Norton House Trading as Poole Beresford Ltd

Norton House is a care home which can accommodate up to 23 people. At the time of our inspection there were 21 people living in the home.

We carried out an unannounced comprehensive inspection of this service on 8 May 2019. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve need for consent and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Effective and Well-led which contain those requirements. We also looked at Safe as the evidence gathered at the last inspection under this key question contributed to the breach recorded in Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

People’s experience of using this service and what we found

Systems for assessing and managing risk had been improved. Care plans included up to date and comprehensive individual risk assessments which gave staff the information they needed to maintain people’s safety. New and emerging risks including the effects of COVID-19 had been assessed.

Improvements had been made to the systems for managing medicines and regular auditing meant these systems remained safe.

Systems were in place to make sure people were safeguarded from the risk of abuse. The provider had liaised with the local authority safeguarding team to revise and improve the safeguarding policy and procedures.

Systems for recruitment of new staff remained safe and people said there were enough staff available to meet their needs in a timely manner.

Clear processes were in place to prevent and control infection within the home. The provider had been proactive in following government and local guidance in relation to managing the COVID-19 pandemic.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider had made improvements in systems for assessing people’s capacity to make decisions.

The provider assessed peoples’ needs before they began to use the service and regular reviews took place to make sure care plans reflected people’s current needs.

People’s nutritional needs were assessed, and plans put in place to make sure they were met. People we spoke with said the food they received at the service was very good.

People were supported by a range of health and social care professionals to maintain their overall health and wellbeing.

Staff received the training and support they needed to care for and support people safely and effectively.

Changes in the management structure had been effective in improving quality assurance systems.

Analysis of accidents and incidents enabled the provider to learn lessons from previous events and implement positive change.

Feedback from people who used the service and their relatives had been analysed and produced in a format which gave people an overview of the responses received.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Norton House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

The service had improved from our last inspection, although some more work was required before we could consider a rating of ‘good’. Some aspects of the service met the characteristics of good, however.

Staff were providing safe care, however we made a recommendation about reviewing some aspects of care plans to ensure information was up to date. People told us they felt safe, and we saw there were enough, safely recruited staff to provide care and support when people needed it.

Medicines were usually managed safely, and we people lived in a clean and safe environment.

Any accidents and incidents were investigated as required, and reports were made to bodies such as safeguarding and the CQC when necessary.

Although people were offered choice, some aspects of recording people’s capacity to make decisions and the support they received to make these decisions needed further work. Staff had access to training and support, although records in this area needed updating.

People had no concerns about the food served, and we saw people received the support they needed to maintain good nutritional health. When people needed to see doctors or other health professionals this was arranged for them.

The staff and registered manager were caring and did not discriminate against people, and supported them to remain as independent as possible. There was a lack of evidence of people’s involvement in their care planning and review, however.

People’s complaints and concerns were well managed, and people felt able to talk to the registered manager at any time.

Improvement had been made to the monitoring of quality in the service, however there were still some aspects of this that required improvement. People and staff were able to make suggestions about improving care in the home.

Rating at last inspection: We published our last report on the service in November 2018, and rated the service ‘Inadequate’ overall. At this inspection we found the provider had made improvements and have rated the service ‘Requires Improvement.’ This service had been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Why we inspected: This was a scheduled inspection based on previous rating.

Enforcement We identified one breaches of regulations relating to consent, as people’s capacity to make decisions was not always assessed and documented.

Follow up: We have asked the provider to send us an action plan showing how they will make the required improvements. We will continue to monitor the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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 ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 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.

"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.