Newton Hall Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk people could be harmed.

The provider was in breach of legal regulation in relation to people’s safe care and treatment, Infection prevention and control, environment and the ways people’s medicines were managed safely.

This service scored 50 (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 have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

Staff knew people well and listened to concerns about safety and reported safety events via accident and incident records which the registered manager reviewed. However, accident and incident forms did not always include ‘recommendations to prevent similar incidents occurring’ and had not always indicated if a review of risk was required. There was limited evidence to demonstrate incidents were consistently subject to robust investigation, or effective action had been taken to reduce the risk of recurrence. For example, incidents where people became anxious or distressed were not effectively monitored. Staff document these incidents; however, they only completed the section describing the behaviour. Information about what triggered the behaviour and what happened afterwards was not recorded, meaning important details were missed. As a result, the provider was unable to effectively review incidents, identify patterns or triggers, and use this information to develop more detailed and responsive care plans.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

People’s safety was not always robustly monitored or managed. Risk assessments were not always adequate or assessed appropriately. This meant information passed to other agencies such as hospital staff may not contain accurate information. Additionally, people’s initial assessments were completed on a paper document and not transferred to the electronic records which meant staff did not have the information to understand people needs prior to joining the service as they had no access to the paper records.

Although the provider worked closely with the local GP, who visited the home regularly, appropriate referrals for some people had not been made for example people who were self-neglecting and had swallowing difficulties. As a result, there was a risk individuals' changing support needs were not being fully assessed, reviewed, or met in a timely manner.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Whilst there was limited evidence of safeguarding concerns being raised, we were not assured management, and staff fully understood their responsibilities in relation to safeguarding people from the risk of harm. We observed one person whose personal care needs appeared not to be adequately met, and whose room had a strong unpleasant odour. The registered manager told us the person often declined support with their personal care. However, there was no evidence advice, or support had been sought from relevant healthcare professionals or other agencies to help manage the situation and promote the person's wellbeing while respecting their choices.

Additionally, a review of the provider's safeguarding log found records contained limited detail, making it difficult to understand the nature of incidents, the actions taken in response, and the outcomes achieved. There was limited assurance safeguarding concerns had been appropriately investigated, managed, and monitored.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Some people’s care plans and risk assessments lacked sufficient detail and were not consistently tailored to people's individual needs and circumstances. This increased the risk staff did not have the information required to provide safe, consistent, and person-centred care. For example, one person's care plan contained general guidance on managing diabetic hypoglycaemia (low blood glucose levels) and hyperglycaemia (high blood glucose levels). However, individual risks associated with the person's condition had not been specifically identified or assessed. The care plan did not include clear, person-centred instructions for staff on the actions to take if the person experienced an episode of hypoglycaemia or hyperglycaemia. This meant staff may not have had access to sufficient information to respond consistently and appropriately to the person's needs. However, some people's care plans and risk assessments were detailed and person-centred, providing information about their preferences, how they wished to be supported, what was important to them, and the measures required to keep them safe.

We raised this concern with the registered manager. They acknowledged the shortfall and advised all care plans would be reviewed and updated to include the necessary risk assessments and guidance for staff.

The provider did not always detect and control potential risks in the care environment. They did not make sure equipment, facilities and technology supported the delivery of safe care.

The registered manager maintained a detailed record of checks undertaken on equipment used within the service. However, several concerns were identified regarding the cleanliness and maintenance of the environment. Carpets throughout the home were observed to be poorly maintained, and the kitchen required a thorough deep clean to ensure it was hygienic and safe for food preparation. A persistent malodorous odour was present within the home, which staff advised was linked to a previous toilet overflow that had leaked onto the carpet. Despite this incident, management advised a request had been submitted to head office for a professional deep clean of the affected area. However, this request had not been approved, resulting in the contamination and associated odour remaining unresolved.

Some areas of the home were looking tired and required maintenance, but we saw this was a project which the registered manager had already requested from the provider. When we arrived on day two, some of the areas had improved.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Staff received training relevant to their role. However, when we spoke with staff about the training they received, we found several staff were lacking knowledge about how they used their training in day-to-day practice. This included for safeguarding and the Mental Capacity Act 2005.

Some staff expressed concerns about the shortage of permanent staff and the reliance on agency workers. They told us significant time and effort were required to induct and support new or temporary staff, which affected continuity of care. We observed interactions between staff and people were, at times, task-focused rather than person-centred. This meant opportunities to build meaningful relationships and engage with people beyond meeting their immediate care needs were sometimes missed.

Recruitment procedures were in place which included the necessary checks to ensure staff were suitable for the role.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Parts of the environment were not clean or well maintained. We observed some people's bedrooms were untidy, and both en-suite and communal toilet facilities were unclean. This increased the risk of infection spreading among people.

We raised these concerns with the registered manager, who explained staffing shortages had affected domestic support arrangements. The registered manager told us they had been unable to secure agency cover for a domestic worker and, as a result, only one domestic staff member was available on the day of our inspection instead of the usual two. However, during our second visit, we were informed that the provider had authorised the increased use of agency staff on an interim basis while recruitment of permanent staff was ongoing.

Staff had access to personal protective equipment (PPE) and were observed to be using this appropriately to reduce the risk of infection.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in care planning.

People’s medicines were not always managed safely. We checked a selection of people’s prescribed medicines. Records overall confirmed people received their medicines, however, observations of medicines administration identified staff were not consistently following appropriate guidance and best practice when administering medication. Electronic medication administration records (eMAR) did not contain all the information required to support the safe administration of medicines. For example, specific administration instructions for medicines such as Lansoprazole and Alendronic Acid were not clearly recorded within the eMAR. These medicines should be administered in accordance with prescribing and manufacturer guidance, including being given at least 30 minutes before food. The absence of this information increased the risk of medicines not being administered correctly, potentially affecting their effectiveness and placing people at risk of harm.

Additionally, written guidance for staff about some medicines prescribed for occasional use (PRN) was not available. We raised this with the registered manager who assured us this would be changed. This was changed on our second visit to the service.

Medicines were stored safely and at correct temperatures.