This inspection took place on 15 August 2017 and was unannounced.

Orton Manor is one of three homes owned by a small provider and provides accommodation, personal and nursing care for up to 40 older people living with physical health conditions or dementia. The home has two floors, each with a communal lounge and dining area. At the time of the inspection 36 people lived at the home. Orton Manor was last inspected by us in September 2016, and we awarded the home a rating of Requires Improvement.

The home 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’s medicines were not always administered as prescribed, and medicines records did not always demonstrate that medicines were administered consistently. Some prescribed creams were being administered by care staff who had not been trained to do so. Audits designed to check medicines practice was safe and in line with best practice had not identified some of the issues we found.

Risk assessments were not always in place where risk had been identified. Risk assessments did not always give staff the information they needed to manage risks safely and consistently.

People told us they felt safe with the staff who supported them, and we saw people were comfortable with staff. Staff received training in how to safeguard people and understood what action they should take in order to protect people from abuse. The provider ensured staff followed safeguarding policies and procedures.

There were enough staff to meet people’s needs effectively. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.

People were asked for their consent before staff supported them. Where people lacked capacity to make particular decisions, this had been assessed to ensure people were protected. Where people lacked capacity and had been deprived of their liberty to keep them safe, the provider ensured they applied to the relevant authority to ensure this was done lawfully.

People and relatives told us staff were respectful and treated people with dignity. We observed this in interactions between people, and records confirmed how people’s privacy and dignity was maintained. People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People had access to health professionals when needed and care records showed support provided was in line with what had been recommended. People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication needs, their likes, dislikes and preferences. People were involved in how their care and support was delivered.

People and relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. People and staff told us the management team were approachable and responsive to their ideas and suggestions. There were systems in place to monitor the quality of the support provided, and the provider was developing ways to ensure people were at the centre of helping the service to develop.

The inspection took place on 6 September 2016 and it was unannounced.

Orton Manor is one of three homes owned by a small provider and provides accommodation, personal and nursing care for up to 40 older people living with physical health conditions or dementia. The home has two floors, each with a communal lounge and dining area. At the time of the inspection 37 people lived at the home. Orton Manor was last inspected by us in June 2014 and we found the regulations were met.

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post. Since our last inspection, there has been a change of manager, with the new manager registering with us in March 2016.

People felt safe living at the home because staff were there to support them when needed. Staff knew what abuse was and how to report any concerns to the registered manager. People were supported to take their prescribed medicines by trained staff. Risks associated with people’s care were not always assessed and actions were not always put into place to reduce the risk of harm. Staff did not always have the information available to refer to, if needed, to know how to keep people safe from identified risks.

Staff worked within the principles of the Mental Capacity Act 2005 when supporting people with personal care. People had choices offered to them about what they wanted to eat and drink and overall, were supported to maintain their health and, when needed, were referred to health professionals. However, checks on people’s health did not always take place as planned.

Staff had received some training and felt this gave them the skills and knowledge they needed to effectively meet people’s needs and further training was planned.

The providers had installed Closed Circuit Television (CCTV) in all communal areas of the home, but had not given consideration as to how consent was sought from people when they were filmed. The information guide about the home, given to people, did not inform people about the use of CCTV or how recordings might be used.

People said staff were kind to them and involved them in making decisions about their day to day care and how they spent their time. There were planned group activities for people to take part in if they wished to, and people were supported to practice their religious beliefs if they wished to.

Staff promoted people’s privacy and dignity and encouraged people to be independent whenever possible. People felt staff effectively responded to their care and support needs and listened to their views.

Systems were in place to assess the quality of the service provided but improvement had not always taken place as planned for. Feedback was sought from people who lived at the home and relatives and action taken to make improvement where needed.

During our inspection we looked to see whether we could answer five key questions: Is the service safe, effective, caring, responsive and well led?

Two inspectors carried out this inspection on Thursday 12 June 2014. We visited the service from 7.00am to 4.00pm. At the time of our visit there were 35 people living at Orton Manor Nursing Home. We spoke with the registered manager, two visiting relatives, five people who used the service and five members of staff. We observed people moving around the home and we spoke to some people who were being looked after in bed.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We saw there were systems in place to identify, assess and manage risks relating to the health, welfare and safety of people living in the home.

Equipment was safe, clean and hygienic and was maintained and serviced regularly. Care plans were regularly reviewed to ensure people's equipment remained appropriate for their needs. Instructions to staff were clear as to their responsibilities for checking the safety and suitability of equipment.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There was nobody living at Orton Manor Nursing Home who had a current DoLs in place.

Is the service effective?

People all had an individual care plan which set out their care needs. These provided staff with the information they needed to support people with their care. Where people had specific health conditions, there were care plans in place which informed staff how those conditions were to be managed.

One person told us, “I couldn’t walk when I came. People told me I wouldn’t be able to walk again and there was no point in my having a physio. One day someone was helping me to be weighed and I thought I might be able to stand to be weighed so they helped me to see if I could weight bear and I could. Then they helped me to try to take a few steps and now I am mobile again. They supported me to do that."

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and respect when supporting people. People being transferred by hoist were relaxed and comfortable during the process. People and their relatives told us they were happy with the support they received.

Is the service responsive?

Where people had complex needs that required the input of specialist health care services, referrals had been made to the appropriate professionals. The service worked well with other agencies and healthcare professionals to make sure people received nursing care that met their needs. People had regular access to dentists, opticians and chiropodists.

Is the service well-led?

Quality assurance processes were in place to ensure people received a good quality service. People, their relatives and staff were asked their views of the home through a quality assurance questionnaire. The results were analysed to identify any areas where improvements were required.

Staff understood their roles and received support and training on a regular basis. Some training was due to be refreshed and dates had been set. This would ensure staff were competent to provide care and support to the required standard. Staff were supported to obtain qualifications appropriate to their work.