Newton Hall Residential Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulation in relation to consent to care.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Some care plans were not always accurate or comprehensive, and information was inconsistent across documents. Care plans were not always reviewed regularly which reduced the opportunity for staff to provide effective care. For example, one care plan review contained someone else’s name and information.

Whilst some people’s needs were assessed and included consideration of their physical, social and communication needs, we found the information was not always sufficiently detailed, or up to date. Assessments relating to some people’s eating and drinking needs, personal care needs, and risks associated with self-neglect had not been adequately completed. As a result, opportunities to identify needs and provide appropriate support were missed. There was limited evidence people were supported in shared decision-making and goal setting to determine the plan of action they needed to move forward or achieve goals.

Initial assessments were completed before people moved into the service and information recorded in people’s care documents.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

In line with the International Dysphagia Diet Standardisation Initiative (IDDSI) framework, one person required food and fluids to be prepared to a specific consistency due to an identified risk of choking. However, information relating to the person's dietary requirements was not consistent across care records.

We found discrepancies in the guidance provided to staff regarding the use of thickening agents. Some staff told us they added one scoop of thickener to the person's fluids, whereas the manufacturer's instructions stated four scoops were required to achieve the prescribed consistency. While some staff were aware of this inconsistency, others were not. This meant we could not be assured the person was consistently receiving fluids prepared to the correct thickness, as recommended, placing them at potential risk of harm.

We raised this concern with the registered manager. They took immediate action by contacting the person's GP and the Speech and Language Therapy (SALT) team to obtain clarification. We were subsequently informed the correct guidance had been confirmed and the issue had been resolved.

People and relatives told us the food was generally very good, and if people wanted something which was not on the menu, this would be prepared for them. We saw this happening in practice and time was taken to ensure the person received their preference. One person told us, “I can be fussy with food, so if I don’t like something, they will make me something else. They [staff] are good like that.”

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Although there was evidence staff worked with a range of health and social care professionals, they were not always proactive in seeking multidisciplinary support when it was required. For example, we observed some people were receiving modified diets; however, a review of their records found no evidence of involvement from specialist services, such as the Speech and Language Therapy (SALT) team, who are qualified to assess swallowing difficulties and recommend appropriate food and fluid consistencies. Staff told us softer foods had been introduced following choking incidents to reduce risks. However, without a specialist assessment, we could not be assured these dietary modifications were appropriate, safe, or in line with best practice.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People who may have been at greater risk of chocking incidents, appropriate escalation and referrals had not always taken place. Although no harm was caused, these incidents should have triggered a referral to allow input from other healthcare professionals.

People and their relatives told us they had good access to healthcare professionals. This included weekly GP visits, where needed, and regular appointments with a chiropodist. However, there was limited evidence to demonstrate people were actively involved in planning their own care. For example, one person was unaware the GP was visiting on the day of our inspection. They told us they wished to discuss some health concerns with the GP and had previously requested support to do so, but this had not been arranged. This indicated people were not always fully supported to participate in decisions about their health and wellbeing or to make informed choices regarding their care.

This contributed to the breach of regulation in relation to safe care and treatment and good governance.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves.

Systems to monitor and improve outcomes for people were not always effective. Care records did not consistently show people’s health and wellbeing were routinely monitored. There was a lack of clear information about expected outcomes, which meant it was not always possible to measure whether people’s care and support had been effective.

Our observations identified inconsistencies in the information relating to one person’s prescribed fluid-thickening requirements. Thickening agents were used to support safe swallowing and reduce the risk of choking. As a result of these inconsistencies, the person was provided with drinks of varying thickness levels, which placed them at increased risk of choking.

We raised this with management who promptly sought support from the SALT Team.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The provider did not consistently act in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and associated code of practice. The provider and staff’s lack of knowledge and understanding of MCA and what it means in practice meant people’s rights were not maintained and upheld.

Mental capacity assessments were not always completed for specific decisions requiring consent, and robust best interest decision-making processes had not consistently been followed. Examples included decisions relating to consent to care, restricted access to certain areas of the building, personal care and continence support, dietary needs, medication management, and smoking.

As a result, people's rights were not always fully considered when assessing their ability to understand, make, and consent to specific decisions. Best interest records did not consistently provide a clear rationale for decisions made on a person's behalf. They often lacked details of who was involved in the decision-making process and did not demonstrate consideration of the person's past wishes, feelings, beliefs, or values before they lost capacity. In addition, where a Lasting Power of Attorney (LPA) for health and welfare was in place, records were not always accurate or evidenced appropriately. This placed people at risk of decisions being made that were not lawful or in line with their rights and preferences.

Additionally, there was limited evidence that people had been meaningfully consulted about the use of 24-hour surveillance in communal areas of the home. As a result, it was unclear whether people’s views and preferences had been sought and respected, or whether the use of continuous surveillance had been considered and evidenced as the least restrictive option.