Newlands

Newlands is a residential care home providing personal and nursing care for up to 50 people. The service provides support for adults, including people with living with dementia and mental health needs. At the time of our inspection there were 42 people using the service.

The care home has three separate wings, each of which has separate adapted facilities. One wing is for people who are elderly and frail, one wing is for people living with dementia, and there is another wing for men who are living with dementia who have additional needs.

People’s experience of using this service and what we found

People supported in this home and their family members told us they were very satisfied with the care this service provides. One family member summed it up as, “Newlands have got it right, you would think that it is their own family they are looking after.”

We found people were safe. There were effective systems in place to help ensure the safety of people living and working in the home. Though there had been minor gaps in medicine records, these were addressed by the registered manager during the inspection.

People received consistent quality care because the registered manager followed the provider’s auditing and quality procedures. People found the registered manager to be approachable and responsive.

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.

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 good (published 7 October 2017).

Previous recommendations

At our last comprehensive inspection we recommended the safe management of medications and quality assurance management systems were improved. At this inspection we found the provider had improved both, although there were still improvements to be made regarding medicines management during the inspection.

Why we inspected

We received concerns in relation to the management of medicines, people’s care needs, staffing and management practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection. We found no evidence during this inspection people were at risk of harm from the concerns raised. See the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Newlands on our website at www.cqc.org.uk.

Recommendations

We recommend the registered manager reviews and adapts their medicine audit practices in line with best practice and reviews medication errors for trends and themes. The registered manager had already started doing this during our inspection.

We recommend the provider review, with their pharmacy, the completion of medication administration records (MAR) records to ensure following best practice.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had good procedures for preventing visitors from catching or spreading infection. End of life visits had taken place so that a family member could sit with their relative. New visiting arrangements were in place, both in the home and within a special visiting 'pod'. We met visitors who were happy to take a test, have their temperature taken and to fill in a declaration about Covid-19.

The staff could support people to access Face time or Skype to contact families and friends. Families could talk with staff by phone. Consultations with health care professionals were done virtually and some professionals had visited. Suitable activities and entertainments were on offer and people we met were settled in the home.

The staff team had supported people to isolate during the outbreak of Covid-19 and, where possible, people had understood the reasons for isolation. People had now recovered from the virus. New admission only happened once the person had a negative test for Covid-19. People who had recently been admitted were being barrier nursed and staying in isolation. Good arrangements were in place so that people kept a safe distance in shared areas. People living with dementia were guided and supported to socially distance as much as possible.

The staff and the people who lived in the home had been tested routinely. Those who had a negative test continued to be tested. Staff and service users had all received the Covid -19 vaccine. Most of the staff and all of the service uses had received a second vaccine.

The home was very clean and hygienic. The staff followed national and local guidance during the outbreak and rigorous systems were in place to ensure good levels of hygiene. There were cleaning schedules and other systems to ensure good infection prevention and control measures. Staff understood how to use and dispose of personal protective equipment.

We met with staff who were very positive about their work and told us the welfare of people in the home was very important to them. Staff had suitable levels of support from the provider and the registered manager. Arrangements had been put in place to ensure the staff could return to work safely. Staff told us they could access confidential counselling if they were experiencing difficulties and that their work during the pandemic had been positively acknowledged by the provider. Good risk management was in place for service users and staff from ethnic minorities or who had underlying issues that would reduce their risk of serious illness.

Following the comprehensive inspection in November 2016 the provider wrote to us to say what actions they would complete in order to meet the legal requirements in relation to the breach. They sent us an action plan setting out what they would do to improve the service to meet the requirements and a date by when this would be completed. During this inspection we saw that appropriate actions had been taken to comply with the regulation.

At the last inspection in November 2016 we also made two recommendations. We asked the provider to review their best interest decision making process and to ensure records relating to care and treatment were consistent in providing accurate information. During this inspection we saw that work had been completed in response to these recommendations. However we found some areas of practice for the management of medications could be improved along with records relating to elements of care such as fluid monitoring and repositioning. We have made two new recommendations for these areas.

Newlands is a purpose-built nursing home. The home is divided into three units. The Lakeland unit providing care for men with complex mental health needs and dementia, whose behaviour may be challenging. The Lonsdale unit for people who are living with dementia and a third unit that caters for people who are physically frail and have nursing needs.

During the inspection we deemed that there were sufficient numbers of suitable staff to meet people’s needs and the provider was in the process of recruiting more staff. However people told us mixed comments about their experiences of staffing levels. Staff had completed a variety of training that enabled them to improve their knowledge in order to deliver care and treatment safely.

Medicines were administered and stored safely however some records did not contain all of the relevant information that could improve the safety of the administration process.

We have made a recommendation about records relating to the safe management of medications.

When employing fit and proper persons the recruitment procedures of the provider were robust in ensuring suitable people had been employed.

People’s rights were protected. The staff team were knowledgeable about their responsibilities under the Mental Capacity Act 2005. 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.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were being made.

People told us they were happy with the care and that they had been involved in planning their care and treatment. We observed the interactions between staff and people living in the home and they demonstrated genuine affection, care and concern. Staff treated people with kindness and were respectful.

People were supported and encouraged to engage in regular activities of their choice.

Since the last inspection the provider had been responsive and proactive in improving the systems used in their quality monitoring and recording of information about people’s needs and the planning of their care. However we found that some areas still needed to show consistency such as recording information for people’s fluid intake and repositioning.

We have made a recommendation that the service develops the quality monitoring systems to ensure records are consistently completed to ensure the safety and quality of care and treatment.

There was a clear management structure in place and staff were happy with the level of support they received.

During this inspection we found a breach of Regulation12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 this was because some risks associated with people’s care had not been managed effectively.

Newlands is a purpose-built nursing home. The home is divided into three units. The Lakeland unit providing care for men with complex mental health needs and dementia, whose behaviour can be of a challenge to the service. During this inspection we did not find any concerns on this unit and found there to be a calm atmosphere and the unit was well run. There is also a unit with 12 beds for people living with dementia called the Lonsdale unit. The third unit caters for people who are physical frail and have nursing needs.

We found some risks associated with the delivery of safe care and treatment including swallowing difficulties and the safe use of some equipment had not always been recognised. Even when these risks had been identified they were not always recorded accurately or managed safely.

The provider was in the process of recruiting more staff. On the day of the inspection there were deemed to be sufficient numbers of staff but we observed they were not always available at the time people most needed them.

Medicines were being administered and were being kept safely but records relating to stock control had not always been consistently completed.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions taken by the home to protect people.

All of the people we spoke with living at Newlands and the relatives we spoke to commented favourably on the food provided in the home.

Decisions made in people’s best interests and the consent required about the use of restrictive measures that may deprive people of their liberties had not always been obtained appropriately.

We have made a recommendation that the provider review their best interest decision making process to ensure it follows guidance outlined in the Mental Capacity Act 2005 in order to gain the appropriate authority for consent.

We observed good humoured and supportive interactions between staff members and people living at Newlands.

Some care records lacked vital information about peoples individual care needs. Care was not always provided in a person centred way.

We have made a recommendation that records relating to care and treatment are consistent in providing accurate information to enable staff to follow the most appropriate plan of care.

We received very positive comments about the registered manager from people who lived visited and worked at Newlands.

‘You can see what action we told the provider to take at the back of the full version of the report.’

' Is the service caring?

We spoke to more than half of the people who lived in the home and to some relatives and had positive responses from those people we spoke to on the day. Here are some of the things they told us:

"They go out of their way to do their best for you."

"I am very happy here and the staff look after you well."

"If you are under the weather they try hard to make you feel better."

' Is the service responsive?

We saw care staff and catering staff asking people about their preferences on the day of our visit. We saw evidence in files that showed that the staff responded well to people's needs. One person told us:

"You can ask anyone (staff) a question and they will always get you an answer even if they have to ask someone else."

' Is the service safe?

We had evidence to show that the new registered manager was able to recognise abuse and could report and manage safeguarding matters appropriately and effectively. We saw how the staff team had managed a situation in a proactive way to lessen risk to people in the home.

People who we spoke to said they felt "safe and secure". We saw that entry to the home was secure and that things like records and medication were stored securely.

Recruitment was done correctly so that new staff had the aptitude and skills to support vulnerable adults.

We did note, however, that some parts of the building and grounds needed improvement so that they would be safer for vulnerable people. We made a compliance action about the environment because there were some health and safety issues in the home. We also made a compliance action because medication was not always administered safely.

We noted that the home had some problems with maintaining good staffing ratios on some days but we saw that the manager was taking steps to manage this effectively.

' Is the service effective?

We saw that many people in the service received effective care and support. For example people in the Lakeland Unit were helped to stay as calm and orientated as possible through good care planning. We had examples of good outcomes for people with physical health needs. A health professional told us:

"Hard work and good nursing has alleviated multiple problems for this person..."

We did however see inconsistent care planning in some parts of the service. Some of the dementia care needed to be improved. We also found problems with the management of medication. We made compliance actions about these issues around effective care.

' Is the service well led?

This service has had a number of managers who had not stayed in the service for any length of time. The company had appointed a new manager who had been the lead nurse for the Lakeland unit. She had a proven track record of managing staff and delivering care in this unit. She had been in post for around six months when we visited.

We saw that she had established a good quality assurance system in the home, had established the roles within the nursing staff team. She had also looked at performance issues with staff. We saw that although care planning was still problematic the delivery of care had improved and that care plans were being audited and worked on. We saw that she had assessed care needs for almost everyone who lived in the home. We had sight of the plans in place to develop the service.

People who lived in the home told us that they were satisfied with the care provided. We also met some relatives of people with dementia who told us:

"I am more than satisfied with the care given to my relative. I think the nurses and the care staff are all wonderful."

"I am pleased to tell you that, as a family, we feel that our relative is as safe and as well looked after as possible. We are aware that it is not an easy task but we all think that the staff do really well. They understand that we find it very difficult and they look after us too."

We checked on how the service made sure that people were kept safe from any abuse or harm. We could see that staff in the home understood their responsibilities and knew how to report any potential abuse.

On the day of our visit the home was clean, tidy and fresh. We judged that some areas of the home needed some redecoration and refurbishment. We had evidence to show that this was underway.

The home had suitable equipment to support people who had poor mobility or specific nursing needs.

Staff in the home had been given suitable training but, due to the absence of a manager and other staffing issues, some aspects of team development had been lacking. We could see that supervision, appraisal and competence checks were not always up to date. We could see that the new manager had plans for team development and we look forward to seeing how this progresses.

People told us and we saw that staff gained consent to care and treatment in a sensitive way and where people lacked the capacity to make decisions, advice and guidance was sought. All paperwork was in order in respect of the Mental Health Act 1983 and the Mental Capacity Act 2005.

People were well supported and cared for by staff who knew what their care and welfare needs were and they were encouraged to be as independent as possible. People's nutritional needs were met, although the provider may wish to review the mealtime experience, to ensure that people who used the service were receiving the level of support they needed at mealtimes.

People told us: "I've spent a lot of years here now and been happy all the time...this is the best spot around...I would recommend this place to everyone."

Medicines in the home were well managed by competent staff, although more attention needed to be paid to the destruction of medicines that were no longer required.

The provider undertook a standardised process to recruit staff and appropriate checks on identity, qualifications and suitability for the role were carried out prior to staff being employed. There were a suitable number of adequately qualified care and nursing staff employed at the home and rosters ensured there were enough staff on duty to meet peoples care and welfare needs.