Newnton House Residential Care Home

We found the following examples of good practice.

¿ The provider had appropriate arrangements for visiting to help prevent the spread of infection. All visitors were required to book a time prior to visiting people. Visits were scheduled for no more than one hour to minimise the risk of infection. Visitors were supported to wear a face covering when visiting. Hand washing facilities, signage of infection control procedures and hand sanitizer stations were available near the entrance and throughout the care home.

¿ The provider had appropriate arrangements to test people and staff for COVID- 19 and was following government guidance on testing. This ensured that people and staff were tested for COVID- 19 in a consistent way in line with national guidance.

¿ The provider ensured that staff received appropriate training and support to help prevent the spread of infection. All staff had received training on infection control and the use of PPE. Staff were assigned to work at the one location to help minimise the risk of cross infection. Staff wellbeing was supported if they became unwell and when they returned to work.

¿ The provider ensured that people using the service could maintain links with family members and friends. People were supported to have visits from their relatives and friends in a designated area in the garden where social distancing was observed. Family members and friends who were unable to visit the home could stay in touch with people with phone and video messaging. The provider understood the communication needs of people.

Further information is in the detailed findings below.

Newnton House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Newnton House provides care and support for up to 9 people with mental health needs, many of whom have a forensic history and learning disabilities. The service aims to provide a short-term service for people before they are able to live more independently. At the time of our inspection there were eight men using the service. The service is based in a large house in Hackney, which contains nine bedrooms, three bathrooms, a large lounge and activities room, a kitchen and dining area and a communal garden. There was a staff office within the building and a staff sleeping in room.

There was a registered manager at the service at the time of our inspection. 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.

People told us they felt safe with staff and there were enough staff to meet their needs. Staff were trained in safeguarding and knew how to safeguard people against harm and abuse. People’s risk assessments were completed, regularly reviewed and gave sufficient information to staff on how to provide safe care. Staff kept detailed records of people’s accidents and incidents. Staff wore appropriate protection equipment to prevent the risk of spread of infection. Medicines were stored and administered safely. The home environment was clean.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their own best interests. We saw people were able to choose what they ate and drank. People told us they enjoyed the food. The home was well decorated and adapted to meet their needs of the people.

People told us that they were well treated and the staff were caring. We found that care records were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service. People had access to a wide variety of activities.

The service had not recorded exploring people’s wishes for end of life care. We have made a recommendation about involving people in decisions about their end of life care.

The service had a complaints procedure in place and we found that complaints were investigated and where possible resolved to the satisfaction of the complainant.

Staff told us the service had an open and inclusive atmosphere and the registered manager was approachable and listened to concerns. The service had various quality assurance and monitoring mechanisms in place.

Newnton House provides care and support for up to 9 people with mental health needs, many of whom have a forensic history and learning disabilities. The service aims to provide a short-term service for people before they are able to live more independently. At the time of our inspection there were nine men using the service, and two people received support with personal care. The service is based in a large house in Hackney, which contains nine bedrooms, three bathrooms, a large lounge and activities room, a kitchen and dining area and a communal garden. There was a staff office within the building and a staff sleeping in room, with a manager’s office in a shed at the end of the garden.

The service had a registered manager who had been in place since November 2015. 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.’

At our previous inspection in October 2015 we rated this service “Requires Improvement”. We found a breach of regulations with regards to notifying CQC of significant events which had occurred in the service, and made recommendations about the management of medicines and providing activities to people. We found that the provider had taken satisfactory action in response to the last inspection report.

We found that there were measures in place to ensure the safety of the building and risks to people who used the service had been assessed. However, these risk management plans were generic in places and although a number of people had behaviour which may challenge there were not detailed plans in place for recognising the signs that a person may be about to become challenging or how to deescalate the situation. Accidents and incidents were recorded, but in some instances actions required in response to these had not been carried out, and the recording of incidents did not always record the circumstances which had lead up to an incident, which would be useful for developing plans to manage people’s behaviour.

Staffing levels were adequate to meet people’s needs and appropriate checks had been carried out of the suitability of staff. People who used the service told us they felt safe there and were treated well by staff. People benefitted from a small, stable staff team which allowed good caring relationships to develop. Staff promoted people’s dignity and privacy and maintained confidentiality. Staff received training in line with the provider’s policy and regular supervision and appraisals, but the provider’s policy did not fully assess the training needs of the staff team in line with working with people with mental health needs.

We found that care plans documented people’s needs, including their activities and there were tools for monitoring their recovery. However, we found that the service didn’t always document people’s preferences or have plans in place to communicate with people who had difficulty speaking, hearing or reading. This meant we could not be certain that people had always understood the contents of their care plans before they had consented to these. Where people were deprived of their liberty in their best interests, the provider had taken appropriate measures to do this lawfully. When people were free to leave the service, the provider took measures to ensure people were safe, including monitoring when they had left and following missing persons plans when they had not returned. Medicines were safely managed by staff who had the appropriate training and skills to do so, and this was checked by a pharmacist regularly.

The provider worked with mental health teams to monitor people’s health and promote recovery, and there was good communication of how people’s needs had changed. There was a complaints policy in place, and people were confident in approaching managers with concerns, but the provider did not record informal concerns or verbal complaints. People were supported to speak up through keyworking, residents meetings and had access to advocacy services.

We made a recommendation about how the service records verbal complaints. We found breaches of regulations in relation to safe care and treatment and person centred care. You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

People who used the service were treated with dignity and respect. Peole's views and the views of their family and representatives were included as part of their care planning.

Staff took into account risks to individuals to ensure the safety and welfare of people. However care plans and risk assessments needed further development to ensure people's needs and how to meet them were clearly identified. Medicines were kept safely and handled appropriately.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that the service was compliant in seeking consent from people who used the service.

Is the service effective?

Care workers were knowledgeable about how to meet people's needs when caring for particular individuals. People were overall stable in their placement and progressing well with their individual plans and goals. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

People's mental and physical healthcare needs were monitored and met by health and social care professionals.

Is the service caring?

People who used the service were supported by kind and attentive staff. People were overall positive about staff. They said staff were caring, helpful and encouraged them to ensure they remained independent.

People's diversity, values and human rights were respected. The provider consulted people and their representatives about individual needs and wishes, including their cultural and religious needs. Individual preferences were taken into account as part of their care.

Is the service responsive?

Individual care needs were reviewed and their plans updated to ensure people received a service that met their current needs.

Staff acted appropriately in response to people's emotional and behavioural needs. Staff used assessment tools to monitor the health and wellbeing of people, consulting other professionals for advice and input where needed. There were no complaints about the service, however people said staff listened and were responsive to dealing with any issues they raised.

Is the service well led?

The provider undertook regular audits to check the quality of service. However there was no system in place to analyse and report on the views of people who used the service, their relatives or people involved in their care.

Staff received training and supervision with their manager and said they were well supported and received appropriate professional development. This meant they were familiar with their roles and responsibilities to carry them out more effectively.

People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. People were protected against the risks of unsafe or unsuitable premises.