Newhaven

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

We found the following examples of good practice:

There was a programme of regular COVID-19 testing for both people living in the home, staff, essential carers and visitors to the home. Screening procedures included temperature checks and a negative lateral flow test.

Staff used personal protective equipment (PPE) and followed good guidance and practices. There was ample PPE available to the people living at the home and staff.

Staff were trained on how to manage the spread of COVID-19. People were encouraged to maintain social distancing and use face masks in the community where required.

Daily cleaning schedules were implemented by the care staff.

Staff supported people to access healthcare services.

Newhaven is a residential care home providing accommodation and personal care to 11 people with learning disabilities and or autism at the time of the inspection. The service can support up to 16 people.

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 possible 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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 16 people. Ten people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

During this inspection we found improvements in regard to Registering the Right Support and notifying the Care Quality Commission (CQC) of all incidents in accordance with our statutory requirements.

We have made recommendations in regards to documentation, updating best practice knowledge and environmental risk management.

Some refurbishment had taken place at Newhaven and further refurbishment was planned.

People we spoke with felt safe living at Newhaven and in observations we saw people appeared relaxed around staff. We observed familiar, warm and caring relationships and people were treated with dignity and respect. Staff were able to effectively communicate with people who had non-verbal forms of communication.

Care plans and risk assessments were in place that held appropriate information on how to support a person effectively. People were supported to maintain a healthy diet and had access to healthcare professionals should they need them.

There was an ongoing process where people were asked for their feedback about the service using a range of quality assurance systems that measured and monitored the quality of care and the service.

Accidents, incidents and complaints were dealt with appropriately and people’s medication was administered safely. The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults and whistleblowing.

Staff received induction, training and were supported in their roles to be able to provide safe effective and responsive care for people living in Newhaven.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills, if they chose to, and become more independent.

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 18 December 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, at this inspection recommendations have been made.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Newhaven is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection

Newhaven is registered to provide support for up to 16 people. At the time of our inspection 12 people were living there. At the time of the inspection the home was registered with CQC to provide services for older people. In fact, it provides services for people with a learning disability, many of whom are older people, as recorded within previous inspection reports. We discussed this with the registered manager during the first day of the inspection following which they submitted the relevant paperwork so that this could be rectified.

The home has 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 registered manager is also the provider and has worked at the home since it opened over 20 years ago.

At our last inspection of the home in June 2017 published in August 2017 the service was rated ‘requires improvement overall. At that inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 12, safe care and treatment. This was because risks to the health and safety of service users had not been consistently assessed.

After that inspection the provider wrote to us to say what they would do to meet their legal requirements. At this inspection we identified that improvements had been made with regard to Regulation 12 and the provider was no longer in breach of this regulation. This was because risks to the health and safety of service users had been assessed and plans put into place to reduce known risks.

In June 2017 CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability. At this inspection we assessed the service in line with this guidance.

During this inspection we found breaches in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider’s systems were not always effective at monitoring and improving the service people received. In particular no system was in place for checking that the home was providing support to people in line with current best practice guidance for supporting people who have a learning disability.

We also found a breach of Regulation 18 of Care Quality Commission (Registration) Regulations 2009. This was because the provider had failed to notify us of incidents that had occurred in the home in accordance with our statutory requirements. This meant that we did not have all of the information needed to effectively monitor the service.

Newhaven did not always meet the values and principles of Registering the Right Support and associated guidance. Current good practice guidance encompasses the values of choice, independence, inclusion and living as ordinary a life as any citizen. The size and layout of Newhaven means it does not always operate of feel like an ordinary home.

Some of the practices within the home were institutional and not personalised for individuals. Examples of this included, some staff wearing uniforms, a large sign outside of the home and the use of plastic crockery for everyone.

Systems were in place for safeguarding people from the risk of abuse and reporting any concerns that arose and staff knew what action to take if they felt people were at risk of abuse. A system was also in place for raising concerns or complaints, a complaint received in the past year had been dealt with robustly by the registered manager.

People’s medication was safely managed and they received it on time and as prescribed. Staff provided people with the support they needed to manage their physical and mental health care needs. This included supporting people to attend appointments and follow advice given by health professionals as well as ensuring people used equipment to meet their assessed needs.

People’s care needs had been assessed and regularly reviewed. Where people required support, this was detailed in their care plans which provided guidance for staff on how to meet people’s needs safely and well. Staff were aware of and followed this guidance.

Equipment and the building were monitored regularly to ensure they were safe. The building had adaptations and equipment to support people with their mobility and personal care. This included a hoist and a stair lift.

There were enough staff working at the home to meet people’s care needs. The home had a stable staff team and did not use bank or agency staff, this helped to provide a consistent service for people. Systems were in place and followed to recruit staff and check they were suitable to work with people at risk of abuse or neglect.

Staff had received training to help them understand and meet the care needs of people living at the home. Staff told us they felt supported by senior staff at the home.

People were supported to take part in activities of their choice both at home and out and about in their wider community. People had a choice of meals and we saw that staff offered people support to eat, drink and monitor their nutritional needs.

It was evident from what people told us both verbally and non-verbally that they liked and trusted the staff team. Staff spent a lot of time interacting with people as well as meeting their care needs. Newhaven is a family run home and staff were clear that they tried to promote a family atmosphere. It was evident in meeting people and observing their daily lives that people felt comfortable and cared for.

The provider met the requirements of the Mental Capacity Act 2005. People were supported to make choices and decisions for themselves. Where people lacked the capacity to make important decisions for themselves then the provider took steps to protect them. This included applying to the local authority for a Deprivation of Liberty Safeguard (DoLS) for the person. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the polices and systems in the service support this practice.

Further information is in the detailed findings below.

At the last inspection in March 2015, the service was rated Good. At this inspection we found the rating for the service changed to requires improvement as there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Safe care and treatment. This was because the fire risk assessment was not individualised and specific to Newhaven care home. Also there were no personal emergency evacuation plans in place to give guidance to staff in case of emergency. We also found that risk assessments in people’s care files had not always highlighted risks present in providing people’s care which could be mitigated in care planning. You can see what action we told the provider to take at the back of the full version of the report.

The home required and 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.

People living at the home told us that they were happy, well cared for and they felt safe living at Newhaven. One person told us, “I’ve been here for 14 years. I love it here”. People’s relatives we spoke with told us that they had confidence in the staff and management of the home. One person’s relative told us they thought “Staff go beyond what you would expect”. Another family member told us the managers were, “Very approachable, like an add on family, we sit down and talk like family”.

We saw that there were sufficient experienced and qualified staff on duty to meet people’s care and support needs. Staff had received regular training and refreshers of training, for example in safeguarding vulnerable adults and administering medication. Staff knew people well and had positive relationships with them. This contributed to a friendly and relaxed atmosphere at the home. People were supported in many different activities both in the home and in their community.

People told us they liked the food, there was choice and people’s special requests were catered for. The kitchen had been awarded the highest rating of five star by the local authority environmental health team. The home environment was clean, fresh smelling and well maintained. There had been improvements made to the home since our last inspection.

People had individualised support plans in place which highlighted their wishes and preferences with regard to their support. 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 support this practice.

People’s relatives told us that they felt the registered manager and deputy manager were friendly and approachable. In many areas the service was well led and we saw that the managers made regular checks and audits of areas within the home. However these checks had not addressed our concerns with planning for emergencies and assessing risk in people’s care.

People's medicines were well managed to ensure that they always received what was prescribed by their doctor.

All of the staff had recently completed an eight week course leading to a Certificate in Understanding Working in Mental Health. They had also attended other relevant training.

People who lived at the home were free to choose how they spent their time and had unrestricted access to all parts of the house. Most people had limited verbal communication, however it was evident from smiles and hugs and from the general atmosphere in the home that people felt happy and comfortable. The home had a minibus and most people went out to use leisure facilities in the community including the local theatre. All of the staff team had recently completed the Northern Council for Further Education level 2 certificate in Equality and Diversity.

A district nurse who was visiting the home told us 'The care is absolutely outstanding here.' A feedback form that had been filled in recently by a community staff nurse stated 'I have always been met with helpful and respectful staff. All clients are nicely presented and appear happy. We have always felt instructions have been met and any concerns carers had were discussed openly with us.'