Newton Care Homes Limited

At the time of our inspection, the care home provided accommodation, care and support for three adults with complex needs, including learning disabilities. People who lived in the supported living accommodation had varying needs, and required a range of support including personal care, prompting and monitoring. At the time of the inspection, eight people were receiving personal care in supported living accommodation.

This service also provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. In respect of supported living, this inspection looked at people’s personal care and support. The care service has been developed and designed in line with the values that underpin the “Registering the Right Support” and other best practice guidance. These values include choice, promotion of independence and inclusion. The service worked towards the goal of enabling people with learning disabilities and autism to live as ordinary a life as any citizen.

We have combined the reporting on the services provided by the care home and in the supported living accommodation.

At our last inspection on 12 and 13 April 2016 the service was overall rated Good.

At this inspection we found the service remained Good.

We spoke with some people who received care and support from the service. However, some people were unable to provide us with verbal feedback due to their complex needs. We therefore spent time observing interactions. Following the inspection, we spoke with relatives of people and care professionals. People, their relatives and care professionals told us that they were satisfied with the care provided at the service. We observed that people were well cared for and appropriately dressed at the time of the inspection. People who used the service said that they felt safe in the home and supported living accommodation and around staff. Relatives of people who used the service and care professionals we spoke with told us they were confident that people were safe in the home.

Appropriate policies and procedures ensured people who used the service were safe from abuse and harm. People’s relatives told us people were safe living at the care home or in receipt of care from the care agency. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

People who used the service had various risk assessments and risk management plans, which ensured they were protected from harm in relation to their care. Individual risks faced by people were identified with plans in place to control the risks.

Accidents and incidents were documented and investigated and responded to appropriately.

We observed that there were sufficient numbers of staff to meet people’s individual care needs and staff confirmed this. Staff did not appear to be rushed and were able to complete their tasks and they confirmed this.

Systems were in place to make sure people received their medicines safely at the home and supported living accommodation. Arrangements were in place for the recording of medicines received, their storage, administration and disposal.

We found the premises we visited were clean and tidy and there were no unpleasant odours. There was a record of essential inspections and maintenance carried out. The service had an infection control policy and measures were in place for infection control.

Staff had been carefully recruited and provided with an induction and training to enable them to care effectively for people. Staff had access to a variety of training, which helped them to update and maintain the skills and knowledge in relation to providing care to people. Regular supervisions and appraisals were provided to review staff performance and set learning objectives for the future.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The service had made necessary applications for DoLS and we saw evidence that authorisations had been granted.

Staff were kind, caring and respectful towards the people they supported. They had a clear understanding of people's individual needs, preferences and routines. Staff supported people to remain as independent as possible. There were policies and systems in place to support this practice.

People who used the service had choice of a nutritious and well balanced diet. The service ensured that people’s health was monitored and if required external health care support was sought to ensure people’s health and wellbeing were maintained.

People were offered a variety of activities and outings both in groups and as individuals. Each person had an individual activities programme which was devised based on their individual interests. Activities outside the service were available to all people and included attending the day centre, social club and nightclub. Within the service, people participated in reflexology, movie nights and arts and craft.

The service carried out a satisfaction survey in July 2018 and the feedback was positive. People and relatives told us that the registered manager was approachable and willing to listen.

There was a management structure in place with a team of care support staff, deputy manager and the registered manager. Staff told us that the morale within the service was good and that staff worked well with one another. Staff spoke positively about working at the service. They told us management were approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

There was a comprehensive quality assurance policy which provided detailed information on the systems in place for the service to obtain feedback about the care provided at the home. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result. The service also carried out spot checks and observations to ensure that the service was running well.

At our last inspection on 1 July 2014 the service met the regulations inspected.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and their relatives told us that they were satisfied with the care provided at the home. We observed that people were well cared for and appropriately dressed at the time of the inspection. People who used the service said that they felt safe in the home and around staff. Relatives of people who used the service and care professionals we spoke with told us they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Comprehensive risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm.

People’s care needs and potential risks to them were assessed. Appropriate care plans were in place to ensure that people received safe and appropriate care. Their healthcare needs were closely monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.

We observed that there were sufficient numbers of staff to meet people’s individual care needs and staff confirmed this. Staff did not appear to be rushed and were able to complete their tasks.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We found the premises were clean and tidy and there were no unpleasant odours. There was a record of essential inspections and maintenance carried out. The service had an infection control policy and measures were in place for infection control. There was a cleaning rota in place to ensure that staff were aware of their responsibilities and ensure the home was kept clean.

Staff had been carefully recruited and provided with an induction and training to enable them to care effectively for people. Staff confirmed that they received supervision sessions and appraisals to discuss their individual progress and development. We noted that since January 2016 the service had introduced a supervision calendar to ensure that all staff received regular and consistent supervision sessions. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, health and safety and first aid. Staff demonstrated that they had the knowledge and skills they needed to perform their roles.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people’s needs changed.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The home had made necessary applications for DoLS and we saw evidence that authorisations had been granted.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs were met. People were satisfied with the meals provided. Food was freshly prepared and people were encouraged to eat healthy food.

People and relatives spoke positively about the atmosphere in the home. There was a homely atmosphere in the home. Bedrooms had been personalised with people’s belongings to assist people to feel at home.

People told us that there were sufficient activities available and we saw that each person had their individual activities timetable based on their interests. Activities available included attending the local day centre, going to the park and shopping. During the inspection we saw some people go out to the local day centre.

The home had carried out a satisfaction survey in 2015 and the feedback was positive. The feedback received was positive. People and relatives told us that the registered manager was approachable and willing to listen.

There was a management structure in place with a team of care workers, senior support worker and the registered manager. Staff told us that the morale within the home was good and that staff worked well with one another. Staff spoke positively about working at the home. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

Staff were informed of changes occurring within the home through staff meetings and we saw that these meetings occurred quarterly and were documented. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

There was a comprehensive quality assurance policy which provided detailed information on the systems in place for the service to obtain feedback about the care provided at the home. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result. The service also carried out spot checks and observations to ensure that the home was running well.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed, and the records we looked at. If you want to see evidence that supports our summary please read the full report.

We spoke with three people who used the service, the registered manager, the provider, three staff and two family members.

This is a summary of what we found:

Is the service safe?

Both family members told us they felt their relative was safe in the care of staff.

Staff had received safeguarding training.

During our inspection we assessed how the Mental Capacity Act (MCA) 2005 was being implemented. This is a law which provides a system of assessment and decision making to protect people who do not have capacity to give their consent. We also looked at Deprivation of Liberty Safeguards (DoLS). DoLS aim to make sure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We saw that because of people's complex needs they were unable to leave the home without the assistance of staff. This may mean deprivation of liberty authorisations were required.

We saw that systems were in place to protect people against the risks associated with medicines.

We found that recruitment procedures were in place and appropriate checks had been carried out to ensure suitable staff were employed.

Is the service effective?

From our observations and from speaking with staff we found that they had a good understanding of people's care and support needs and knew them well.

People's health and care needs were assessed in conjuction with the person and their family members. Staff told us care plans assisted them to meet people's needs. We saw that information in care plans, including risk assessments was sufficiently detailed to guide staff and had been regularly reviewed.

Is the service caring?

Staff showed patience and gave encouragement when supporting people. One person said 'Staff were caring' and another person said they liked the staff. Both family members gave positive feedback, one said in respect to staff they were, 'Brilliant and work very well,' the other said staff were, 'O.K.'

People's preferences, interests and diverse needs were recorded, and care and support was provided in accordance with wishes of people using the service and their families.

Is the service responsive?

People took part in activities within the home and the wider community.

Both family members told us they knew how to make a complaint and we saw there was a process in place to respond to any issues of concern.

Is the service well-led?

The service had quality assurance systems to identify and address issues. All members of staff we spoke with were clear about their roles and responsibilities.

People who used the service received appropriate care and support that met their individual needs and were treated with dignity and respect. One relative told us 'It is the right home for my son, we are very lucky to have found this home'

There were processes in place to protect people who used the service from harm. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

The staff were supported to provide care and treatment to people who used the service and were being trained, supervised and appraised appropriately.

There were systems in place to monitor the quality and safety of the service and accurate and appropriate records were maintained.

Records kept were fit for purpose and held securely.

One person told us 'I enjoy going to the day centre, doing my job and seeing my girlfriend' another person told us 'I am happy here, I like buying music and the staff take me to see my parents and help me call them on the phone'.

We looked at the care records of two people and found people consented to the care they received. Where people were unable to express consent, the provider had acted in accordance with legal requirements.

We found care plans were detailed and they provided enough information for staff to be able to deliver a high standard of care. For example, where people expressed behaviours that challenged the service, there were clear guidelines for staff to follow to ensure the behaviours could be managed effectively.

We observed the cleanliness of the home and found people were cared for in a clean environment.

We looked at staff rota's and observed staff levels and found there was sufficient staff on duty to meet people's needs.

We looked at the complaints procedure and found there was an effective way of recording and making a complaint.