10–12 Reservoir Road, Prenton, Birkenhead, Wirral, CH42 8LJ
Piara Miah, Mary Rutter, Denise Williams, Elaine Evans
Healthwatch Wirral would like to thank Norway Lodge for welcoming Healthwatch Authorised Representatives who visited to view the facility and talk to staff, patients and visitors on 28/11/18.
Please note that this report relates to findings observed on the specific date and time of the visit. Our report is not a representative portrayal of the experiences of all service users and staff, only an account of what was observed and contributed at the time.
What is Enter and View?
Part of the Healthwatch Wirral’s work programme is to carry out Enter and View visits. Local Healthwatch representatives carry out these visits to health and social care services to find out how they are being run and make recommendations where there are areas for improvement.
The Health and Social Care Act allows local Healthwatch Authorised Representatives to observe service delivery and talk to service users, their families and carers on premises such as hospitals, residential homes, GP practices, dental surgeries, optometrists and pharmacies.
Enter and View visits can happen if people tell us there is a problem with a service but, equally, they can occur when services have a good reputation – so we can learn about and share examples of what they do well from the perspective of people who use the service first hand.
General profile of the service that was entered and viewed
Norway Lodge is a large detached house situated in a quiet residential area of Prenton. The home has 3 floors serviced by a lift. The driveway leads to a car parking area and the building is set in spacious mature landscaped gardens. The home provides residential and nursing care for up to 25 people. At the time of our visit there were 23 people living at the home.
Purpose of visit
Type of Enter & View visit undertaken
The visit is not designed to be an inspection, audit or an investigation, rather it is an opportunity for Healthwatch Wirral and Elected members to get a better understanding of the service by seeing it in action and talking to staff, service users and carers/relatives. If during a visit Healthwatch Wirral identifies any aspects of a service that it has serious concerns about, then these concerns are to be referred to the appropriate regulator or commissioners of the service for investigation or rectification. Any safeguarding issues identified will be referred to the Local Authority or Commissioner for investigation.
The rectification of less serious issues may be directly with the service provider on the day.
The Green visits are a snapshot view of the service and findings are reported based at the time of the visit.
Enter and View visits are conducted in a way that works in accordance with Merseyside Safeguarding Adults Board’s principles and procedures. Information will be shared accordingly in order to safeguard adults at risk on Wirral and promote quality of local services.
Discussions, findings and observations
Discussion with Manager
We were welcomed by the Manager and Deputy who asked us to sign in and escorted us to one of the resident’s rooms for a discussion about the home.
The Manager was keen to show us a care plan which appeared to be comprehensive, detailed, individualized and covered all aspects of the person’s life and needs.
Risk assessment included nutritional risk, risk of falls and also risk of developing pressure sores.
Dietary intake was monitored using the MUST tool (Malnutrition Universal Scoring Tool) and end of life choices were recorded through the advanced care planning. All care staff can write in the plan and relatives and residents sign in agreement with the plan. Care plans and daily evaluation records are reviewed regularly.
It was reported that one GP practice looks after a majority of the residents and a ‘ward round’ is completed every Tuesday.
Staff and Training
We were informed that the home employs 13 care staff. The Manager reported that staffing levels are adequate to provide safe care to residents.
We were told that staff turnover is low and that the home does not use Bank or Agency staff as they cover any absences with their own staff.
- Day – 1 or 2 Registered Nurse
- AM – 4 Carers, NVQ level 2 or above
- PM – 3 Carers, NVQ level 2 or above
- Night – 1 Registered Nurse plus 2 Carers
All staff receive an induction, 8 supervisions per year, or more if required, and 2 appraisals per year.
All staff have NVQ level 2, 3 or 4 and have received mandatory training in core subjects
The home also participates in the ‘6 Steps’ End of Life training and offers further training such as CPR, Defib, Medicines Management, Dementia Awareness, Falls Prevention, Palliative Care, Wound Management and Bladder and Bowel Training.
This home also participates in the Tele-triage System Scheme.
The scheme, created through a partnership between the NHS, University of Cumbria and Wirral Council provides the home with iPads.
The iPads act as a single point of contact between care home staff and senior nurses whenever a resident falls ill with the ability for nurses to seek a second opinion from specific clinicians if necessary.
Instead of dialing 111 when a resident falls ill, trained staff are able to contact a senior nurse at any time of day or night. The iPad’s camera together with information provided by staff (who are trained to take blood pressure, oxygen saturation levels and temperature) will enable the nurse to help diagnose and recommend treatment.
We were informed that the home stores medicines in a locked cupboard and controlled drugs in the Controlled Drugs cupboard. Nurses check that medication is given to the correct resident and the home does not administer covert medication. Nurses sign the MAR’s sheets and medicines ordered monthly are signed in by 2 nurses.
Nutrition and Hydration
Dietary intake is monitored using the MUST tool (Malnutrition Universal Scoring Tool) Residents are weighed when they arrive at the home and their weight is regularly monitored and recorded. When applicable, dietary supplements are provided. All staff are aware of the need for adequate hydration and nutrition for residents and drinks are offered on a regular basis. Care staff are on hand to assist residents with their dietary needs. Residents are given a good choice of food and staff know individual preferences.
The home uses a ‘protected time’ policy at meal times but visitors may join residents if special arrangements are made.
We were informed that all alerts are reported and investigated.
There is a complaints book and procedure. All staff and residents are aware of how to proceed if they wish to make a complaint
This home receives very few complaints and most are minor. We were informed that complaints are dealt with in house and the manager has an open door policy.
The Manager reported that all complaints are investigated and the outcomes are fed back to the person making the complaint.
DoLS and DNAR’s
The home follows legal requirements and best practice guidelines.
Falls are recorded in the accident book and care plans. Risk assessments are carried out and the home uses specialist equipment such as alarmed mats and bed rails to prevent falls.
Pressure Ulcer Care
The home manages any pressure ulcers by using specialist pressure relieving equipment and using the Tissue Viability Service.
Norway Lodge offers 1 to 1 outings to the shops and activities include crafts, quizzes, movies and games. Residents are asked what they would like to be included in the programme of activities planned. Birthdays and other events are celebrated.
Residents are also encouraged to pursue their own hobbies, if they wish to do so, and activities may be geared around the individual.
Extra services offered include hairdressing and beauty therapies.
It was reported that Norway Lodge monitors the quality of the service it provides by conducting audits, monitoring complaints, using surveys and holding regular resident forums.
We were asked to sign in the visitors book and Healthwatch Authorised Representatives used the hand sanitiser provided.
There were plenty of notice boards displaying statutory notices, and current information. Christmas decorations were displayed around the home.
The corridors were generally free from obstruction. They were well lit, had hand rails and were wide enough to enable residents to move around safely. The signage used throughout the home was not Dementia friendly.
A small number of doors had chips on the paintwork.
The communal lounge was spacious, tidy and clean. The décor was good and the chairs looked comfortable. However, the chairs were placed very close together around the perimeter of the room. Healthwatch Authorised Representatives thought that this arrangement may make it difficult for the staff to assist residents. Also, this arrangement is not always conducive to residents having group discussions.
We pointed this out to the Manager who responded that this arrangement had been agreed with residents as they liked to have their own chair to be with their friends.
The dining room was spacious and appeared to be clean and tidy. At the time of our visit residents were eating their lunch. Staff were seen to be assisting and encouraging residents to eat.
Bathroom and Toilets
The toilet and bathrooms viewed on the day were clean, tidy, fresh and were equipped with appropriate safety equipment. Call bells were placed within reach for residents using these facilities.
The bedrooms viewed were nicely decorated and furnished.
There was a strong smell from the air fresheners being used in these areas.
We were invited to use one of the resident’s rooms to have a discussion with the Manager about the home. Unfortunately, we found the room to be a little malodorous at the time of our visit.
Resident’s rooms were of different sizes, some having ensuite facilities, but all rooms had sinks. Call bells were within reach and all of the beds were profile and had washable mattresses. Residents have input into how their rooms are decorated and it was evident that they can personalise their own rooms.
The kitchen had an environment rating of 5. It was clean and appeared to be adequately equipped. Staff informed us that they were aware of resident’s nutritional needs and preferences.
Laundry is done on site and the laundry room was tidy and organised.
We were informed that there is a low incidence of loss of items. Staff, residents and relatives all understand laundry arrangements at the home.
The external areas included gardens and carparks. They appeared to be well maintained apart from an area in the front driveway which needed repairing.
The garden was large and the lawn was level and attractive.
Ramps were available to aid residents to safely manoeuvre around and the area was furnished with seating to encourage residents to use the facilities.
Staff were observed treating the patients with dignity and respect.
They were assisting residents with their meals at the lunchtime sitting and appeared to be patient and caring.
The residents looked clean and tidy and appeared to be happy.
Residents who spoke to Healthwatch at the time of the visit said that they liked living in Norway Lodge and that staff treated them well.
Healthwatch Authorised Representatives spoke to a person visiting their relative and were informed that they were very happy with the care given to their relative and that they did not have any concerns.
- Within the limits of a short visit, Healthwatch representatives found that residents appeared to be well cared for, happy and contented.
- The atmosphere was welcoming and friendly.
- The impression gained during our visit was that the staff were attentive to the needs of residents and were appropriately trained and motivated.
- Residents, and the visitor that we spoke to, stated that they were very satisfied with all aspects of their care, and felt that they could approach the manager with any concerns that they may have.
Recommendations and Considerations
Consider providing a ‘Dementia Friendly’ environment throughout the home.
Deep clean any areas or carpets that may be malodorous or consider substituting carpet with hard flooring.
Post-visit supplementary feedback from the provider
Norway Lodge believes this to be a fair reflection of our services, the one exception is with regards to the comment of a malodorous room that was used for the meeting, we cannot find any evidence of the cause of this. This room is occupied by a relative of the management team and is visited daily.
Norway Lodge has long since prides itself on the home not having an aroma on entry.
In relation to the chair that looked dirty, as there were not enough chairs in the allocated room, a chair was brought in for your staff to use. The permanent chairs in the room were the property of the resident and were not dirty.
Healthwatch follow-up action
Revisit in 2020
CADT – Central Advice and Duty Team
CSW – Care Support Worker
CQC – Care Quality Commission
DoLS – Deprivation of Liberty Safeguards
DNAR – Do not attempt resuscitation
MUST – Malnutrition Universal Screening Tool
NVQ – National Vocational Qualification
PEEP – Personal Emergency Evacuation Plan
RGN – Registered General Nurse
Distribution of Report
Healthwatch Wirral will submit the report to the Provider, Commisioner and to CQC.
Healthwatch Wirral will publish the report on its website and submit to Healthwatch England in the public interest.