Newgrove House Care Home

We found the following examples of good practice.

Visits were arranged in line with government guidance.

People and staff were part of a regular testing programme.

People had detailed risk assessments in relation to COVID-19.

Staff had received the COVID-19 vaccination as a condition of their deployment.

This comprehensive inspection took place on 8 March 2018 and was unannounced. At the last comprehensive inspection on 19 and 20 July 2017, the service had an overall rating of ‘Inadequate’ and was placed in special measures. We had found concerns with person-centred care, consent, safe care and treatment, staffing and overall governance of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, is the service safe, effective, responsive and well-led? to at least good. We received a comprehensive action plan and regular updates which demonstrated progress made with the improvement programme. At this current inspection, we looked at the previous breaches of regulations and the action plan to check that improvements had been made and sustained over a period of time. We found significant improvements had been made in all areas.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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. A new manager had been in post since August 2017 and completed their registration with the CQC in February 2018.

The provider, registered manager and staff had worked hard to make improvements. People, their relatives and visiting professionals provided only positive feedback about the service. We found the leadership and management of the home had improved. The operations manager had a more active role in the running of the service. Everyone spoke highly of the new registered manager who they said was approachable and supportive. Quality assurance systems had been fully implemented and maintained since the last inspection and we saw action had been taken when issues had been identified. The audit tools for medicines and care records required further development and this was completed following the inspection. The operations manager and registered manager had worked hard with implementing many positive changes and were committed to ensuring the improvements made were sustained and developed further, to make sure people consistently received high quality care.

Staffing numbers had increased and were consistently maintained. People told us staff responded quickly when they needed assistance. Throughout our inspection we observed there was a visible staff presence at all times. The registered manager monitored the dependency levels regularly, ensured staffing levels were sufficient and staff deployment was effective.

The service was operating within the principles of the Mental Capacity Act 2005 (MCA). We found improvements in records when people were assessed as not having capacity to make their own decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff were clear about the need to obtain consent prior to carrying out care tasks.

People’s care plans had improved and further development was planned to make sure the care records were more person-centred. Risks to people’s health and safety were better assessed and managed. The assessment records were completed accurately and updated when people’s needs changed. Improvements had also been made in relation to environmental risks and any maintenance work required was completed in a timely manner.

The home was clean, comfortable and bright. Many areas of the home had been refurbished and redecorated and this was on-going. Equipment used in the service was checked and maintained.

A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience and were suitable to work with people who used the service. Recruitment of suitable skilled staff had been positive in the last six months and there were no staff vacancies. Staff received the training and support they required to carry out their roles and meet people’s needs. Training updates were scheduled for some staff.

Systems were in place to make sure people received their medications safely, which included key staff receiving medication training. Some minor recording shortfalls were identified, which the registered manager took steps to address.

Staff knew how to safeguard people from the risk of harm and abuse. They had completed safeguarding training and knew how to raise concerns and who to speak to about them.

Staff worked closely with health and social care professionals to ensure people were supported to maintain good health. People received a well-balanced diet that offered variety and choice. People told us they liked the meals provided to them and their nutritional needs were met.

People and their relatives were complimentary about the attitude and capability of the staff. Staff were kind and considerate; they had developed good relationships with people who used the service. People’s privacy and dignity was respected by staff who had a good knowledge of what people could do for themselves, how they communicated and where they needed help and encouragement. Private and sensitive information was stored confidentially.

We saw people were encouraged to participate in a range of activities within the service and local community. Relatives told us they could visit at any time and we saw staff supported people who used the service to maintain relationships with their family.

There were systems in place to manage complaints and people who used the service and their relatives told us they felt able to raise concerns and complaints.

The registered manager practiced a management style that was open and inclusive. People, their relatives and staff had opportunities to comment on the service through surveys and meetings.

The service had a registered manager in post. A registered manager is a person who has registered with CQC 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. Following the inspection we were informed by the operations director that the registered manager had taken the decision to step down and had left the service. The day to day management of the service would be undertaken by the operations director until a new manager was recruited.

We undertook this unannounced comprehensive inspection on the 19 and 20 July 2017. The last comprehensive inspection took place on 26 and 27 May 2016 and although no breaches in regulations were identified we rated the service ‘Requires Improvement’ for four out of the five key questions and rated the service ‘Requires Improvement’ overall.

Due to concerns found during the inspection regarding assessing and delivering person-centred care, managing risk, need for consent, notifying CQC of incidents, having an effective monitoring system and ensuring sufficient numbers of staff were deployed at all times, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the inspection, we received an interim action plan. We also requested and have received weekly updates to assure us actions have been taken to address the concerns. We found multiple concerns and are considering our regulatory response. 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. You can see what action we told the provider to take at the back of the full version of the report.

We found there was inconsistency regarding the application of the Mental Capacity Act 2005. The provider and manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests.

People were left exposed to avoidable risks because steps had not always been taken to assess and mitigate risks to people’s health and safety.

We found there were times when there were insufficient staff deployed to meet people's needs.

People had care plans in place, however, we found these were not always person-centred and missed important information regarding how staff were to care for them. The care plans were not always updated when people’s needs changed. This meant that important care could be missed.

The quality monitoring system had not been effective in highlighting areas that required improvement such as the care records, risk management and consent to care. We found action had not been consistently taken in order to address these. There were discrepancies regarding the records of some people who used the service which made it difficult to check if the correct care and treatment had been delivered. We found where accidents had been logged, these highlighted specific issues but lacked analysis to ensure lessons were learned to prevent reoccurrence. The CQC had not always received notifications of incidents which affected the welfare of people who used the service.

We received mixed feedback regarding the leadership of the service, which had affected staff morale and the turnover of staff in recent months. Visiting health care professionals felt the communication at the home was not always effective; there were some delays with referrals and the implementation of their guidance was inconsistent at times. The operations manager was undertaking a review of each person’s heath and care needs.

People liked the meals provided to them and there was sufficient quantity and choice available. Staff supported people to eat their meals in a sensitive way when required. We saw there were plenty of drinks and snacks available in between meals.

There was a range of activities for people to participate in and staff supported people’s access to the local community.

We found people who used the service were protected from the risk of harm and abuse because staff had received safeguarding training and they knew what to do should they have any concerns.

Staff were recruited safely and employment checks were carried out before new people started work in the service. People received their medicines as prescribed and they were obtained, stored and recorded appropriately.

The majority of staff had received regular supervision from their line manager. Staff had access to a range of training. There were some shortfalls and delays with staff completing some courses or refresher training. We have made a recommendation about reviewing the staff training programme in relation to the quality of the induction training and timely access to courses.

People told us they were supported by caring and attentive staff who knew their needs and understood their preferences. Relatives we spoke with were complimentary about staff’s approach and felt their family member’s needs were met in a caring way. People told us and we observed they were treated with dignity and respect by staff.

There was a complaints procedure on display in the service and it was included in information given to people. Staff knew how to manage complaints and people spoken with felt able to raise concerns.

The service did not have a registered manager in post. The previous manager had resigned and a new acting manager had been appointed four weeks prior to the 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 2008 and associated Regulations about how the service is run.

This inspection was unannounced and took place over two days. The previous comprehensive inspection of the service took place on 15 September 2014 and the registered provider was found to be non-compliant with one of the regulations inspected. We undertook a follow up inspection on 15 April 2015 and found compliance had been achieved.

There had been some staffing difficulties with a number of senior staff leaving the service in recent weeks; this included the previous acting manager and two team leaders. Although the service had tried to cover all shortfalls, staffing numbers had not been maintained on all shifts. During the inspection, we found this was being addressed and recruitment was well underway.

We saw recruitment checks were carried out, although one member of staff had started work before their references had been returned. People told us there were sufficient staff to support them and they were not kept waiting long when they called for assistance.

People’s nutritional needs were met and they were happy with the quality of the meals although some felt the menus were repetitive and needed review. We found the mealtime experience for some people was not positive on the first day of the inspection but improvements were made on the second day to ensure people received more consistent support.

We found staff had access to training and support. Although formal supervision was behind schedule, staff told us they could talk to the acting manager at any time and they were available for advice.

We found the quality monitoring system was limited and had not been effective in highlighting some areas to improve and action had not been consistently taken in order to address shortfalls. Delays in renewal of the premises were evident, however a major refurbishment programme was underway which included the provision of suitable adaptations and décor to better support the orientation and safety of people living with dementia. The regional manager confirmed new quality monitoring systems were being introduced.

Staff approach was seen as kind and caring; they took time to speak to people, they respected their privacy and dignity and involved them in day-to-day decisions. Staff had developed positive relationships with people and their families. We saw people were encouraged to maintain their independence where possible.

Staff involved people and sought consent from them prior to carrying out tasks. We saw when people were assessed as lacking capacity to make their own decisions, the service worked within the law.

People told us they felt safe living at the home. We saw there were systems and processes in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce any risks were in place to ensure people’s safety.

Medicines were stored safely and procedures were in place to ensure they were administered correctly. We saw people received their medicines from senior staff who had been trained to carry out this role.

People told us their needs had been assessed before they moved into the home and we saw they, or their relatives, had been involved in planning their care. The four care files we checked reflected people’s needs and preferences in detail. Care plans and risk assessments had been reviewed on a regular basis to assess if the planned care was working, or if changes needed to be made. We found improvements were needed with the recording of people’s behaviour that challenged the service to inform effective review.

People had access to an activities programme which provided regular in-house activities and stimulation. People told us they enjoyed the activities they took part in, but could choose not to participate if they preferred. They were particularly complimentary about the new vegetable patch and helping with the planting or sitting in the garden and watching.

The people we spoke with said they had no complaints, but would feel comfortable speaking to staff if they had any concerns. We saw the complaints policy was easily available to people using or visiting the service. We saw that when concerns had been raised these had been investigated and resolved promptly.

Following the last inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach in regulations. We undertook a follow up inspection on 15 April 2015 to check they had followed their plan and to confirm they now met the legal requirements.

This report only covers our findings in relation to this topic. We considered the evidence we had gathered under the outcome: Is the service safe?

Below is a summary of what we found. The summary is based on our discussions with the registered manager, staff and from looking at records. If you want to see the evidence supporting our summary please read the full report.

The registered manager and staff were fully aware of their responsibilities in ensuring people received appropriate emergency treatment and care where necessary. New policies had been put in place and discussed in staff meetings.

We saw care records detailed contact with and support from emergency care practitioners when people had experienced falls or their health condition had deteriorated. This showed staff ensured people received appropriate treatment and their health and wellbeing was properly protected.

At our follow up inspection on 15 April 2015 we found the registered provider had followed their action plan and legal requirements had been met.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and relatives, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service were treated with dignity and respect by the staff.

Risk assessments were completed so staff had guidance in how to support people in ways that minimised the risks.

The manager and staff were aware of The Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS); one DoLS application had been requested and was awaiting assessment. Training records showed the care staff had completed courses in MCA and DoLS.

The manager set the staff rotas and they took into consideration people's care needs when deciding on the numbers of staff on duty and the skills they required to meet people's needs.

Is the service effective?

People were able to make choices about aspects of their lives and could take part in some activities inside the service.

People's health and social care needs were assessed with them and there was input from relatives. Specialist needs in relation to diet, falls, mobility and equipment were identified and planned for.

Is the service caring?

People told us they were supported by helpful, caring and friendly staff. We saw staff interacting with people in a positive way, enabling them to be as independent as possible while offering on-going support.

Care files contained person centred information that reflected people's needs and preferences. We saw care and support had been provided in accordance with people's wishes.

Satisfaction surveys and meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. People's comments indicated they were happy with how staff supported them, and the home's facilities.

Is the service responsive?

We found that although people who used the service had access to health professionals, staff had not consistently secured emergency advice or support following an accident.

People who used and visited the service knew how to make a complaint if they needed to. People we spoke with said when any requests were made staff were quick to respond to them.

Is the service well-led?

There was a quality assurance system in place to assess if the home was operating correctly. This included surveys and audits. We saw action plans had been put in place to address any shortfalls.

There was a registered manager in post to oversee the management of the home and they were supported in this by the team leaders. There were staff meetings held and staff were provided with supervision and training.

What people who used the service, and those that matter to them, said about the care and support they received: -

Comments about the staff included: 'The staff are very good; they work hard, they always come when I ring my bell,' 'There always seems to be enough staff around' and 'Staff are attentive and helpful.'

Comments about the care provided included: 'I am glad to be here, the staff are lovely and will do anything for you' and 'Very satisfied with the care; the food is tasty and there are more things to do now.'

A relative told us they had made a positive decision in choosing the home. They told us they visited on a regular basis and were 'Very satisfied and reassured' with the service delivered.

People told us that staff supported them well with health and personal care needs and took prompt action when required, to get medical attention. A relative told us they were very happy with the service provided and that staff kept them informed about decisions and changes that were needed.

We found that people were provided with a choice of nutritious home cooked meals. People told us they enjoyed their food and one told us that mealtime experiences were, 'Like staying in a hotel.'

We saw that records were maintained of regular checks of equipment, to ensure people's welfare was safety promoted. People told us they were, 'Very comfortable' and happy with the facilities provided.

We saw that training had been delivered to staff to ensure they had the skills needed to perform their roles. People who used the service and their relatives told us they were confident that appropriate action would be taken, to deal with any concerns they might raise and that staff were, 'Very good.'

We spoke with four people who used the service, and a relative who was visiting on the day of our visit..

We observed that staff displayed an open and welcoming approach and saw them interacting with people in a kind and positive manner. We saw that staff offered support in a sensitive and considerate way to people to ensure their personal dignity was respected.

We observed there was a calm and friendly atmosphere throughout the home and saw that people looked clean and well cared for. We saw staff spending individual time with people who used the service, to ensure their health and well being was positively promoted.

A relative told us the service was 'Like a second home' and that even the domestic staff were involved in interacting and talking with people.

People who used the service said that staff were 'Kind' and 'Lovely' and that they were 'Warm and comfortable.' People told us they felt 'Safe' living in the home. A relative told us they had 'No concerns' about the service and that staff were 'Really caring and friendly.'