About the service:

Norton Place is a nursing home, for up to 11 people with learning disabilities and complex health needs. At the time of our inspection there were nine people living at the service, which is close to the seafront in Shoeburyness.

People’s experience of using this service:

People had good outcomes at Norton Place. They lived in a peaceful setting and their needs were met by care staff who knew them well. Feedback from relatives was positive about the service, with one relative saying, “[Person] is in the right place and is happy. It’s the best care they have had over the years.”

The service was effectively managed by a well-established registered manager and deputy manager. They led by example and had a passion for continually driving improvements and placing people at the centre of the service. They promoted a culture which shifted the emphasis away from people’s health needs and focused on them as individuals. The registered manager developed positive links with outside agencies and used feedback to learn from mistakes.

As part of the conditions of their registration the provider had to ensure there was always a qualified nurse on site. The service was very dependent on agency staff due to the difficulty in employing permanent nurses. There were increased risks from a high turnover of agency nursing staff as they did not always know people and the providers processes. The registered manager had effective measures in place to minimise this risk.

People were safe at the service. There were enough safely recruited staff to meet their needs. Staff knew what to do if they had concerns about a person’s safety and the registered manager investigated concerns thoroughly and openly. Staff minimised risks from the spread of infection.

People received their medicines safely. In the past there had been concerns about the administration of medicines. There had been several improvements as a result, which had improved the safety for people in this area. A new room was being converted into a dedicated area for the nursing staff and for storage of medicines. This would improve safety and privacy for people receiving support with their medicines.

Staff had a good understanding of risk for each person. The registered manager ensured measures to minimise assessed risk did not unnecessarily restrict people. There were effective processes to ensure the service met legal requirements where people’s freedom was restricted. Staff offered people choice and when they did not have capacity, made decisions which were in people’s best interest.

Staff were well trained, supported and supervised. Concerns about staff morale and poor practice were managed well. Staff had developed effective skills to meet the complex needs of the people at the service. Staff worked well along with external professionals to maintain people’s physical and emotional wellbeing. People ate and drunk in line with their preferences and dietary needs.

Support was person centred and tailored around individual’s specific needs. Staff reviewed and adjusted support when changes happened. People were supported to take part in pastimes and interests. The provider had invested in new training and a new vehicle to ensure people remained stimulated and able to access the community.

People and their families felt able to raise concerns. There was a formal complaints process, and although there were few complaints, the registered manager encouraged feedback and was pro-active about investigating and resolving informal concerns.

Staff had received training and guidance around supporting people who needed end of life care. Whilst no one at the service was currently receiving palliative care, staff spoke with respect and fondness of people and families who they had been able to support when end of life care was required.

More information is in the detailed findings below.

Rating at last inspection:

Good. The last report was published on 3 September

This inspection took place on 25 July 2016 and 2 August 2016 and was unannounced.

Norton Place provides accommodation and nursing care for up to 11 people who have a learning disability; some of whom may have dementia related needs. There were 10 people living in the service on the days of our inspection.

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.

There were enough well trained and supported staff who had the knowledge and skills to care for people safely and meet their individual needs and wishes. Staff had been safely recruited to ensure they were fit to work with vulnerable people. Where people were not able to share their views with us verbally they used their individual style of communication which included facial expressions and body language to communicate with us. People indicated that they felt safe and we saw they were comfortable in staffs’ presence. Staff demonstrated a good knowledge and understanding of how to protect people from the risk of harm. They had been trained and had access to information and guidance to support them with the process.

Risks to people’s health and safety had been assessed and well managed. There were support plans together with risk assessments in place to ensure people were cared for safely. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines.

The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications when needed.

People had enough to eat and drink to meet their individual needs and preferences. Their care needs had been fully assessed and their support plans provided staff with the information they needed to meet people’s needs and to care for them safely. People’s healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when needed.

Staff treated people with respect and were kind, caring and compassionate in their approach. They respected people’s privacy and treated them with dignity at all times. People expressed their views and opinions in their own individual style of communication. People were supported to participate in activities that were meaningful to them and they regularly accessed shops and parks in the local community. People’s family and friends were able to visit at any time and were always made to feel welcome. Advocacy services were available when required. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

Relatives had confidence in the service and felt that the registered manager would listen and act on any concerns or complaints. Improvements had been made to the systems used to assess and monitor the quality of the service.

This inspection took place on 29 June 2015.

Norton Place provides accommodation and nursing care for up to 11 people who have a learning disability; some of whom may have dementia related needs. There were 11 people living in the service on the day of our inspection.

Improvements were needed to the quality assurance system because shortfalls in the quality of the service had not been identified through routine management checks therefore the quality assurance system was not always effective.

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.

Staff had the necessary skills and knowledge to meet people’s assessed needs safely. They were well trained and supported. There were sufficient staff who had been recruited safely to ensure that they were fit to work with people.

People were not able to share their views with us verbally but they used facial expressions and body language to communicate with us. They indicated that they felt safe and were comfortable with staff. Staff had a good understanding of how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them with the process.

Risks to people’s health and safety had been assessed and the service had support plans and risk assessments in place to ensure people were cared for safely. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines.

The manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made applications appropriately when needed. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals.

People were supported to have sufficient amounts of food and drink to meet their needs. People’s care needs had been assessed and catered for. The support plans provided staff with sufficient information about how to meet people’s individual needs and preferences and how to care for them safely. The service monitored people’s healthcare needs and sought advice and guidance from healthcare professionals when needed.

Staff were kind and caring and treated people respectfully. People participated in a range of activities that met their needs. Families and friends were made to feel welcome and people were able to receive their visitors at a time of their choosing. Staff ensured that people’s privacy and dignity was maintained at all times.

There was an effective system in place to deal with any complaints or concerns.

People who use the service had limited communication. They communicated with us using facial expressions and body language when we spoke with them. We spent time with many of the people who use the service and they indicated that they were happy and that the staff and food were good. People responded positively when asked if they were treated nicely.

We saw that staff treated people well and took their time when speaking with them. Staff actively listened to people and responded appropriately at a level and pace that was suitable for the individual.

There was a good range of activities on offer which included arts and crafts, painting, ball games, cards, dominoes, puzzles, movement to music and the use of sensory items. People regularly received massage therapy from a visiting professional masseuse.

The support plans and risk assessments had been well written and they provided good information about the individual. The daily notes were detailed and informative.

Safeguarding procedures were in place and people appeared relaxed and happy. Staff had a good knowledge of the safeguarding procedures and had received regular training.

There were good procedures in place for handling medication. Staff had been trained in handling medicines and their competence had been regularly assessed.

People’s rooms were personalised and the environment was clean, tidy and fresh.

The majority of people who were living at Norton Place had communication difficulties and were unable to tell us about their experiences of using the service. Our observations suggested that they were very happy living at the service and that they felt safe and well cared for. We spoke with one relative and they said that the care provided by support assistants at Norton Place was excellent.

People's health and personal care needs were assessed and there were detailed care plans for support assistants to follow to ensure that people were supported safely, effectively and in accordance with people's individual wishes. Support assistants spoken with demonstrated a good understanding of people's health and personal care needs and how each person wished to be supported. Our observations showed that support assistants ensure that care and support provided to people who use the service was person led, flexible, consistent and able to meet their changing needs. Evidence showed that staffing levels may not always meet the needs of the people using the service. This referred specifically to people having to wait on occasions to receive personal care, to have their manual handling needs met and to be supported to eat their meals and/or be given a drink. The provider may wish to review these arrangements.

We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place.

People using this service were in the main unable to communicate with us verbally in a meaningful way. One person told us that they were very happy living at Norton Place and told us about the activities that they enjoyed. Other people through gestures, facial expressions, body language and interactions indicated that they were happy and content living at Norton Place.

We saw that staff understood people's needs and responded to non-verbal cues when providing support. People enjoyed the food provided by the service.