CQC report explained · a nursing home
What the CQC found at Norlands Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2019
Rated Good; inspectors found safe, kind and personalised care after improvements since the previous inspection.
This was an unannounced planned inspection on 16 July 2019. One inspector spoke with people living at the home, staff, the registered manager, the provider and a relative. They also reviewed care plans, medicines records, staff files, training records, safety information and quality audits.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe and well cared for. Inspectors saw kind interactions, patient support with eating and drinking, varied activities and care plans that reflected people's preferences.
The home had improved medicines management, emergency evacuation information and quality checks since the previous inspection. The provider was no longer in breach of regulations at this inspection.
There were a few points to follow up. Nurse clinical competencies needed review by an appropriate professional. The dining room was small, with plans to extend it, and feedback from people and relatives had not yet been gathered since the previous inspection.
Safer medicines systems
Medicines records had improved. Allergy status was recorded, cream charts were used and medicines were audited.
“Medicines administration records (MAR) were fully completed and recorded people's allergy status.” from the report
Kind and respectful care
People described staff as kind and caring. Inspectors saw staff supporting people gently, including during personal care and meals.
“We witnessed kind interactions, playful, appropriate humour and caring moments throughout our inspection” from the report
Personalised care
Care plans included people's likes, dislikes, life history and preferred ways of receiving support. One-page profiles helped staff understand people quickly.
“The care plans were now accompanied by a one-page profile which gave easy read, pictorial information” from the report
Improved management oversight
Quality audits were more regular and actions were taken when problems were identified. The provider was no longer in breach of the regulations identified at the previous inspection.
“Audits were regular and included the health and safety of the home, medicines, housekeeping and care plans.” from the report
Good meal support
People could choose alternatives and receive modified or fortified food when needed. Inspectors saw patient and dignified help with eating and drinking.
“People who required assistance with eating and drinking were helped with patience and dignity.” from the report
Nurse competency checks
needs fixingNurse clinical competencies were up to date but needed review by an appropriate professional. The provider said this would be arranged when the competencies were due.
“We will review this at our next inspection.” from the report
Limited feedback from families
minorThe home had not gathered feedback from people and relatives since the previous inspection. Inspectors said this was about to be undertaken.
“We saw feedback from people and their relatives hadn't been gained since the last inspection.” from the report
Small dining room
minorThe dining room was small. The home had plans to extend it, but inspectors said they would review this at the next inspection.
“While the dining room was small, there were plans to extend which we will review at our next inspection” from the report
- 01How are nurse clinical competencies reviewed now, and has the review by an appropriate professional been completed?
- 02What happened to the plans to extend the dining room?
- 03How do you now gather feedback from people and relatives, and what changes have resulted from it?
- 04How often are medicines records and stock levels audited now?
- 05How are people's care plans and one-page profiles kept up to date when their needs or preferences change?
This was an unannounced planned inspection that considered all five CQC questions and reviewed both the care provided and the home premises. This explanation was written from the published report of 9 August 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.
What inspectors found, July 2018
Rated Requires Improvement; inspectors found kind care, but serious problems with medicines, risk records and management oversight.
The inspection took place over two days, on 9 May and 14 May 2018. The first visit was unannounced and the second was arranged. Inspectors spoke with people, relatives and staff, observed care, and examined care plans, staff files, medicines and safety records.
The home was caring, with staff who knew people well and treated them kindly. People received training and support from staff, had access to activities and healthcare, and were offered freshly prepared food and choices at mealtimes.
However, inspectors found unsafe medicines arrangements, contradictory information about choking risks and disorganised care records. The home also lacked effective systems to monitor risks and quality. Two regulations were breached, covering safe care and treatment and good governance.
The overall rating Requires Improvement means the home was not consistently meeting the required standards. The caring rating was Good, but Safe, Effective, Responsive and Well-led were all Requires Improvement.
Kind and respectful care
Staff were seen treating people with warmth, kindness and respect. People and relatives gave positive comments about the staff.
“Throughout our inspection we observed lots of instances of warm and caring interactions between staff and people living at the home.” from the report
Skilled permanent staff
The home had low staff turnover, used permanent staff and provided training and professional development. Inspectors found staffing levels were sufficient for people's needs.
“People received care and support from staff who knew them well and who had the skills and training to meet their needs.” from the report
Clean and accessible environment
The home was clean and well presented, with landscaped gardens and outdoor space accessible to people using wheelchairs or with limited mobility.
“As we toured the home we found it to be well presented, clean with no mal odours.” from the report
Medicines safety
seriousMedicine records did not show allergy information, cream administration was not recorded correctly, and arrangements for unexpected or as-needed medicines were not responsive. This was part of a breach of Regulation 12.
“This placed people at an increased risk of receiving a medicine that they were allergic to.” from the report
Choking-risk information
seriousCare plans contained contradictory information about thickened drinks and special diets, and the kitchen was not always told about dietary needs. Inspectors asked for immediate reviews and raised safeguarding alerts.
“We found the information recorded in people's care plans was contradictory and did not reflect the most recent swallowing assessment completed by a Speech and Language Therapist (SaLT).” from the report
Poor care records
needs fixingCare records were spread across several systems, often contained historical information and did not adequately record people's preferences or involvement in reviews.
“Documentation for recording day to day care and support was disorganised and spread across multiple systems.” from the report
Weak management oversight
seriousAudits and quality checks did not identify important problems or analyse trends. This was part of a breach of Regulation 17.
“Systems for audit, quality assurance and questioning of practice were disorganised and not sufficiently detailed enough to provide assurance that oversight was being maintained.” from the report
Limited dining space
minorNot everyone who wanted to eat at the dining table could do so because of limited space. Inspectors discussed staggering mealtimes with the management team.
“This meant a number of people were required to eat their meal in the lounge area.” from the report
- 01How do you now record allergies, cream administration and medicines needed as and when required?
- 02How do you make sure each person at risk of choking has one clear, up-to-date care plan that matches the latest swallowing assessment?
- 03Who is currently managing the home, and how are the responsibilities of the registered manager being covered?
- 04How do you check that care records reflect each person's current needs, preferences, relationships and involvement in decisions?
- 05What new audits or quality checks have been introduced, and how do you analyse problems and trends?
This was a two-day inspection covering all five key questions, including care, medicines, records, staffing, premises and management systems. This explanation was written from the published report of 21 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.
Every inspection of Norlands Nursing Home
3 rated inspections over 3 years: the service has held its Good rating throughout.
- August 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 11 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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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 £980 to £1,260 a week. 89 can care for a couple. 10 years' experience on average.
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“She is an exemplary carer, she is knowledgable empathetic and very respectful in the home.”
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