This inspection took place on 11 and 19 September 2018 and was unannounced. At the last inspection in March 2017 the service was rated as good.

Norton House Trading as Poole Beresford Ltd provides care for up to 23 older people. At the time of the inspection 19 people were using the service. People in care homes receive accommodation and 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 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.

At this inspection we identified people were not safe. Risk was not well managed and concerns around people’s safety were not always identified or dealt with quickly enough. The provider was not using screening tools to help identify potential risk. Some environmental hazards were identified on the first day of the inspection; the provider had started to address these when we returned to complete the inspection. There were enough staff to keep people safe but the provider did not carry out robust pre-employment checks to make sure staff were suitable. Medicine systems were generally well organised. We have made a recommendation about guidance when people receive their medicines ‘as required’ rather than on a regular basis.

Staff told us they received support from their colleagues and the management team. However, we found training and supervision was variable which meant staff might not be equipped with the relevant knowledge and skills.

People were not always supported to have maximum choice and control of their lives and the policies and systems in the service did not support this practice. The provider was following the application process when people were being deprived of their liberty but they failed to meet conditions which were part of the authorisation procedure.

People enjoyed the meals, and had plenty to eat and drink. They accessed services which ensured their health needs were met. Two health professionals told us staff acted upon advice given. People lived in a pleasant and well decorated environment. They were comfortable and walked freely around different areas of the service.

People were complimentary about the staff who looked after them and the management team. They told us they were well cared for. Staff knew people well and supported people at their own pace and in a person-centred way. However, care plans varied in quality. We have made a recommendation about providing accessible information to meet people’s communication needs. Social activities were offered but these were not always relevant to people’s interests.

The registered manager and provider were visible and interacting with people who used the service, visitors and staff. Survey results showed people were satisfied with the service they received. People told us they felt comfortable sharing concerns but the system for recording complaints was not consistent. We have made a recommendation about the management of complaints.

There were widespread and significant shortfalls in the way the service was led. The provider did not have effective systems to assess, monitor and manage the service. They did not have processes to learn lessons and drive improvement. The provider was not always responsive and did not demonstrate an understanding of their responsibilities.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014, which related to safe care and treatment, need for consent, staffing, recruitment of workers and governance arrangements.

The overall rating for this service is ‘Inadequate’ and the service therefore is in

Care service description.

Norton House is registered to provide accommodation and personal care for up to 22 older people, nursing care is not provided. The accommodation is arranged over two floors with the lounges, dining room and conservatory on the ground floor. There are bedrooms on both floors. At the time of the inspection 17 people were living at the home.

Rating at last inspection.

At the last inspection the service was rated as ‘Good.’

At this inspection we found the service remained ‘Good’ and had improved in the ‘Well-led’ section from ‘Requires improvement’ to ‘Good.’

Why the service is rated Good.

Staff were recruited safely and there were enough of them to provide people with the care and support they needed. Staff received appropriate training and support and were very enthusiastic about working at Norton House.

Care plans were person centred and up to date. Care workers knew people well and understood their personal preferences. People’s healthcare and nutritional needs were being met and activities were on offer to provide people with stimulation.

The registered manager and provider had introduced a range of audits which were effective in identifying and addressing any shortfalls in the service. People who used the service, relatives and professionals had all been consulted about the way the service was managed and any improvements which could be made. Their responses had been acted upon which showed their views were valued.

Further information is in the findings below.

We inspected Norton House on 25 November 2015 and the visit was unannounced.

Our last inspection took place on 12 September 2013 and, at that time, we found the regulations we looked at were being met.

Norton House is registered to provide accommodation and personal care for up to 22 older people, nursing care is not provided. The accommodation is arranged over two floors with the lounge, dining room and conservatory on the ground floor. There are bedrooms on both floors.

The service has 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.

People told us they felt safe at Norton House and staff told us they would report any concerns to the registered manager or deputy manager. The registered manager and deputy manager understood how to report any suspicions of abuse in order to make sure people were safe at the home.

We found the home was clean and odour free. The home was generally well maintained and bedrooms had been personalised and communal areas were comfortably furnished. 

Recruitment processes were robust and thorough checks were always completed before staff started work to make sure they were safe and suitable to work in the care sector. Staff told us they felt supported by the registered manager and that training was on offer. However, we found some training was not up to date.

There were enough staff on duty to make sure people’s care needs were met, people told us they liked the staff and found them kind and caring. On the day of our visit we saw people looked well cared for. We saw staff speaking calmly and respectfully to people who used the service.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s health care needs were met. Safe systems were in place to manage medicines so people received their medicines at the right times.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

People told us their visitors were made to feel welcome and if they needed to complain they would speak to the registered manager.

We saw there were some quality assurance checks in place, however, the providers checks were not robust and were not picking up issues we have identified in this report. Equally there were no ‘best practice’ or developmental issues being identified as part of these visits.

We found one breach of regulations and you can see what action we told the provider to take at the back of the full version of the report.

This inspection was carried out to assess whether the service had taken action to make sure that the systems for managing medicines in the home were safe. We had told the provider during our inspection in May 2013 that this must be done.

We found that action had been taken and the systems were safe.

Due to the focussed nature of this visit, we did not speak with any of the people who lived at the home on this occasion.

During this visit we spoke with ten people who use the service. All of the people spoke highly of the environment and of the staff but all but one said that they would like more to do with their time. These are some of the things they said:

"The staff are fantastic, they are kind, helpful and come quickly when I need them"

" We sometimes get entertainment but usually it is just watching the television"

" I get bored but the staff are too busy to spend more time with us"

"The food is good plain home cooking. If we don't want what has been made we can choose something else"

"It is always clean and tidy here, the cleaner is very thorough"

"I get all the help I need"

Staff told us that they enjoy working at the home and fell well supported in their roles. We found that the environment very clean and tidy and provided people with choice of pleasant areas in which to spend their time.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.

We spoke with nine people who live at Norton House. Overall, all of these were happy with their care and support. They told us they trusted the staff who worked there. They added that they were kind, respectful and competent. They made comments like “Everything’s perfect”. And “I’ve come alive since I’ve come here. It’s better than a five star hotel.”

We spoke to six people who live at the home. They all told us that they were very happy at the home and with the care and attention they get from staff. Two people told us that their general health and mobility have improved since they moved into Norton House. They also said that the home was kept spotlessly clean and is always tidy. People commented about the friendly, homely atmosphere and that there are activities arranged to keep them occupied.