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Inspection carried out on 2 April 2019

During a routine inspection

About the service:

Newbrook provides care for up to three people who have learning disabilities. At the time of inspection there was two people using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice and independence. People using the service received planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

The service met the characteristics of a good service in all the areas we reviewed. The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways. The service promoted choice, control and independence.

Each person had their own bedroom. The service was person centred. People had maximum control over all aspects of daily life. This included their routines, activities and meals. People’s support focused on increasing their opportunities and providing them with skills to become more independent.

Risks to people’s health and safety were assessed and appropriate risk assessment documents were in place which were subject to regular review. People received their medicines safely and as prescribed, with people encouraged to be involved in the management of their own medicines.

There were enough staff deployed to ensure people’s needs were met. Staff were recruited safely and only worked with people following training and if they were deemed competent.

Staff were kind and compassionate and treated people well. People were listened to, considering their individual methods of communication. People were involved in care and support planning.

Whilst a registered manager was not in place, the manager was working within the service daily. They had a good oversight of the service;

Rating at last inspection: The service was last inspected December 2018 and rated Requires Improvement. At this inspection we found the service had improved in all areas and improved to Good.

Why we inspected: This inspection was planned based on concerns found at the previous inspections and the service rating.

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

Inspection carried out on 10 December 2018

During a routine inspection

This inspection took place on 10 December 2018. This was unannounced.

At our last inspection on 1 and 2 May 2018 we rated the service as ‘Inadequate’ and identified five breaches of regulation which related to person centred care, staffing, safeguarding people from abuse and improper treatment, safe care and treatment and good governance. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and are ongoing and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. Newbrook provides care for up to three people who have learning disabilities. At the time of inspection there was two people using the service. People in care homes receive accommodation and personal care as a single care package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service had a manager in place who had started working at the service two weeks prior to the inspection but they had not registered to manage this service yet. They told us they were planning to submit their application soon. It is a legal requirement that this service has 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.

We found the manager, regional manager and staff had worked hard to make improvements in the areas of concern found at the last inspection. At this inspection, we found improvements in all areas. However, we discussed with the manager and regional manager more work was needed to ensure a robust and sustained service moving forward. The management agreed with this and told us they had been focusing on ensuring the home was safe and people received the right support.

We found the care and support plans now being completed for people were centred around their needs and preferences. The manager had discussed the changes in care planning with staff at the last staff meeting.

We found improvements in relation to how people’s risks were managed in the care plans. We also saw the manager had re written one person’s care plan with the support from family and staff. The manager told us this would be ready to implement to the service over the next few days. We have made a recommendation about care plans in the report.

We found fire safety had improved and the home had actioned maintenance issues since the last inspection.

We found improvements to how incidents and accidents were recorded.

At the last inspection people were not receiving their personal financial allowance. We found the management team had placed robust financial records in place for people living at Newbrook.

We found staff were receiving regular supervisions and training and these were clearly recorded on an action plan for the upcoming year. At the last inspection we also found limited members of staff on duty. We found this had improved and the rota clearly stated where someone received a one to one support.

We spoke to a relative who told us they were happy with the staff, however had lost faith in the provider due to changes in management throughout the last year

We saw medicines were managed safely.

People lived in a pleasant environment. People had nicely decorated bedrooms with personal pictures in their rooms. We saw improvements in relation to how people’s health needs were managed and we saw evidence to support people were attending appointments from health professionals. We al

Inspection carried out on 1 May 2018

During a routine inspection

This inspection took place on 1 and 2 May 2018. At the last inspection in August 2017 we found the provider was in breach of four regulations which related to safe care and treatment, staffing, person centred care and governance arrangements. At this inspection we found they had not made improvements and were still in breach of the same four regulations and an additional two regulations which related to safeguarding people against financial abuse and notifying CQC about significant events.

Newbrook provides care for up to three people who have learning disabilities. At the time of this inspection three people were using the service. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service did not have 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.

The service was not safe because risks were not assessed or well managed. We identified issues around fire safety. Incident forms were not completed even though daily records showed these were occurring on a frequent basis and there was no evidence action was taken to prevent similar issues from reoccurring. People were not receiving their personal financial allowance. Staff were not appropriately trained and supervised. There was a high turnover of staff and because only one member of staff was on duty for most of the time people had limited opportunities. Relatives raised concerns about the service. Medicines were managed safely.

People lived in a pleasant environment but the lack of communal space impacted on people’s quality of life. People’s health needs were not met because they did not always receive health checks and support from health professionals. The provider did not monitor if people’s nutritional needs were met. Food records showed meals were not varied.

Support plans had been re-written but these were still not always accurate and did not reflect people’s current needs. People had not been involved in the support planning process. One person planned their week and had the freedom to arrange activities which were based on their preferences and wishes. Others did not engage in person centred activities. Capacity assessments and best interest decisions around medicines, personal care and finances had been completed; other people had been involved in these processes. We have made a recommendation about Deprivation of Liberty Safeguards.

We observed friendly interactions. Two members of staff were mainly responsible for providing care to people during the day. We saw interaction by both staff and it was evident that people who used the service were comfortable with the staff who supported them. One person was excited and hugged the member of staff when they entered the room. One relative told us staff were very kind.

There were widespread and significant shortfalls in the way the service was led. Some important records could not be located. Staff and resident meetings had not been held so people did not have opportunities to share their views. The provider did not have effective systems to assess, monitor and manage the service. They did not have processes to learn lessons and drive improvement. The provider did not respond to external reports.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014, which related to safe care and treatment, staffing, person centred care, governance arrangements and safeguarding people against financial abuse. We also found a breach of the Health and Social Care Act 2008 (Registration) regulations 2014 because the provider had not

Inspection carried out on 29 August 2017

During a routine inspection

The inspection took place 29 August 2017 and was announced. At the last inspection in January 2015 we found the provider was meeting the regulations we looked at; the service was rated as good.

Newbrook provides care for up to three people who have learning disabilities. At the time of this inspection three people were using the service. The service 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.

The service was not safe because there were not enough staff to meet people’s needs and preferences. There was often tension between two people who used the service. A member of staff explained at meal times people were positioned so they did not sit next to each other and did not make eye contact. This meant a member of staff had to sit in between. The service only had two communal areas, which were next to each other. One person spent most of the time in their room. The provider had robust recruitment and selection procedures in place so appropriate checks were carried out before staff started working at the service. Medicines were stored appropriately and medication administration records were well completed, however, care around medicines was not planned to ensure people’s needs and preferences were met. Certificates and records confirmed checks had been carried out to make sure the premises were safe.

Staff received training and supervision to help them understand their role and responsibilities. However, they did not feel supported because there was a lack of management involvement. Staff understood people who lacked capacity to make decisions were protected by the Mental Capacity Act 2005. More effective support plans for decision making and considering capacity were being introduced to ensure people’s rights were protected. People said they enjoyed the food and had plenty to eat. Pictorial menu cards with instructions for cooking were available and had been used, although not consistently. Menus were not used for planning meals and food records were not always completed. People’s care records showed they had accessed a range of health professionals.

People told us staff were kind and it was evident from observations staff knew people well. However, we saw staff sometimes made decisions based on their view rather than providing support that reflected the person’s preferences and individual needs. We saw some good care practice where staff engaged with people and encouraged them to make decisions but we also saw practice where staff did not promote people’s rights and choice. People’s rooms were personalised but the general décor in the home needed attention.

People’s needs were not always assessed and support plans did not reflect how they would like to receive their care and support. We were shown a new style support plan for one person’s morning routine; this had clear information which guided staff around how care should be delivered. The registered manager said these were going to be rolled out for everyone. People’s engagement in activities varied and was often determined by staff rather than people’s preferences.

There was a lack of provider and management oversight, which meant staff worked with very little direction. The provider’s systems to monitor and assess the quality of service provision were not effective. Actions that had been identified to improve the service were not implemented. A system was in place for managing complaints.

After the inspection the registered manager wrote to us and told us what action they had taken in response to our findings.

“The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be k

Inspection carried out on 13 January 2015

During a routine inspection

This was an unannounced inspection carried out on the 13 January 2015.

Newbrook is an adapted residential semi- detached house which provides accommodation for three people who have a learning disability. There are shops and a local supermarket close by. It is close to a main bus route and only a short journey from the town centre and all amenities.

At the last inspection in July 2014 we found the provider had breached six regulations associated with the Health and Social Care Act 2008.

We found that before people received any care or treatment they were not always asked for their consent and where people did not have the capacity to consent, the provider was not always acting in accordance with legal requirements. Care and treatment was not consistently planned and delivered in a way that was intended to ensure people's safety and welfare. People who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. We also found that people were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We saw the home’s Statement of Purpose was out of date and the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We told the provider they needed to take action and we received a report on the 19 September 2014 setting out the action they would take to meet the regulations. At this inspection we found improvements had been made with regard to these breaches and the issues we identified had been addressed.

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 and associated Regulations about how the service is run.

There were effective systems in place to ensure people’s safety and manage risks to people who used the service. Staff could describe the procedures in place to safeguard people from abuse and unnecessary harm. Recruitment practices were robust and thorough. Appropriate arrangements were in place to manage the medicines of people who used the service.

People were cared for by sufficient numbers of suitably trained staff. We saw staff received the training and support required to meet people’s needs well. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. People had detailed, individualised care plans in place which described all aspects of their support needs.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions to enhance their capacity and where people did not have the capacity decisions had to be in their best interests.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity.

People participated in a range of activities both in the home and in the community, this also included supported employment. People were able to choose where they spent their time.

Staff were aware of how to support people to raise concerns and complaints and we saw the provider learnt from complaints and suggestions and made improvements to the service.

There were effective systems in place to monitor and improve the quality of the service provided.

Inspection carried out on 18 July 2014

During a routine inspection

On the day we visited we gathered evidence and inspected against six outcomes to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

We met and spoke to all the people who lived at the home and observed how people who used the service were being cared for. We spoke to three staff which included the manager. At a later date we had a phone call discussion with a service user�s relative. We examined three care plans, two staff files and inspected the home's records. Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report.

Safe

Although staff felt the services were safe we had concerns related to staffs understanding of safeguarding and the Mental Capacity Act, the induction and training of care staff, the implementation of infection control procedures, the facilities for staff during sleepovers and the overall maintenance of the building.

Effective

The provider operate a Key worker system and we saw that care was personalised, planned and risks were assessed appropriately by them. However, the monitoring and recording of those risks that were identified was inconsistent and numerous evaluation records lacked identification and the comments made perfunctory.

Caring

The necessary caring skills were evident during our inspection and this was confirmed by the people and by the relative we spoke to. However it is not sufficient in itself and staff were not provided with the support and training they needed to communicate effectively and deliver the physical skilled care to the particular vulnerable people in their care safely.

Responsive

People who lived at Newbrook or their relatives were appropriately involved in their care planning and reviews. They are encouraged to be independent and empowered, making choices about their preferred social activities, entertainment and meals. However one person is clearly interested in a relationship but has not received any sexual health support or advice.

Well Led

The registered manager has left and a new manager has recently been appointed to cover three care homes which includes Newbrook but they were new to management and had not completed a level 5 management programme as recommended by the Skills for Care. They have the support of one deputy who is an experienced care worker. The new manager is well liked, trusted and respected by staff we spoke to, although the relative had not met or spoken to them.

We found that the provider had failed to ensure staff were appropriately supported and trained to complete their roles in particular in relation to the Mental Capacity act (2005) and Infection Control Guidance (NICE 2012), failed to maintain the building to an appropriate standard and ensure the implementation of their own health and safety policies in line with the 1974 act and Bond Care Quality Assurance policies and procedures.