and falls risk assessments are accurate and kept up to date?
- 02How are toiletries, denture cleaner and other items now kept secure, and what changes have been made to the fire exit arrangements?
- 03What has changed about mealtimes, including waiting times, food temperature and the presentation of pureed meals?
- 04Has the activities staff member started, and how do you make sure people living with dementia receive regular meaningful interaction?
- 05How do you monitor staff treatment of residents and respond when care is not kind, respectful or person-centred?
This was an unannounced planned inspection that assessed all five CQC questions, using observations, conversations and records; the report does not describe it as a focused inspection. This explanation was written from the published report of 28 November 2019 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 Norfolk Lodge
4 rated inspections over 7 years: the service has held its Good rating throughout.
- July 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Good
- November 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 23 December 2010.
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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13 live-in carers within about an hour of Norfolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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