Archived: Newlands

Newlands is registered to provide accommodation and personal care for people who have a learning disability and who need support with their personal care. Newlands is situated on the outskirts of Canterbury, accommodation is provided over two levels. Communal areas include a lounge and dining room, with access to gardens. Each person had their own personalised bedroom.

Newlands had not been designed in line with the values that underpin the Registering the Right Support and other best practice guidance. Newlands was designed, built and registered before the guidance was published. The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 21 people and 19 people were using the service. This is larger than current best practice guidance.

However, as to the size of the service having a negative impact on people, this was mitigated by the building design fitting into the residential area and the other domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, visible industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

While the design of the service did not meet current guidance, the service had however applied the principles and values of Registering the Right Support and other best practice guidance. These ensured that people who used the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected these principles and values by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible to gain new skills and become more independent.

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

People were happy living at the service, they appeared relaxed and comfortable with staff and each other. However, we found management checks were not consistent to ensure the environment was always safe. This was because checks had not taken place to ensure water temperatures were limited to prevent risks of scalding; the storage temperatures of some medicines were not monitored and some statutory notifications were not sent to us when they should have been. Audits and quality assurance processes had not identified or acted on these issues as was their intended purpose.

Otherwise, medicines were stored and managed safely. There were policies and procedures in place for safe administration of medicines. People received their medicines when they needed them from staff who had been trained and competency checked.

Staff monitored people’s health and referred them to healthcare professionals when required. Feedback from healthcare professionals praised the vigilance of staff and credited their actions with two people receiving lifesaving treatment. Family and friends placed great confidence in the staff and the service, they were without exception complimentary and supportive of the home.

Risks associated with people’s care had been identified and full risk assessments were in place. People were protected from abuse and staff had received regular safeguarding training.

Care plans were up to date and contained the level of detail needed. People’s care was based on their needs and preferences. People were supported to do things they enjoyed. People were independent and chose how to spend their time.

Staff followed guidance to keep people as healthy as possible. People were supported to eat a balanced diet. An appropriate complaints system was in place.

Staff were knowledgeable about the Mental Capacity Act 2005. They knew to seek consent for care and knew the process to help those who lacked capacity to make decisions. People’s needs were met by the adaptation and design of the service.

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.

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

Rating at last inspection

The last rating for this service was Outstanding (published 29 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection, we have identified breaches in regulations about the governance of the service and the requirement to inform us of some statutory matters.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Newlands is registered to provide accommodation and personal care for up to 21 people who have a learning disability and who need support with their personal care. Newlands is on the outskirts of Canterbury. Accommodation is provided over two levels, there were 19 people living at the service at the time of inspection and each had their own personalised bedroom.

The service had a registered manager, who was present throughout 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.

The feedback we received from people, relatives and professionals was wholly positive. We heard about standards of care which significantly improved the quality of people's lives and gave their families peace of mind. We observed warm, caring attitudes from a motivated staff team who worked consistently well together to provide the best possible care and support for people.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

Equipment and premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLS authorisations for people who were at risk of having their liberty restricted.

People received care and support that was planned specifically to their individual needs. The care and support needs of each person were different, and each person’s care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way. These were reviewed with people and their relatives to make sure they continued to have the support they needed. People were actively encouraged to be as independent as possible.

Staff actively encouraged participation. People were offered wide range of varied activities and participated in many social activities of their choice. Staff knew people and their support needs very well. The registered manager and staff team were fully committed to ensuring that activities were tailored to meet the needs of each individual living at Newlands. Activities and social events were praised by people, their families, community links and professionals. Throughout the inspection interactions between people and staff were positive and caring, and it was evident that people were comfortable and at ease. Newlands was relaxed, friendly and inviting, with lots of laughter.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. There was clear affection between staff and people and this was evident in actions such as the registered manager visiting people in hospital in their own time. The care people had been given at the end of their life received high praise from relatives and professionals. The registered manager and staff team demonstrated commitment in supporting people and their families at that time; ensuring people received the care and support they needed at all times, and that people always had someone they know with them at all times.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks and cook when they were able and wanted to. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements.

Staff told us that the service was well led and that they felt supported by the registered manager to make sure they could support and care for people safely and effectively. Staff said they could go to the registered manager at any time and they would be listened to. The registered manager had good management oversight and was able to assist us in all aspects of our inspection.

A health professional we spoke to told us 'The care and support people receive here is excellent. The home is very proactive in meeting people's health needs and gaining assessments where necessary. They have no problem in pursuing things when they are not happy about the health care and treatments people have experienced'. Another professional we spoke to told us. "People experience a very good quality of care here and the home has built up good relationships with health and social care authorities '.

We used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching how staff and people who used the service interacted and helped us record how people spent their time and whether they had positive experiences. This included looking at the support that was given to them by the staff. We observed that all interactions between staff and the people who used the service were positive.

We saw that the service followed legal requirements around issues of consent and that people who used the service were supported to make choices on a daily basis.

We saw that there were lots of activities on offer at the home and although people were encouraged to join in, it was readily accepted if they chose not too. We saw that people were supported to make choices about what they would like to eat, and what they would like to do. In addition, we saw that people were encouraged to have a voice and that they were respected and listened too. We found that staff knew each individual person who uses the service well and saw that they interacted with people positively and supportively.