We carried out this unannounced comprehensive inspection on 22 and 24 August 2018. At our last inspection in January 2017 the service was rated Good overall.

During this inspection we found four breaches in safe care and treatment, staffing , person-centred care and good governance. We found the provider was responsive to all our findings and has either already rectified or is in the process of making improvements to the service. You can see the action we asked the provider to take on the back of our full-length report.

Norbury Hall is a residential care home that provides support and personal care for up to 81 older people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Norbury Hall is set in a landscaped park. One section of the home is an older large Grade ll listed building and the other is a purpose-built extension. Accommodation within the home includes bedrooms on the ground, the first and second floors. There are two passenger lifts to access all floors. At the time of our inspection 50 people were using the service.

We met with the manager at this inspection who was in the process of becoming a registered manager with the CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were not always protected from the risk of harm due to environmental concerns. We found adequate window restrictors were not in place meaning people could fall from height. We found call bell cords had been tied up and some areas of the service were not clean. On the second day of our inspection we found the provider had fitted window restrictors and work had started to deep clean some areas.

Not all risks had been identified for people and some risk assessments had not been reviewed after people had fallen. Some information about people’s care was not always complete. This meant staff did not always have the guidance they needed to support people and manage their risk according to their individual needs.

There were not enough staff to keep people safe. People and their relatives told us the service needed more staff. There had been a large about of unwitnessed falls at the service and relatives told us they thought this was due to a lack of staff. We saw staff were task focused in the mornings and woke people early to get them washed and dressed. The provider had not completed an assessment of needs for each person so could not be sure how many staff were needed and at what time of the day to support people safely. Not all floors or communal areas were staffed during our inspection resulting in an increased risk to people sustaining injuries, or not receiving the care they needed. The provider assured us they would address these issues.

People and staff told us they liked the new manager and the changes they planned to make. We found communication methods were in place to obtain the views of people and their relatives although it was not always clear how these were acted upon.

We found some systems were not in place to ensure all care records and risk assessments were up to date and accurate. Audits were regularly completed, however, some health and safety and infection control audits were missing so issues that could put people who used the service and staff at risk had not been identified.

Newly introduced care records focused on people and gave a good picture of the individual including their physical, health and social needs. Plans were in place to update all care records, but at the time of inspection not all care records provided accurate or complete information

This unannounced inspection took place on 25 and 26 January 2017. The service was last inspected on16 January 2015, at which the service met all the regulations.

Norbury Hall is a residential care home that provides support and personal care for up to 81 older people. It is set in a landscaped park. One section of the home is an older large Grade ll listed building with 40 bedrooms. A new purpose built extension with an additional 41 en-suite bedrooms was recently completed. Accommodation within the home includes bedrooms on the ground, the first and second floors. There are two passenger lifts to enable people access all floors. At the time of our inspection 36 people were living at the service, one person was in hospital.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge and understanding of how to identify if people were at risk of abuse and knew what to do in these circumstances. People told us they felt safe and were treated with dignity and respect. Staff recruitment showed some shortfalls in procedures which the manager acknowledged and addressed promptly.

We saw the home had systems in place for the safe storage, administration and recording of medicines. Each person’s medicine was stored securely and only senior competent staff were authorised to administer medicines. During the inspection all medicine records we observed had been filled out correctly and medicine audits were completed to ensure medicine procedures were robust. The manager was introducing changes to medicine policies and procedures that included annual competency assessments.

Staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

Staff reported positively about the training available. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were kept up to date. We observed positive and appropriate interactions between the staff and people who used the service. Staff were caring and treated people with kindness, dignity and respect. People who used the service and their relatives were complimentary about staff and the quality and the standard of care received. There were nominated dedicated dignity champions within the staff team. Events that promoted qualities such as dignity included “Dignity Teas” Relatives spoke of feeling reassured that their family members were respected and had their dignity promoted.

People’s nutritional needs were monitored and appropriate actions taken where required. People made positive comments about the food. Preferences and dietary needs were being met. People were supported to maintain good health and had access to appropriate healthcare services. There were two dedicated doctors for people and a weekly GP surgery was held at the home. People with nursing needs and requiring insulin or wound care were seen by the district nurses, referrals were made promptly to the community team when a nursing need was identified. Family members confirmed that their relatives were seen regularly by doctors and district nurse as well as other healthcare professionals such as community psychiatric nurses.

Communication was e

We visited Norbury Hall unannounced as we had received anonymous information that was of concern.

The information we had received had focused on two main areas. These areas included the building and sleeping environment and the effect of this information on the care and welfare of people using the service.

During our inspection we spoke with the registered manager and deputy manager of the home.

We spent several hours at the home which included inspecting the building and sleeping environment. We looked at care plan records for people who use the service. We found no substance for the concerns that had been reported.

Norbury Hall is a large well maintained Grade ll listed home. During our inspection we observed that renovation works were being undertaken on the building and a new extension was being added to the existing building. The deputy manager informed us that the planned extension will add another 27 en-suite bedrooms to the homes capacity and the works were scheduled to be completed shortly. We observed the current environment to be suitably furnished, warm and clean.

At the time of our inspection there were 30 people residing at Norbury Hall. We used different methods to help us understand the experiences of people who use the service as not everyone who lived at the home was able to communicate verbally with us in a meaningful way. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We met and spoke with 7 people using the service, 2 family members and or visitors to the home and 7 members of staff including the deputy manager. Feedback from people who use the service was generally positive. They told us they were happy with the care and support provided at the home and felt the staff were kind and very helpful. One person told us “I can get up when I want and have something to eat when I want. The staff help me to retain my independence”.

During our inspection we observed positive staff interactions with people who used the service. Generally staff interactions were characterised by kindness, warmth, understanding and empathy.

People’s views and experiences were taken into account in the way the service was provided and delivered and there were effective systems in place to record, monitor and resolve any complaints, comments or suggestions made.

Two inspectors visited Norbury Hall unannounced as we had received anonymous information that was of concern.

The information we had received had focused on three main area; the building and environment, staffing levels and nutritional needs.

We spent approximately two hours at the home, and found no substance for the allegations that had been made.

We were only able to speak to one person who uses the service and a visitor in a meaningful way. They were able to tell us that ‘staff are marvellous, I’ve no complaints’.

To help us understand the experiences of people at Norbury Hall, we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s daily experiences were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff.

Feedback from people who use the service included ‘I like it very much’, ‘it’s nice here’, ‘it’s ok’ and ‘it’s alright but I’d rather be at home’. One person described it as ‘mundane’ whilst another said that they had ‘no complaints’ about the service provided.

Three visitors were spoken with who felt that the home was ‘very very good’ and there were ‘always things going on’.

We asked people if they were treated with dignity and respect and everyone we spoke to said that staff were polite and respectful to them.

Comments about the food provided included ‘I like it’, ‘nice’, ‘it suits me well’ and ‘I like the food here’. Other feedback included ‘it’s ok’ and ‘alright’. One person was heard to say ‘compliments to the chef’ after they had their lunch.

The people we spoke to were happy with the environment provided to them. No issues were raised about the cleanliness of the service. Feedback from individuals included ‘my bedroom is nice’, ‘it’s a very nice area’, ‘I go out into the garden’ and ‘quite nice’.

This inspection took place on 15 and 16 January 2015. The visit on 15 January was unannounced and we told the provider we would return on 16 January to complete the inspection.

We last inspected the service in January 2014. At that inspection we found the service was meeting all the regulations we assessed.

Norbury Hall provides support and personal care for up to 47 older people. It also caters for people living with dementia. There were 37 people using the service at the time of our inspection.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Norbury Hall provided a safe, clean environment which promoted the health and safety of people who used the service and that of staff. The control and prevention of infection was managed well. Staff followed policies, procedures and guidance, and understood their role and responsibilities in relation to infection control and hygiene.

There were clear procedures in place to recognise and respond to abuse, care staff had been trained and were knowledgeable in how to follow these.

Staffing numbers were kept under review and were appropriate to help make sure people were kept safe, and as a result the service was able to quickly respond as people’s needs changed.

People received their medicines as prescribed and at suitable times. Medicines were stored securely and safely, and safe practice was followed around the administration of medicines.

Care staff looked after people in a warm and caring manner. The care people experienced helped them to feel comfortable and relaxed and to maintain as much independence as they were able to.

Staff understood people’s diverse needs, wishes and preferences and demonstrated this in practice. Staff were appropriately trained to provide care which met people’s individual needs. They understood their roles and responsibilities and were supported to maintain and develop their skills through regular supervision and training.

Suitable arrangements were in place for people to have a healthy and nutritious diet and people’s dietary needs were met.

The quality standard of the service provided was regularly assessed and monitored, and improvements made where necessary. People who lived in the home, and their relatives felt involved and included in the way the home was run and were encouraged to express their views and opinions about the services provided.