We carried out this unannounced inspection on 24 and 25 January 2017. At our last inspection in November 2014 we rated this service “Good”. At this inspection we found that the service remained “Good.”

Norton House is a residential care service for up to 40 older people and people living with dementia. The service provides care over four floors, each of which has an accessible bathroom and shared living and dining room. On the ground floor there is a large communal dining room. On the first floor there is a short-term rehabilitation unit. At the time of our inspection there were 39 people using the service.

The service had 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 received personalised care through a detailed system of assessment and review, which ensured that people’s wishes and preferences about their care were taken into consideration. People were supported to speak up, for example through regular residents’ meetings, and through a yearly consultation to ensure people were happy with the service. Where people had made complaints, the provider had taken steps to ensure that these were appropriately investigated and responded to.

People had consented to their care and their choices were respected. The provider was meeting its responsibilities to assess people’s capacity and to apply to the local authority when people may be deprived of their liberty. Managers did inform the Care Quality Commission when this had taken place.

People told us they found staff kind, helpful and caring, and that they were treated with dignity and respect. There were measures in place to ensure people received good nutrition and access to health services. There was a programme of training and supervision in place to ensure staff had the appropriate skills to carry out their roles.

Managers had systems of audit to ensure that the service was well-run. There were effective health and safety checks to ensure the building was safe, however the risk to people from using the stairs was not managed effectively. The provider had steps in place to safeguard people from abuse, and had risk management plans in place to mitigate risks to people, however in some cases these required revision. Medicines were safely managed and administered by staff with the skills to do so, and there were internal and external systems of checks to ensure this was carried out correctly.

We have made a recommendation about how the provider manages risks to people who use the service from using the stairs.

We spoke with a number of people living at Norton House. The comments we received were positive and showed that people were happy with the care provided. One person said that they were "very comfortable, it is like a hotel" and another said that the home was "well managed". Staff were described as being "friendly".

We saw that staff sought consent from people on day to day issues, and people gave their views on what they would like to wear, do and eat each day. Staff completed risk assessments for people in relation to falls, moving and handling and nutrition and people had individual care plans based on their risk assessments.

People we spoke with said they felt "safe" living at Norton House and staff were always available if they needed help. Staff had undertaken training in safeguarding vulnerable adults and understood what was meant by safeguarding.

Staff and people we spoke with said they felt there were enough staff to meet the needs of people living at Norton House.

Systems were in place to monitor the quality of the service provided, and there were plenty of opportunities for people to comment on the service. Audits were carried out regularly on people's records and medication and changes were made where appropriate in response to findings.

Care records, and other records were kept securely and could be easily located when required.

We spoke with people who use the service and their relatives. Everyone we spoke with was very positive about their experience of the home. They told us that they were well cared for and that they felt they lived in a “real home”. One person said the home was “like a family here, lovely”. People told us that staff treated them with dignity and respect. One person said "staff are marvellous, kind and they are very thoughtful”. Another person said “I am very content here. I think I struck lucky”.

People could choose how they spent their time. A typical comment was “I can choose what I do”. They also said that the manager listened to their concerns.

During our visit we spoke to people who use the service, staff and a relative. They told us staff treated people with respect, dignity and they were encouraged to make their own choices. They felt safe living at Norton House and it is a nice environment to live in. Staff are very friendly, supportive and there are adequate numbers to meet their needs. People are encouraged to make their own decisions. This includes care, treatment and joining in with activities provided. The food was generally very good with choices available, although one person said they preferred the type of food their mother used to make.

They also told us they receive their medication on time.

They knew how to complain, who to and were confident they would be listened to and complaints investigated.

This inspection took place on 11 and 12 November 2014 and was unannounced. At our last inspection in December 2013 the service was meeting all the regulations we looked at.

Norton House provides accommodation and personal care for up to 40 older people. There is long-term accommodation for 30 people and a respite and re-enablement service for up to 10 people on the second floor of the home. This is for people who have been discharged from acute services for a period of re-enablement in preparation for returning home or being referred for long term care. People normally spend about eight weeks on this unit before moving on.

There was a registered manager in post who assisted us throughout the two days of the 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 and associated Regulations about how the service is run.

People told us they felt safe and secure at the home and safe with the staff who supported them. One person told us, “They take great care of me.”

We asked one person how they were getting on at the home and they told us, “I’m flourishing.”

The registered manager took appropriate action where people had concerns about their safety.

The management and staff at the home had identified and highlighted potential risks to people’s safety and had thought out and recorded how these risks could be minimised.

People told us that staff were kind and compassionate towards them and listened to what they had to say. One person commented, “They really are first rate.” A relative told us, “Staff treat mum with dignity, honesty and integrity. I am very pleased.”

The respite and re-enablement service, provided on the second floor of the home, required some improvements. People using this service told us they were unclear about how long they should be in the unit and why they were there. The rooms in the unit were not up to the same standard as other rooms in the home and looked sparse.

Staff understood the principles of the Mental Capacity Act (MCA 2005) and we observed staff asking people for permission before carrying out any required tasks for them. We noted staff waited for the person’s consent before they went ahead. People told us that the staff did not do anything they didn’t want them to do.

People were very positive about the food provided. We saw that people were offered choices and alternatives if they wanted. People said that the chef consulted them about their likes and dislikes and that regular food surveys and tasting sessions were conducted. People’s comments about the food included, “They’re always asking me what I want to eat,” “The cook is excellent” and “I’ve got no complaints about the food.”

People and their relatives said they had good access to other healthcare professionals such as dentists, chiropodists and opticians.

People said staff were able to spend time with them, getting to know them and how they were feeling and we observed staff sitting and chatting to people. One person commented, “We have well spent time together.”

People we spoke with were positive about the registered manager and management of the home and confirmed that they were asked about the quality of the service and had made comments about this. They felt the service took their views into account in order to improve service delivery.