Newlands House - Care Home with Nursing Physical Disabilities

We found the following examples of good practice.

People using the service were supported with essential care givers to enable regular visiting to be completed. Visiting procedures were in place in line with government guidelines. A screening questionnaire was completed along with regular testing and temperature checks.

Safe admission processes were in place to support people being admitted to the service. Individual risk assessments were in place to consider the impact of COVID-19 on individual health conditions and regarding the testing and vaccinations.

People continued to receive one-to-one hours of support from staff as per their package of care, utilising regular agency staff for continuity.

The service was cleaned by staff who had cleaning schedules for all areas of the home and high touch areas. Cleaning products had been changed to ensure they were suitable to reduce the risks associated with COVID-19.

Staff participated in the testing and vaccination programme. We observed staff wearing the correct PPE throughout our inspection.

Newlands House - Care Home with Nursing Physical Disabilities is a residential care home providing personal and nursing care to 35 people with physical disabilities. At the time of our inspection there were 29 people living at the home. It is a purpose built home on one level which is accessible to people using wheelchairs.

People received safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and received their prescribed medicines safely. Lessons were learnt from when mistakes happened.

People received caring and kind support from staff who respected their dignity and privacy. They were encouraged to be independent and staff understood their needs well. 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. Staff were skilled in understanding the needs of people and engaged them in meaningful activities. Staff knew them well and understood how to care for them in a personalised way. Care plans were informative and regularly reviewed to support them.

People were supported to maintain good health and nutrition; including partnerships with other organisations when needed. The registered manager was approachable and there were meetings in place which encouraged people and staff to give their feedback. People and relatives knew how to raise a concern or make a complaint.

The environment was adapted to meet people’s needs. There had been refurbishments in the home which people had been included in planning and implementing. Regular monitoring of the home ensured that quality of care was regularly reviewed, and improvement measures were in place. There was a full team approach to implementing an improvement plan which resulted in good outcomes for people.

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 (published 27 September 2018)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

They were last inspected on 14 September 2017 and were found to require improvement. At this inspection they still required improvement.

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.

Risk was not always assessed and actions were not always considered to reduce it. The review of when things went wrong was not always thorough enough to reduce the risk of repetition. Some incidents which could have been reviewed independently as a safeguarding concern, had not been considered as such and had therefore not been reported to the relevant safeguarding authority.

People did not always receive personalised care which was based on their preferences. They also did not always have enough opportunity for meaningful engagement. Information had not been adapted to meet people’s individual needs. Some information in care plans did not give enough guidance and daily records were not always fully completed. The audits and reviews conducted did not always fully consider this and ensure that people were at the centre of their care. Although there were enough staff to meet people’s needs and this was kept under review, the audits did not consider the quality of interaction some people experienced.

Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. They had developed caring, respectful relationships with people and ensured that their dignity and privacy were upheld. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The environment was planned to meet their needs and encourage independence.

People were assisted to maintain good health and had regular access to healthcare professionals. Medicines were managed safely and people received them when they needed them. Mealtimes included a choice of meal and people received patient support to assist them when needed. There were systems in the home to keep it clean and free from infection.

Visitors were welcomed at any time. People and their relatives knew the registered manager and felt confident that any concerns they raised would be resolved promptly. There were regular meetings with people which people told us they enjoyed and that they felt listened to. There were good relationships with other organisations and professionals; including working closely with commissioners to meet actions on improvement plans.

Staff felt well supported by the registered manager and there were regular meetings with them to ensure they were consulted and informed of changes.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Medicines were not always manged to ensure that people received them as needed. When people were prescribed medicines which could be taken ‘as required’ there was not always clear guidance in place for staff to understand when to administer it. The management systems in place to monitor recording and the amount of medicines kept for people were not always effective because no immediate action was taken. People did receive their medicines on an individual basis and when they required additional procedures these were completed in private to protect their dignity.

Improvements had been made in the audits and systems in place to ensure that the quality of the service was monitored. However, they were not all effective in identifying and responding to shortfalls. People were supported to have choice and control of their lives but their capacity to make certain decisions was not always considered or reviewed if their condition deteriorated.

Systems had been put in place for the deployment of staff and they checked that people were safe and well on a regular basis. Staff supported people in a kind and respectful manner. When they were assisting people with meals they ensured that they spoke with people and gave them their full attention.

Staff received training and support to enable them to fulfil their role effectively. They understood their responsibilities to detect and report abuse. People told us that there were enough staff to meet their needs and that they felt safe.

Risk was assessed, actions were put in place to reduce it and their effectiveness was reviewed. People were supported to maintain good health and had regular access to healthcare professionals. Their weight and diets were carefully monitored to ensure that they had enough to eat and drink.

People were encouraged to pursue interests and hobbies and regular activities were planned. Visitors were welcomed at any time and some families were involved in the home as volunteers. People knew the manager and felt confident that any concerns they raised would be resolved promptly.

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.

Medicines were not always managed to reduce the risks associated with them. The systems in place to audit the quality of the service were not always effective because they did not identify the errors that were found. The service did not always promote peoples dignity and privacy and there were not always enough staff deployed to meet people’s needs.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. They knew people well and provided care that met their preferences. They understood the importance of consent. When people did not have the capacity to consent to their care, assessments were completed and decisions made in their best interests.

People were supported to maintain good health and had regular access to healthcare professionals. They had enough to eat and drink and specialised meals were provided when needed. Their care plans were regularly reviewed to correspond with changing support needs and they were personalised and accessible.

People were encouraged to pursue interests and hobbies and activities were planned on a daily basis. Visitors were welcomed at any time and volunteers supported activities and fundraising activities.

People told us that they knew the manager and felt confident that any concerns they raised would be resolved promptly. They were supported to understand their choices in the care they received, including using communication systems to help them with this. The provider had systems in place to assess risk, actions were put in place to reduce these and their effectiveness was monitored and regularly reviewed.

All of the medication records we looked at, comparing them with the medication for people, were accurate. This shows that people using the service receive their medicines at the times they need them and in a safe way.

We found that people who used the service were safe and their health and welfare needs were met by sufficient numbers of staff. People who used the service provided positive comments about the staffing levels in the home. One person told us 'I enjoy living here. I liked the bungalow but now I'm here I know there are always staff around who can help me if I need it'.

Although significant improvements have been made, staff are still not being properly supervised by the provider in line with their policy.

The provider has completely changed the care plans that they use. They have introduced a plan called 'My Support Plan' which contains very specific person centred information. The new care plans contain relevant information about people using the service and information contained within them is very easy to find.

We saw that the provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had 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.

Two people requiring specific one to one support were not receiving it and this had an adverse effect on people living in the bungalow. People did not experience care, treatment and support that met their needs and protected their rights.

We found that staffing levels were not sufficient and as a result people who were funded for one to one care were not always receiving it.

Staff working at Newlands House were not being supervised in line with the provider's supervision policy. This means that the provider was not properly supporting staff to provide care and treatment to people who used the service.

Care plans did not contain accurate information about people who use the service. They were described by staff as complicated and information was difficult to find.