We carried out an unannounced comprehensive inspection of this service on 12 November 2018.

Norton Hall is a ‘care home’. 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. A maximum of 31 people can live at the home. There were 28 people living at home on the day of the inspection and nursing care is provided. A number of people lived with dementia.

This service also provides a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to 15 older adults.

There was a registered manager in post. 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us that the care and support they received from staff made them feel safe. . People told us that staff assistance maintained their safety and staff understood how they were able to minimise the risk to people’s safety. We saw staff help people and support them by offering guidance or care that reduced their risks.

Staff understood their responsibilities in reporting any suspected risk of abuse to the management team who would take action. There were enough staff to meet people’s needs in a timely way. People told us their medicines were managed and administered for them by staff. Infection control measures were in place to prevent the spread of infections and where incidents or accidents had happened the provider had reviewed and made changes where needed to ensure that learning from these events took place.

Staff knew the care and support needs of people and people told us staff were knowledgeable about them. Staff told us their training courses and guidance from the registered manger helped to maintain their skills and knowledge. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had a choice of where they ate their meals and enjoyed the meals offered. Where people needed support to eat and drink enough to keep them healthy, staff provided assistance. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People were seen talking with staff and spent time relaxing with them. Relatives we spoke with told us staff were kind and friendly. Staff told us they took time to get to know people and their families. Family members were updated about their family member’s well being. People’s privacy and dignity was supported by staff when they needed personal care or assistance. People’s daily preferences were known by staff and those choices and decisions were respected. Staff promoted people’s independence and encouraged people to be involved in their care and support.

People’s care needs had been planned, with their relative’s involvement where agreed. Care plans included people’s care and support needs and were reviewed and updated regularly. People told us activities were offered in the home which were of interest to them.

People and relatives were aware of who they would make a complaint to if needed. People told us they would talk thoug

Norton Hall is registered to provide care and accommodation to up to 31older people. At the time of our inspection 30 people were living there.

The inspection took place on 15 and 25 April 2016 and was unannounced.

At the time of our inspection a registered manager was in post. 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.

Improvements had taken place since our last inspection regarding the management of people’s medicines and in the audits undertaken by the registered manager. These improvements were made to ensure people received safe and effective care and support. Systems were in place to monitor and review people’s experiences.

People told us they felt safe living at the home and that staff treated them well. Staff were seen to be kind and considerate and treated people with respect and dignity. People’s privacy was respected.

Staff were aware of different types of abuse and were able to describe the actions they would take to keep people safe. People felt sufficient staff were on duty to meet their needs. The provider had systems in place to review staffing levels. Systems to ensure safe recruitment processes were in place and to ensure nurses were registered to practice.

Staff were supported by the management and received training to ensure they had the skills and knowledge necessary to care for people. Staff received regular one to one meetings with a manager and attended staff meetings were they were able to voice their opinions. People’s care needs were well known by the staff we spoke to.

People were asked for their permission prior to receiving care and support so people were able to give their consent. Where people were not able to give their consent decisions were made in their best interests.

People’s healthcare needs were monitored and health professionals were consulted in order to maintain people’s well-being. People told us they liked the food available and confirmed a choice was available to them.

People were satisfied with the care provided and were supported in a way they wanted. People had care plans in place describing their needs and risks associated with their care.

Staff told us they enjoyed their work and liked the management team. People and their relatives were confident any complaints made would be listened to and responded to.

The home provided care for older people. During this inspection we spoke with six people who used the service, three relatives, the manager and three staff. People we spoke with were complimentary about the care and support that they received. One person said the staff: “Are very friendly and helpful”. A relative told us: “The staff are pleasant, I am quite happy with them”.

People or their relative told us that they felt involved in any decisions that needed to be made about their care and these were made in their best interests. We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that medicines were prescribed and given to people appropriately to ensure that they were managed safely. To ensure people received their medicines as prescribed.

Staff had been recruited in an appropriate way and checks had been undertaken to ensure that they were suitable to care for vulnerable people.

We found that any comments and complaints people made were responded to appropriately to ensure that people were listened to.

The last inspection found that the provider was not meeting some of the essential standards. This follow up inspection took place to see what improvements had been made.

We spoke with the manager, home support manager, five people who used the service, two relatives, three staff and a health care professional.

We found that improvements had been made in all of these areas where needed. People we spoke with were complimentary about the care and support that they received. One person said: “We are very settled and happy here” and another person said: “There have been lots of changes for the better”. A relative said: “I can assure you that everything is alright here”.

We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Robust arrangements were in place to ensure people were safeguarded from the risk of harm.

Systems were in place for the prevention and control of infection to ensure that people lived in a clean environment.

People were asked about their preferences about their care so they felt involved in their care and treatment. A system of audit had been put in place to ensure that people were not placed at risk of receiving inappropriate care. These systems now needed to be embedded to ensure that the current standards are improved upon and sustained.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

When we visited Norton Hall we spoke with four people who used the service. People told us that they were, “Very happy generally, the atmosphere is lovely” and, “Quite nice”.

We found that suitable arrangements were not in place to promote people’s choice, independence, privacy and dignity at all times.

People we spoke with told us the staff were, “Kind and caring” and they felt safe living at Norton Hall. We found that the provider had not responded appropriately to incidents of alleged abuse. This meant that people were not being safeguarded against the risk of abuse.

Appropriate standards of cleanliness and hygiene were not being maintained. This placed people at risk of acquiring an infection.

People were cared for by staff who were supported to deliver care and treatment to an appropriate standard.

Effective systems were not in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. Accurate records about people's care were not being maintained. This placed people at risk of receiving inappropriate care and treatment.

When we visited Norton Hall we found that people had been treated with respect and their dignity and choice had been considered by staff. People who used the service and their relatives and advocates were involved in making decisions about their care and treatment.

People were able to express their views through ‘Home Forum’ meetings, satisfaction surveys or by speaking to the registered manager as we were told that her “door is always open”.

We found that people experienced care, treatment and support that met their needs. One person told us the care received by these people was “fantastic”, and they were “more than delighted” with the service. Another person said the care the person who used the service received was “good”, they were “always clean and clean shaven”. A relative told us that the staff were “caring when handling people, I watch and there are always two staff. They are gentle with people. They are lovely”.

People who used the service told us they “always” felt safe and they were aware of how to complain. All of the people we spoke with told us that if they raised a concern they felt it would be listened to. We found that people who used the service were protected from the risk of abuse, although policies and procedures needed to be more thorough. This would make sure that in the event of any potential abuse that it would be responded to appropriately by all staff.

We looked at parts of the premises and found that some of the equipment and décor were badly damaged and in need of repair or replacement. This would make the service a more homely place for the people who lived there and prevent the risk of cross infection.

We found that some staff had not received appropriate training, supervision and appraisal to make sure that people who used the service received an appropriate standard of care to safeguard them from any unacceptable risk of harm.

We found that systems to assess and monitor the quality of the services provided needed to be more thorough, as people were not being protected from the risk of inappropriate care and treatment.

We found that the two records that we looked at contained missing or inaccurate information. This meant that people were not protected from the potential risk of inappropriate care and treatment. Some records were not being kept securely.

We inspected Norton Hall on 7 and 8 April 2015 and was unannounced. The provider is registered to provide accommodation and nursing care for up to 30 people who have nursing needs. At the time of the inspection 28 lived at the home.

At the last inspection in June 2014. We found that the provider had breached the Health and Social Care Act 2008 in relation to the management of medicines, supporting workers, assessing and monitoring the quality of service provision and records. Following that inspection we were sent an action plan informing us of the actions they would take to address the breaches we found. We found that improvements had taken place however the management of medicines remained to be of concern.

We found that some people had not always been administered their medicines as prescribed by a doctor to ensure that individuals health care needs were met. The stock of house hold remedies did not balance with the records held.

Staff were seen to obtain people’s consent before they provided personal care. People who lived at the home and their relatives told us that they felt people to be safe at the home and that staff treated them well. Staff were knowledgeable and recognised their responsibilities regarding keeping people safe. Staff knew about individual risks and were able to respond to people’s needs. We saw that staff treated people with dignity and respect while they supported people with their needs.

People had sufficient food and drink to maintain a healthy diet. People told us that they liked the food and that a choice was available. People’s health, wellbeing and dietary needs were known to staff members. People had access to healthcare services and were supported to see professionals such as doctors, dentist and opticians.

People told us that staff were kind, caring and respectful. We observed that people were relaxed in the company of staff. People were confident that they were generally involved in the running of the home and making decisions. Staff confirmed that when busy they did not always have time to escort and assist people to the dining room for their lunch. As a result people were seen eating within the lounge.

Staff were aware of people’s likes and dislikes. People were assisted to follow their individual needs in relation to their social and leisure interests. We saw that staff received training and were supported by the registered manager.

People we spoke with were confident that any concerns they raised would be listened to and that action would be taken as necessary. People who used the service, relatives and staff told us that they had found the registered manager to be supportive and approachable. We found that the provider and the registered manager had systems in place to ensure the quality of care provided was monitored. Audits and checks were in place however these did not consistently show the actions taken to ensure that improvement was made.