Norcrest is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement.

Norcrest does not provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service supports up to eleven people with learning disabilities and/ or autism. There were eleven people using the service at the time of our inspection.

When we last visited the home on 19 and 20 August 2015 the service was meeting the regulations we looked at and was rated Good overall. At this inspection we found the service remained Good overall and also for each key question.

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.

People were protected from abuse and improper treatment. The provider trained staff in safeguarding. The registered manager discussed safeguarding regularly with staff and also people using the service, reminding people how to stay safe. The provider managed risks relating to people’s care through suitable risk assessment processes. The provider made improvements when things went wrong and had systems to share learning across the provider’s services.

Staff were recruited via recruitment processes to check their suitability. There were sufficient numbers of staff deployed to support people. Processes were in place to manager people’s medicines safely.

The premises were well maintained and the provider had good infection control procedures in place. The premises met people’s support needs and people had access to all communal areas.

Staff received suitable support with induction, training, supervision and annual appraisal to help them understand their role and responsibilities.

The provider worked with other services to help people receive coordinated care when moving between services such as hospital admissions and admission as a new resident to the care home. People’s care needs were assessed though consulting with people, relatives and professionals involved in people’s care.

The provider had followed the Mental Capacity Act 2005 in assessing people’s capacity in relation to some aspects of their care, such as managing their finances. However, we identified the provider had not assessed people’s capacity in relation to some other decisions relating to people’s care. The provider told us they would rectify this as soon as possible. The provider applied for and followed authorisations to deprive people of their liberty (DoLS) as part of keeping them safe.

People received their choice of food and drink and were supported to maintain their health. People had access to the healthcare service they required. However, referrals for speech and language assessment in relation to choking risk were pending and the provider told us they would make the referrals for people who may be at risk as soon as possible.

Staff cared about the people they supported and were respectful. Staff understood people’s needs including their communication needs. People were supported to maintain their privacy and dignity and the registered manager encouraged staff to consider people’s dignity at all times. People were supported to maintain and build their independent living skills. People were supported to maintain and develop relationships to reduce social isolation.

People’s care plans reflected their physical, mental, emotional and social needs, their personal history, individual preferences, interests and aspirations. People were supported to develop care plans setting out their preferences for their end of life care. Staff understood the information in people’s care plans

On the day of our inspection there were ten people living at Norcrest on a permanent basis. We used a number of different methods to help us understand the experiences of people using the service because some of the people who lived at this care home had complex needs. This meant they were not always able to communicate with us.

We met four of the people who used the service, three members of staff and the registered manager. We were able to observe that people's experience of the service was a positive one. During our inspection we saw staff treated people with respect and dignity and people were supported to make informed decisions about how they lived their lives. One person who used the service told us “It’s alright here, not bad” and “the staff speak to me nicely”.

We also gathered evidence of people's experiences of the service by speaking to the registered manager and other staff who worked in the home and by reviewing various records the provider is required to keep.

We saw that policies and procedures had been put in place to ensure the safety and well-being of people using the service and we saw evidence of a quality assurance system regularly monitored by the provider.

We looked at training records for staff and found not all staff had received appropriate training. We also noted that many staff members required refresher training as previous courses had been attended over three years ago.

At the time of our inspection there were nine people using the service. During our visit we spoke with four people who use the service and three staff.

People who use the service told us they liked living at the home and enjoyed the food provided. People said the staff were friendly and knew what they liked. We saw staff being respectful towards people and communicating with each person in different ways, depending upon their needs.

The systems for the administration of medicines ensured that people were given their medicines safely, by appropriately trained staff.

Staff were supported by the organisation, and they felt there were sufficient staff to meet people’s needs.

The residents present during the time of the site visit had limited conversational skills. However, they were able and willing to show us their rooms and demonstrate the activities they liked to engage in. Their attitude and relationship towards staff were comfortable, relaxed and confident.

We visited the service on the 19 and 20 August 2015. The first day of the inspection was unannounced and we informed staff that we would be returning on the second day to complete our inspection.

Norcrest is an 11 bed residential care home for adults with moderate to severe learning disabilities, mental health and associated conditions such as epilepsy. At the time of our inspection 10 people were using the service. At our last inspection in July 2013 the service did not meet all the regulations we inspected however in January 2014 the service was reviewed and demonstrated that they were meeting the essential standards.

We met with the recently appointed manager who was approaching the end of their registration process with the Care Quality Commission (CQC) to become a registered manager. 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.

The service knew how to keep people safe. Staff helped make sure people were safe at Norcrest and in the community by looking at the risks they may face and by taking steps to reduce those risks.

People were cared for by staff who received appropriate training and support to do their job well. Staff felt supported by managers. There were enough qualified and skilled staff at the service. Staffing was managed flexibly to suit people's needs so that people received their care and support when they needed it. Staff had access to the information, support and training they needed to do their jobs well.

We observed staff had a good understanding of people’s needs and were able to use various forms of interaction to communicate with them. Care records focused on people as individuals and gave clear information for people and staff using a variety of photographs, easy to read and pictorial information. Staff supported people in a way which was kind, caring, and respectful.

Staff helped to keep people healthy and well, they supported people to attend appointments with GP’s and other healthcare professionals when they needed to. Medicines were stored safely, and people received their medicines as prescribed. People were supported to have a balanced diet and were able to make food and drink choices. Meals were prepared taking account of people’s health, cultural and religious needs.

A number of audits and quality assurance systems helped the manager and provider to understand the quality of the care and support people received. Accidents and incidents were reported and examined and the manager and staff used this information to improve the service.