Norton Street

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified a breach of regulations in this key question in relation to premises and equipment. Arrangements to provide personal care were not acceptable. For example, due to mobility issues, 3 people required a level access shower but the provider had failed to make adequate provision in the properties where each of 3 people lived. This meant people were required to go to another property to access shower facilities. This was unacceptable not only for reasons of accessibility, but also because there were concerns around privacy, dignity, and safety. People were not always supported to a maintain a safe and healthy living environment. For example, sinks intended for personal care were visibly dirty and unhygienic, several rooms contained lots of discarded dirty cups and plates, there was excessive clutter, and waste bins were overflowing. These issues had previously been identified by the area manager through internal audit and escalated to the provider, but the provider had failed to take remedial action.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they generally felt safe within the service. This was reflective of the findings from the providers residents survey completed in 2023.

Staff told us they felt able to raise safeguarding concerns, although they did not always feel confident these would be followed up by head office. For example, staff had raised concerns about people smoking in the properties, but the provider had failed to act. Comments from staff included, “I can't say I believe action would be taken. We’ve had plenty of issues that needed change, and nothing happens” and, “In some situations I have seen change, we talk with the community mental health nurses and other medical professionals for advice.”

At the time of this assessment up-to-date safeguarding training for staff was at 70% with 7 staff still needing to complete their refresher training. The provider acted during this assessment to ensure this was completed.

People told us they could generally speak with staff about risks, for example others smoking within the premises.

Staff sought to work with people to address known and emerging risks. However, some staff described to us the whole approach to risk management felt like they were fighting a losing battle, partially around the smoking safety issue. Comments included “We report Incidents and accidents, and these goes to [other location] for a manager to review and we get told what action to take” and, “Head office want to be controlling and not allow staff to be proactive, so we need their say so for a lot of things.”

There was a formal process for staff to follow, both in terms of recording risks and action taken to mitigate risks in care plans and via incident report forms. However, as described above, staff told us current processes were not working effectively.

Staff told us concerns had been raised about the buildings, but no meaningful action had been taken. Comments included, “Our concerns are not listened to, particularly around the structure of buildings” and, “We report issues to maintenance but get told maintenance are waiting for tools or has to report to head office. It now takes time to get any repairs done.”

Arrangements to provide personal care were not acceptable. For example, due to mobility issues, 3 people required a level access shower but the provider had failed to make adequate provision in the properties where each of 3 people lived. This meant people were required to go to another property to access shower facilities. This was unacceptable not only for reasons of accessibility, but also because there were concerns around privacy, dignity, and safety. People were not always supported to a maintain a safe and healthy living environment. For example, sinks intended for personal care were visibly dirty and unhygienic, several rooms contained lots of discarded dirty cups and plates, there was excessive clutter, and waste bins were overflowing. These issues had previously been identified by the area manager through internal audit and escalated to the provider, but the provider had failed to take remedial action.

People told us staff come when they call them but they felt there was not always enough staff on duty to support them to go out. People told us they had not been able to go out for a meal together since last Christmas.

Because of staffing issues, staff told us they did not have the time or resources to support people as they would wish. Staff told us it was routinely planned for there to be 4 support workers, but this was simply not enough to meet people’s needs. Comments from staff included, and “We can’t really do everything required for 8 people; some get support and others don’t. We do what we can do.”

There were shortfalls in staff training, competency checks, and 1:1 supervision. Staff did not receive any training in using the recovery star model. Training records showed staff did not receive annual medicines competency checks. A support worker confirmed to us they had not completed a medicines competency check since their initial induction training. The provider confirmed new medicines policies were being introduced, which included undertaking medicines competencies with all staff trained to administer medicines. Managing behaviours that challenge training had not been refreshed and or completed for 6 staff. We found shortfalls in staff participating in 1:1 supervision. For example, 9 out of 23 staff had no recorded sessions.

Tasks related to day-to-day cleaning and upkeep of communal areas were carried out by domestic staff. Staff told us cleaning products and materials were readily available. Staff confirmed they only cleaned and maintained communal areas, not people’s private bedrooms.

The provider had a policy for infection prevention and control (IPC), but a copy was not available within the service. Basic cleaning schedules were in place for communal areas, but these were a simple ‘tick box’ exercise and did not allow for issues to be highlighted. Provider audits and spot checks to ensure staff were following the correct guidelines in relation to good IPC practice were not in place. For example, the last hand hygiene audits were undertaken in August 2022. The provider had not sought to build relationships, advice or support from the local authority health protection team. During our assessment, we made a referral to the health protection team to raise our concerns. Improvements were needed to ensure staff take appropriate action to help reduce the risk of the spread of infection, such as wearing appropriate personal protective equipment and good, regular hand-washing techniques.

Overall, people received their medicines as prescribed. A recent medicines audit had identified issues, and remedial action had been taken.

We noted one medicines error on the day of our assessment. We saw two blister packs on a bedside table in a person’s bedroom. One blister pack contained a small white tablet that had not been taken. It was not clear which date this missed medication related to, as all medication had been signed as administered. Other medicines issues related to audit and oversight are addressed in the governance, management and sustainability quality statement.