Newlands Care Home

Newlands Care Home is a care home with nursing operated by Angel Care plc located in Salford. Newlands Care Home is registered with CQC to provide care for a maximum of 30 people. There were 24 people using the service at the time of the inspection.

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

Some improvements were still required to ensure medicines were managed safely. Audits were completed to monitor the quality of service to ensure good governance, however, medication audits still required further improvement. We have made a recommendation regarding this.

There were enough staff to care for people safely and correct staff recruitment procedures were followed. The premises and equipment were well maintained and we found the home to be clean and tidy during the inspection.

Record keeping had improved and we observed people to be clean and well presented, both of which had been concerns at our previous inspection. Care plans contained good levels of detail about the support people required and we observed several activities taking place during the inspection. Complaints were handled appropriately.

There were systems in place to seek feedback from people living at the home, including the use of satisfaction surveys and staff and residents’ meetings. The provider had a number of links within the local community and worked well with partner agencies including the local authority.

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.

Rating at last inspection

The last rating for this service was requires improvement (published January 2021) and the provider was in breach of regulations relating to safe care and treatment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of some regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in December 2020. Breaches of regulations 12 and 17were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

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 Requires Improvement. This is based on the findings at this inspection.

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

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.

Enforcement

We will continue to monitor the service and will take further action if needed. We have identified breaches in relation to medication and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Newlands Care Home is located in Salford, Greater Manchester and is operated by Angel Care plc. The home is registered with the Care Quality Commission (CQC) to provide care for up to 30 people, some of whom are living with dementia. At the time of the inspection there were 24 people living at the home.

We found the following examples of good practice:

There was a booking system in place to facilitate safe visiting. Lateral flow device testing (LFD) was carried out and personal protective equipment (PPE) was required to be worn by visitors on entry to the home.

All staff working at the home were fully vaccinated and completed regular COVID-19 testing.

Arrangements were in place so staff could maintain safe social distancing during breaks. The home had a number of entrances and these were restricted for use by different people such as staff or visitors.

All staff deemed to be at higher risk of contracting COVID-19 had been appropriately assessed and there were measures in place to ensure their safety.

The provider supported people using the service to access appropriate vaccinations, including COVID-19 vaccinations and boosters.

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

Medicines were not always stored and administered as prescribed, including controlled drugs (CD’s). We found there were several environmental risks within the home which were not always well managed. Improvements were required to the home environment including people’s bedrooms. External garden areas also looked cluttered and untidy.

At the time of our inspection the home was free of Covid-19. On the front door of the home, there was a poster stating a risk assessment should be completed for any visitors to the home. This included asking about their current health and if they had symptoms of the coronavirus. This process was not always followed.

People living at the home did not have communication care plans in place and we saw people were not always supported to wear sensory equipment as required such as glasses. Some personal care charts were not accurately completed and certain aspects of people’s personal care, such as nail care, was not always carried out as needed.

Governance and quality assurance systems were in place. However, these needed to be improved to ensure the concerns identified at this inspection acted upon in a timely way.

People living at the home and their relatives told us the home was a safe place for people to live. Staff demonstrated a good understanding about how to safeguard people from the risk of abuse. Staff recruitment procedures were robust and there were enough staff to care for people safely. The premises were well maintained, with regular servicing of equipment and the building.

We received positive feedback about management and leadership from everybody we spoke with including staff, people living at the home and their relatives. Staff told us there was a positive culture at the home, with good team work throughout. Appropriate systems were in place to enable staff, relatives and people living at the home to provide feedback about the care they received.

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 October 2018).

Why we inspected

The inspection was carried out due to information of concern shared with us by the local authority. This included concerns about medication, the environment, infection control, staffing levels, communication and the quality of care plans and records.

We therefore inspected the key questions of safe and well-led to review these concerns. During the inspection we took the decision to also inspect the key question of responsive, due to identifying areas of concern whilst we were at the home.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions (effective and caring). We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

Follow up

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

Newlands care home is registered with the Care Quality Commission to provide care for up to 30 older people. The home provides accommodation across two floors and provides both residential and nursing care. The home is located on Tetlow Lane in Salford and is close to local transport routes into Manchester city centre. The home provides care to people who are of Jewish faith, although people of all religions are welcome.

At the time of the inspection there were 23 people living at the home.

Newlands 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.

At our last inspection of Newlands in September 2017, the home was rated as ‘Requires Improvement’, with three breaches of the regulations identified. These were with regards to safeguarding people from abuse, good governance and staffing. A warning notice was also issued because of unsafe staffing levels within the home. Following this inspection, we were sent an action plan by the home which detailed the improvements the intended to make.

This comprehensive inspection checked to see if the concerns from the previous inspection had been addressed. We found improvements had been since our last inspection visit.

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.

The people we spoke with said the food served at the home was of good quality and we saw people being supported to eat by staff at meal times. People were weighed on a regular basis and more frequently if they were identified as being at risk of losing weight. Suitable facilities were available to cater for Kosher diets where people required this as part of their religion.

We saw the home responded appropriately where people had lost weight. However, we recommend actions set during the monthly weight audits done within the home, such as offering people higher calorie foods, are clearly documented within people’s food and fluid intake sheets as being either offered, consumed or refused by people. Also, that people’s nutritional supplements are clearly documented on both MAR and fluid sheets to ensure records of fluid people had consumed were accurate.

We saw people’s fluid charts indicated people received good levels of fluids throughout the day. However we recommend the targets staff should encourage people need to consume are clearly documented within care plans so that staff know how much people need to drink each day. We raised these issues with the registered manager during the inspection feedback, who immediately sent us copies of updated documentation where this information would be recorded.

We found there were enough staff to care for people safely, with staff having access to appropriate training to support them in their role. The registered manager told us the provider was now more willing to provide additional staff if people’s care needs increased, or if occupancy increased.

The service was now working within the principles of the MCA (Mental Capacity Act), with capacity assessments and best interest meetings held where people were unable to consent to their care and treatment.

Improvements had been made to overall quality monitoring systems to ensure the service was being monitored effectively.

People who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise risk. Staff recruitment was robust with appropriate checks undertaken before staff started working at the home.

We found staff received sufficient training, supervision and induction to support them in their role. The staff we spoke with told us they were happy with the training they received and felt supported to undertake their work.

We found the home worked closely with other health professionals and made appropriate referrals if there were concerns. Details of any visits from other professionals was recorded within people’s care plans.

We received positive feedback from people we spoke with about the care provided at the home. Visiting relatives said they had no concerns with the care being delivered at the home. People said they felt treated with dignity and we observed staff treating people with respect during the inspection.

Each person living at the home had their own care plan in place which provided an overview of their care requirements and any associated risks.

There were a range of different activities available for people to participate in and the home had recently recruited a new activities coordinator, with people living at the home being involved in the recruitment process.

We found complaints were responded to appropriately. A policy and procedure was in place and was displayed near the main entrance for people to refer to.

Staff meetings took place, giving staff the opportunity to discuss their work and raise any concerns about practices within the home. We also observed a handover taking place where nurses provided an update on people’s care needs from that shift.

Staff spoke positively about management at the home and said the manager was supportive and approachable.

Policies and procedures were in place and were being reviewed regularly.

Newlands Care home provides accommodation, nursing and personal care to up to 30 people. At the time of the inspection there were 30 people using the service. The service is designed to meet the religious and cultural needs of the Jewish community.

There was a registered manager in post who supported us throughout 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.

There were insufficient numbers of suitably trained staff to keep people safe and meet their needs in a timely manner. The provider had not responded to the registered manager's request to increase the staffing levels to ensure people's needs were met.

Risks of harm to people were reduced, however some action taken to reduce the risks may not have been the least restrictive.

The principles of The Mental Capacity Act 2005 (MCA) was not consistently followed to ensure that people who lacked the mental capacity to agree to their care and support were supported by the legal representatives to agree in their best interests.

Staff were trained to fulfil their roles, however further supervision was required to ensure that staff practice was safe and appropriate.

People did not always receive care that met their assessed needs or individual preferences and their independence was not always promoted.

The registered manager and staff knew what to do if they suspected abuse and followed the local safeguarding procedures.

People's nutritional needs were met and if their needs changed or they became unwell health care advice and support was gained.

People's medicines were managed, stored and administered safely by staff who had been trained. Staff were employed using safe recruitment procedures to ensure they were of good character and fit to work.

People were supported to engage in hobbies and activities and their religious and cultural needs were met. Staff were kind and compassionate with their interactions with people.

There was a complaints procedure and people were regularly asked their views on the service. Action was taken when people raised concerns.

The registered manager was well liked and respected by people, relatives and staff.

We looked at how people's nutrition and hydration requirements were met and observed part of the lunch time period. This was an organised occasion and people who required assistance to eat and drink were appropriately supported by staff.

We checked the suitability of the premises and found they were fit for purpose. We spoke with four people's relatives during our inspection, two of whom commented that the building needed decoration in places. One relative said to us 'It certainly isn't the most modern place you will see and does need updating in places'.

We also looked at the systems in place to monitor the quality of service provision and recruit staff safely and effectively. This included regular home audits, quarterly surveys and ensuring references and a CRB were produced for all staff.

We looked at how people were protected from harm at the home. We saw there were robust systems in place to protect people. There were policies and procedures to guide the staff and regular training in place to make sure staff were clear about their role in protecting vulnerable people.

We looked at how well staff were supported whilst they worked at the home. Staff told us they felt very well supported and they felt they worked well as a team. Staff told us they had supervision with the manager and appraisal systems were in place. We also looked at the staff team meetings and saw these were held regularly.

People living at the home and the staff confirmed they knew how to raise concerns. There were good systems in place to make sure people were listened and individuals were confident their concerns would be and dealt with promptly.