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Inspection carried out on 7 January 2019

During a routine inspection

Newton House provides personal care and support to seven people with a learning disability, some of whom also have needs associated with autism. The service is operated by Aitch Care Homes (London) Limited under the brand 'The Regard Group'. Twenty-four hour support is provided by a team of staff.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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Why the service is rated Good.

People felt safe while supported by the staff team who made them feel reassured and relatives agreed with this. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. The registered manager had the knowledge to identify safeguarding concerns and acted on these appropriately. The service assessed personal and environmental risks to the safety of people, staff and visitors and took actions to minimise those risks.

The provider had employed skilled staff. They were knowledgeable and caring, making sure people received appropriate care and support. People received support that was individualised to their personal preferences and needs. Their needs were monitored and their support plans were reviewed regularly or as changes occurred. People received their prescribed medicine safely and on time. We found a minor issue with the storage of medicine but it was rectified promptly.

Staff had ongoing support, supervision and appraisals. They felt supported by the registered manager and maintained good team work. People received care and support that was personalised to meet their individual needs. People were able to continue their usual daily activities and access the local community to enhance social activities. Staff understood the needs of the people and we saw care was provided with kindness and consideration.

People and relatives were complimentary of the staff and the support and care they provided. The recruitment and selection process helped to ensure people were supported by suitable staff of good character. There were sufficient numbers of staff on each shift. The service ensured there were enough qualified and knowledgeable staff to meet people's needs at all times. People's rights to confidentiality, dignity and privacy were respected. Staff supported and encouraged people to develop and maintain their independence wherever possible. Relatives were complimentary of the service and the way their family members were supported.

People were given a nutritious and balanced diet and hot and cold drinks and snacks were available between meals. People had their healthcare needs identified and were able to access healthcare professionals such as their GP. The registered manager and staff team knew how to access specialist professional help when needed. People were supported in the least restrictive way possible to have maximum choice and control of their lives. The policies and systems in the service supported this practice.

We observed a calm and relaxed atmosphere during our inspection. People were treated kindly and with respect. Staff were happy in their jobs and there was a good team spirit. The registered manager had quality assurance systems in place to monitor the quality of care being delivered and the running of the service. They promoted a positive culture in the service and ensured people were at the centre of the staff team’s attention.

Staff felt the registered manager was approachable and considerate. They had good communication, worked well together and supported each other, which benefitted the people who use the service. The registered manager had quality assurance systems in place to monitor the running of the service and the quality of the

Inspection carried out on 15 June 2016

During a routine inspection

This inspection took place on 15 and 16 June 2016. We gave the registered manager short notice as we needed to be sure people would be there and to enable them to prepare people for our visit to avoid undue stress to those with needs on the autistic spectrum.

The service was last inspected on 28 July 2014 and was found compliant with the outcomes inspected. Newton House provides personal care and support to seven people with a learning disability, some of whom also have needs associated with autism. The service is operated by Aitch Care Homes (London) Limited under the brand ‘The Regard Group’. Twenty-four hour support is provided by a team of staff.

A registered manager was in place as required in the service. 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 and their relatives felt people were safe and well cared for. Staff had received comprehensive training and were supported through regular team meetings, supervision meetings and annual appraisals. Effective day to day communication took place in handover meetings between shifts. Detailed individual care plans were in place, and people and their representatives were involved in planning their care. People’s daily lives reflected their wishes and aspirations. The service responded in a timely way to changes in people’s needs. People’s heath and dietary needs were well met and the service consulted with external healthcare specialists where appropriate.

Staff understood how to protect and promote people’s rights and freedom and worked with people to support their wishes. Staff offered patient and respectful guidance and understood how people communicated their needs and anxieties. They worked diligently to protect and promote people’s dignity and privacy and in ways which valued people’s individuality.

People were encouraged to take care of their own personal care needs as much as possible and to develop their skills in these areas and in others such as meal preparation. Staff worked alongside people to encourage them to take part in daily living activities and offered praise and encouragement. Relationships between people and the staff were very positive and people actively sought out contact with the staff.

The provider offered a range of training courses focused on developing people’s skills and abilities and these were promoted and attendance encouraged wherever possible. Where people needed support to manage their behaviours, this was provided in the least restrictive way possible and in accordance with appropriate behaviour support plans.

The environment was pleasant and clean and had been developed in response to people’s wishes and needs. People had been asked about the décor of their bedroom and their wishes had been respected. People had access to a wide range of activities and events in the community. Two people were able to go out to activities without staff support. People’s spiritual needs were also provided for.

Health and safety and fire safety were well managed and appropriate servicing and in-house checks took place. Risk assessments relating to the service and to specific people or activities, were in place and regularly reviewed.

Staffing levels were sufficient and were flexible to take account of changing needs or specific events and staff recruitment and induction was robust. People had been involved in the recruitment process where possible. Staff went about their role in a positive and proactive way, suggesting they enjoyed their work.

The service was well-managed and monitored through a range of robust audits and monitoring systems by the registered manager and the provider. The registered manager had recently won a ‘gold award’ for ‘Care Trainer of

During a check to make sure that the improvements required had been made

We re-examined the one outcome where we previously identified non-compliance. Appropriate action had been taken to address the identified shortfalls in medication management systems.

Inspection carried out on 14 May 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected and spoke with the parents of two of the people supported. We used the information to answer the five questions we always ask.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found:

Is the service safe?

People received care and support in accordance with their care and behaviour management plans which were regularly reviewed. Appropriate professionals were involved in reviews as well as family representatives. The relatives we spoke with told us the service was well run and kept people safe.

Staff had sought the advice of external healthcare specialists appropriately to maintain people’s health, wellbeing and safety. The staff were aware of the health needs of the people they were supporting. We found that medication management and recording were not as good as they should be. We have asked the provider to take action to address this.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home had liaised with the local authority DoLS team previously. The regional manager was aware of a recent Supreme Court judgement relating to ‘deprivation of liberty’ and had emailed the manager to carry out ‘capacity’ assessments and make contact with the relevant DoLS teams to discuss the need for referrals.

Is the service effective?

We saw that people’s needs were being met by a knowledgeable staff team. The house was calm and people were given space to do what they wished where they wished. We saw that the people supported enjoyed positive relationships with the staff and demonstrated warmth towards them. The relatives we spoke with told us the home met people’s needs effectively and provided them with a fulfilling lifestyle and access to activities in the community. One said: “X is well looked after and we are kept informed of any changes or incidents.”

Is the service caring?

We saw staff working in a caring and respectful way while supporting people. They showed that they understood people’s individual communication methods well and enabled people to make decisions and choices.

The relatives we spoke with thought the service was caring. One told us the staff were: “very good” and added that: “the team had settled down now and turnover was lower.”

Is the service responsive?

We saw that people’s care plans and other documents recorded people’s needs and where these had changed. Care files showed that the home responded promptly to any changes such as health needs. Advice had been sought appropriately from external specialists where necessary.

Care was provided based on people’s known and indicated wishes and preferences. People had access to meaningful activities and the community. People had opportunities to go on holidays either alone or in small groups.

The relatives we spoke with all felt that they were involved and consulted and that the service responded to people’s needs. One said: “they have managed to reduce some of X’s medication over time.”

Is the service well-led?

We found that the home provided consistent care to people and was well-managed. There were clear lines of managerial responsibility, although some recording systems could have been better monitored and maintained. A range of audit and monitoring systems were used by the management team and provider to maintain an overview of the home’s operation, and highlight areas for improvement. Action had been taken to address issues where these had been identified. The views of people’s relatives were sought and acted upon. The audit system for medication could be improved.

Relatives described the service as: “very good.”

Inspection carried out on 17 June 2013

During a routine inspection

We saw that people and their representatives had been involved in planning their care. Their views, likes and dislikes were documented in support plans and staff were aware of the content. People’s preferred methods of communication were known and recorded and we saw staff engaging people in decisions about their day.

Care plans were supported by risk assessments and where necessary, by behaviour management plans. Records showed that people’s healthcare needs had been met. Individuals accessed activities according to their wishes and were involved in choosing holiday destinations.

The home had appropriate arrangements in place to respond to a range of emergencies.

Systems and training were in place to safeguard people from abuse. Where concerns had arisen, they had been reported and investigated appropriately.

Staff were subject to an appropriate recruitment process prior to being appointed. They were provided with on-going support through team meetings, supervision and appraisal.

The provider and manager had a range of systems in place to monitor the performance of the home. These systems included an on-going cycle of progress review. Complaints were investigated and addressed appropriately.

During a check to make sure that the improvements required had been made

We re-examined the three outcomes where we previously identified non-compliance. In each case appropriate action had been taken to address the identified shortfalls, or was in progress. The provider supplied evidence to demonstrate how ongoing progress is reviewed and action plans are monitored on an ongoing basis.

Inspection carried out on 9 July 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service. People who used the service had complex needs which meant they were unable to tell us about their experiences. We observed the interactions between the people being supported and the staff and sought evidence of the involvement of individuals in decision making. We also telephoned and spoke with the relatives of three of the people supported in Newton House.

The family members we spoke with were happy that they had been involved in planning the care on behalf of their relative. They had also been consulted subsequently at reviews. Staff were described as receptive to suggestions from family members about care issues. People told us that staff treated people in Newton House with dignity and respect.

We were told that people in the home had access to appropriate activities and outings to meet their needs and interests. People were said to be safe and family members felt the staff kept them informed of any significant events.

Relatives felt that staff were friendly and approachable though there had been concerns about staff turnover and level of experience at times. Relatives’ views about how well they felt the home was operating, had been sought by the provider.

Reports under our old system of regulation (including those from before CQC was created)