Newstead Lodge Nursing Home

Newstead Lodge is a care home providing accommodation with nursing or personal care for up to 26 people. The home is purpose-built accommodation, providing care and support to people across 2 floors. At the time of our inspection visit there were 19 people living at the home.

People’s experience of the service and what we found:

People were supported by staff who knew them well and were kind and attentive to them. People’s safety and care needs were identified, their care was assessed and planned, and their needs were met. There was an approach to supporting people, so their individual preferences and lifestyles were respected, whilst their safety needs were balanced with positive risk taking.

Staff understood how to protect people from abuse and were confident the provider would take action to protect people, should this be required. Staff were also confident to refer to other agencies to keep people protected.

The provider had safe recruitment systems to ensure staff were suitable to look after people. There were enough staff on duty to support and meet people’s needs.

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. People’s freedom was not unnecessarily restricted, and people were not physically restrained.

People lived in a safe, clean and maintained environment. Regular checks ensured the environment was safe. People were encouraged to personalise their rooms and some people were involved in decorating their rooms.

Staff worked with people, relatives and health and social care professionals to maintain people’s health and wellbeing.

We found there was a positive and person-centred culture, which focused on meetings people’s needs. People and relatives spoke positively about the service and staff team. People’s views and feedback was sought on the service they received.

People were involved in how their care was received and how they lived their day, such as what they wanted to do and where they wanted to go.

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 requires improvement overall (published 15 May 2023). The overall rating for the service has changed from requirement improvement to good based on the findings of this inspection.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the culture at the service and potential risks to people’s care and the environment. A decision was made for us to inspect and examine those risks.

When we last inspected Newstead Lodge on 29 March 2023 breaches of legal requirements were found. This inspection checked whether they were now meeting the legal requirements. We found no evidence during this inspection that people were at risk of harm.

We undertook a focused inspection to review the key questions of Safe, Effective and Well Led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Newstead Lodge is a care home providing accommodation with nursing or personal care for up to 26 people. The home is purpose-built accommodation, providing care and support to people across 2 floors. At the time of our inspection visit there were 25 people living at the home.

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

Risks were not always mitigated to help ensure people received safe care. Medicines administration procedures required improvement to ensure people always received their prescribed medicines when they should.

People were not always supported to have maximum choice and control of their lives, and staff did not always support people in the least restrictive way possible and in their best interests; the providers systems did not always support best practice.

Checks and audits in place had failed to identify the areas for improvement found at this inspection including safe risk management and safe medicines administration.

We received mixed feedback from people about their experiences at the home. We were not assured people always received enough fluids to maintain their health.

Staff adhered to infection control procedures and protected people from the risk of infection. Staff had completed safeguarding training and felt able to raise concerns.

People were supported to access healthcare services when required.

The provider took immediate action in response to some of the areas we identified as requiring improvement and planned to take further action following the inspection.

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 good overall (published February 2020). The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We identified two breaches of the regulations in safe care and treatment and good governance.

Why we inspected

This inspection was prompted by some feedback we received about the service. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff received training and followed good infection control practices. Staff wore personal protective equipment (PPE) effectively to safeguard people from the risk of infection.

Staff rotas were organised to minimise the risk of transmission of infections between people and staff. Staff were allocated to specific areas of the home to complete their shifts and took their breaks alone.

Staff took part in the ‘whole home testing’ programme which included a weekly polymerase chain reaction (PCR) and daily lateral flow test (LFT). Where staff tested positive, they were not allowed in the home until they had completed a self-isolation period as per government guidance.

The provider understood and met the COVID-19 staff vaccination requirement and ensured all deployed staff were fully vaccinated against COVID-19.

There were robust procedures to ensure visitors were prevented from catching and spreading infection. Visitors were required to show evidence of a negative lateral flow test taken on the day of their visit to show they did not have COVID-19. Visitors were also required to complete screening questions, have their temperature taken and wear PPE before entering the home.

People were admitted to the home safely. Staff followed government guidance to prevent people from spreading infection when admitted to the home from another health or social care service or the community.

Newstead Lodge is registered to provide accommodation, nursing and personal care for up to 26 older people, including people living with dementia. At the time of our inspection visit there were 23 people living at the home. Bedrooms were across two floors with communal areas and a main dining area on the ground floor. People had their own bedrooms and access to an outdoor area.

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

People told us they felt safe living at the home and staff understood how to protect people from abuse. People and relatives raised no concerns about staffing. On the day of our visit, there were enough staff to meet people’s needs. Staff followed safe principles for infection control. Staff practice meant the potential for cross infection risk was minimised. Some people in the home had experienced coughs and cold symptoms and the registered manager reported this outbreak to the relevant agencies.

Staff knew people well, what their preferences were and staff understood how their approach needed to be tailored to each person. Staff told us they were trained and staff training included refresher training alongside an induction for new staff. One to one and group supervision meetings were used as discussions to share best practice about certain topics, such as safeguarding and promoting good nutrition and hydration.

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. However, there was extensive use of continuous CCTV monitoring of internal and external communal areas. Although signs were displayed, there was limited evidence to show people’s feedback and consent had been sought and that the on-going use of CCTV had been considered and reviewed. We signposted the registered manager to our website and other agencies responsible for such imagery as well seeking people’s feedback about its continued use.

People told us and we saw, staff were respectful, kind and caring. People had individual care plans and assessments that met their health and social needs and they were supported by other health professionals and agencies.

People were involved in pursing their interests and hobbies. People’s life history information was used to inform staff about their interests. Regular activity sessions were not always planned. We were told spontaneous and one to one activities worked well for people at Newstead Lodge.

Care plans were clear and they provided staff with the information and guidance they needed to support people in line with their individual care needs. Staff could support people who were at end of life and people’s advanced wishes and preferences were discussed and followed.

People and relative meetings provided opportunities for feedback on the service. The registered manager had an open-door policy and because they worked ‘on the floor’, frequent opportunities were taken to seek and act on feedback.

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

Rating at last inspection and update

The last rating for this service was good (published 20 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

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 understood their responsibilities to protect people from the risk of abuse. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough staff to support people safely. Medicines were stored, administered and managed safely.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the identified risks. The registered manager regularly checked that the premises and equipment were safe for people to use and the provider took action to improve safety when issues were identified.

People were cared for and supported by staff who had the skills and training to meet their needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough to maintain a balanced diet that met their preferences People were referred to other healthcare services when their health needs changed.

The manager and staff understood people’s individual needs and preferences for care and support. People were encouraged to maintain an interest in life, to take part in social activities and maintain relationships that were important to them. Staff promoted people’s independence and respected their privacy and dignity.

People and relatives knew the manager well and were confident any concerns or issues they raised would be dealt with promptly. The manager checked the quality of the service by working with staff and encouraging staff to support and engage with people as individuals.

People and their relatives were encouraged to share their opinions about the quality of the service. Staff were inspired by the registered manager’s leadership, skills and experience to provide a quality service. The service people received was in accordance with the fundamental standards of care.

Further information is in the detailed findings below.

We inspected this service previously on 17 June 2013 and identified that improvements were required in three areas. We found that people’s records were not always accurate. Some records did not contain detailed information about the individual person and care was not delivered in line with people’s care plans. We found that there was no effective system to assess the risk and control the spread of infection in the home. We found that the provider did not have an effective system to identify, assess and manage risks relating to people’s health and welfare.

We found that the provider had made changes since our previous inspection and that improvements had been made in all areas of concern.

We found there was a new infection control policy in place and staff were aware of this and followed it. Staff had received training on infection control. We saw that the laundry was clean and tidy and staff followed a new laundry procedure.

We looked at people’s care records and found that the information they contained was person centred, which meant that it contained detailed information about the individual person. We saw that care was delivered in line with people’s care plans.

We found that the provider had introduced new systems to identify, assess and manage risks relating to the health, welfare and safety of people within the home. These included new health and safety audits which were done on a regular basis.

During our visit we observed the care that was given to people by staff. We saw that staff treated people with dignity and respect.

During our last inspection of this service in January 2013 we made a compliance action due to concerns around the planning and delivery of care to people. During this inspection, we found that some improvements had been made, however there were still areas of concern.

We found that the home had not taken reasonable steps to assess the risk to people regarding infection control.

We read the care records for seven people who lived at the home. Many of the people were not able to tell us about their care and support because of their complex needs, so we observed care practice and staff's interaction with people when they were delivering care.

During our inspection we saw several people having aromatherapy. People appeared to enjoy it. One person we spoke with told us that, “It’s wonderful we have lots of laughs, it’s very homely.”

During our visit we observed that the care staff were polite and asked people’s permission before they supported them.

We spoke with four relatives, three members of staff delivering care, the deputy manager, the home’s administrator and the home’s nominated individual (healthcare manager). We read the care records for three people who lived at the home.

Relatives we spoke with were complimentary of the care and support being provided. They told us: "I am happy with the care the staff are giving X” their family member was “always clean and tidy.” Another relative told us that they were “very pleased, everybody is nice” and that their family member ”is supported a lot” and they got “everything they wanted.”

We saw that the provider had assessed people’s needs. However the care records were not consistent. Therefore the care and treatment that was delivered to people, was not always in line with their individual care plan.

We observed moving and handling practice in the home. Most moving and handling practice we observed was satisfactory and we saw staff support people with dignity and respect. However not all moving and handling practice was delivered in a way that ensured people’s safety and welfare.