Newlands Nursing Care Centre

Newlands Nursing Care Centre is registered to provide accommodation and personal care to up to 25 older people, some who require nursing care. At the time of our inspection, 13 people lived or were receiving respite care in the nursing home.

The service is also registered to provide personal care and nursing to people living in their own accommodation, including apartments and cottages based on the grounds of Newlands Care Centre. Where people are not living in the nursing home, the report refers to them living in their own homes.

While we inspect both aspects of the service, we do not inspect people’s own accommodation, therefore evidence in relation to the environment is based on people living in the care home aspect of Newlands. Three people were receiving personal care in their own homes.

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

People and their relatives told us they felt safe and that staff responded to their needs. Staff had received training in recognising safeguarding concerns and knew the actions to take to protect people from harm. Nursing staff engaged with external healthcare professionals to ensure people received timely care and support that was appropriate to their needs.

Each person living at Newlands, or receiving support from staff in their own homes, had detailed care plans in place. The management had actions to ensure these plans continued to be personalised and reflective of people’s changing needs.

There was a new management team in place at Newlands. New monitoring and governance systems to monitor and improve the quality of care people received had been implemented and had been successful in driving improvements. People and their relatives spoke positively about the management and the caring culture of staff. Staff spoke positively about the support they received from the management team.

Safe recruitment practices were in place. The provider ensured appropriate checks were being carried out to ensure staff were of good character.

There were enough staff deployed to meet people’s needs. Staff spoke positively about staffing at Newlands and spoke positively about people and their needs.

The provider had infection control procedures in place to protect people and prevent the spread of infection. Staff accessed personal protective equipment (PPE) and acted in accordance with government guidance.

We observed positive interactions between people and staff throughout our inspection. People living in the home and in the community clearly enjoyed the time they spent with staff and others. People enjoyed the engagement and activities they had received from staff and others.

Incidents and accidents were reviewed to reduce the risk of a reoccurrence. Complaints were responded to appropriately and opportunity was made to identify and make improvements.

The manager and deputy manager ensured appropriate action was taken when people lacked capacity in accordance with the Mental Capacity Act. Staff supported people in the least restrictive way possible and in their best interests. At the time of our inspection, the deputy manager had applied to the standard authority as 2 people were being subject to Deprivation of Liberty Safeguards.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 12 November 2022) and there were breaches of regulation. 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.

Why we inspected

We carried out an unannounced inspection of this service on 7 and 8 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve people’s care records and their good governance systems.

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 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 changed from Requires Improvement to Good. This is based on the findings 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 COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Newlands Nursing Care Centre is registered to provide accommodation for up to 25 people who require nursing or personal care. At the time of our inspection, 17 people lived in the nursing home.

The service is also registered to provide personal care and nursing to people living in their own accommodation, including apartments and cottages based in the grounds of Newlands Care Centre. The service also provides support to people living in their own homes within a five mile distance of Newlands Care Centre. Where people are not living in the nursing home, the report refers to them as ‘living in their own homes’.

While we inspect both aspects of the service, we do not inspect people’s own accommodation, therefore evidence in relation to the environment is based on people living in the care home. Eight people were receiving personal care in their own homes.

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

People and their relatives told us they felt safe and that staff responded to their needs. However, people cared for in their own homes did not always have risk and care plans in place. Staff therefore did not have complete and up to date information about the care that had been agreed to keep people healthy and safe.

Safe recruitment practices had not always been followed as all required pre-employment checks had not always been undertaken to gather assurances about staff’s previous employment and conduct.

Audits had taken place to monitor the quality of the service. However, these monitoring systems were not always effective in identifying quality concerns and had not identified the concerns we found at this inspection.

There were enough staff deployed to meet people’s needs. Staff told us they had the skills, time and support they needed to meet people’s needs.

Staff had received training in recognising safeguarding concerns and knew the actions to take to protect people from harm. Nursing staff engaged with healthcare professionals to ensure people received timely care and support appropriate to their needs.

The provider had infection control procedures in place to protect people and prevent the spread of infection. Staff accessed personal protective equipment (PPE) and acted in accordance with government guidance.

We observed positive interactions between people and staff throughout our inspection. People living in the home and in the community clearly enjoyed the time they spent with staff and others. People enjoyed the engagement and activities they had received from staff and others.

Incidents and accidents were reviewed to reduce the risk of a reoccurrence. Complaints were responded to appropriately and opportunity was made to identify and make improvements.

People and their relatives spoke positively about the management and the caring culture of staff. Staff spoke positively about the support they received from the manager and representatives of the provider.

Staff supported people in the least restrictive way possible and in their best interests. At the time of our inspection no one was living under Deprivation of Liberty Safeguards (DoLS).

The management and provider were providing nursing care to people in their own homes in accordance with people’s wishes. The provision of these nursing services had not always been fully scoped with the Integrated Care Board (ICB) (an NHS organisation responsible for developing a plan with partners for meeting the health needs of the population). The management were meeting with the ICB to implement agreements to ensure people continued to receive care in a responsive and timely manner. Whilst the provider’s registration was correct, the provider had not updated their statement of purpose to reflect the nursing support they provided people in their own homes.

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 Outstanding (published 16 October 2018)

Why we inspected

This inspection was prompted by information received about the administration and management of people’s prescribed medicines, cleanliness and staffing. This report only covers our findings in relation to the safe, responsive and well led key questions. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

We have identified breaches in relation to good governance, statement of purpose and safe recruitment practices at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

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.

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. For this Infection Prevention and Control review we focused on the care home aspect of the service, however the service has a community approach which meant we discussed how the whole service is managing during the Covid-19 pandemic.

Newlands Nursing Care Centre can accommodate up to 25 older people, people living with dementia. At the time of our inspection 13 people were living or receiving respite care in the nursing home. The service also provided care and wellbeing support to people living in apartments (which were adjoined to the home), in cottages on the site and for three people in the local community.

There was a range of communal areas people could use, including a restaurant, library, bistro area and a large lounge and dining room area. There was a large mezzanine area people could enjoy as well as the home’s grounds. The provider and registered manager offered people living in the apartments and in the cottages a choice to join the home’s shielding ‘bubble’. People living in the apartments chose to shield alongside the care home, whilst people living in the cottages chose to shield independently.

We found the following examples of good practice at Newlands Nursing Care Centre.

¿ The registered manager ensured staff had access to appropriate personal protective equipment (PPE). Arrangements had been made to ensure there was appropriate PPE to care for people who may have symptoms and require support to self-isolate.

¿ The registered manager had implemented risk management processes for staff when starting their shift and when leaving. Staff temperatures were recorded, and staff had a designated changing and washing area. Staff understood the reason for these processes and spoke positively about following them. All bar one member of staff at Newlands Nursing Care Centre solely worked at this home. The registered manager had carried out appropriate risk assessments where staff worked in other employment to enable them to take appropriate action.

¿ The registered manager worked proactively with healthcare professionals. They had weekly support from people's GP and the GP visited the service in person when required.

¿ People were supported with a tailored activities programme, which included support to interact with their loved ones remotely. People spoke positively about their life within the home. People were supported to enjoy special events with people living in their cottages using social distancing. People living in the apartments had chosen to be in the same social bubble as people living in the home. People living in the cottages received support with wellbeing calls, to order a take away and where necessary, support with their care needs.

¿ The registered manager worked with people's relatives to ensure socially distanced visits could work whilst protecting people who were vulnerable. A special visiting room had been created, which supported safe visiting. Visits had been suspended following recent local health recommendations, the registered manager had sought advice regarding this recommendation and had acted accordingly.

¿ The registered manager had implemented robust systems to ensure there was clear oversight in relation to infection prevention and control. The registered manager and deputy manager ensured staff adhered to national guidance on PPE. There were comprehensive infection control audits and cleaning schedules in place to ensure the home remained clean and free from infection.

¿ The registered manager had ensured that all information and guidance, in relation to COVID19 was taken onboard. They spoke positively about summarising this information and providing staff with the key information they required.

At the time of our inspection, 12 people were receiving accommodation and nursing or person care. Nine people were receiving personal care in their own accommodation. Newlands is based in Stow on The Wold in the Cotswolds, a rural area of Gloucestershire. The care home is split over three floors with communal spaces on the ground floor, including a dining room, drawing room, restaurant, library, salon and café. Attached to the home is Newlands House with people freely moving from the apartments to the home. A number of cottages are also in the grounds of the service. The service has large gardens for people to enjoy with views overlooking the countryside. This was an unannounced inspection.

We previously inspected the home on 24 May 2017 and inspected the following areas ‘Is the service effective?’ and ‘Is the service responsive’ and rated the service as “Good”. The service had met all of the required regulations at this time.

At this inspection we rated the service as ‘Outstanding’ overall.

There was a registered manager in place at Newlands Nursing Care Centre. 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 service was outstandingly caring. The registered manager and staff were committed to providing the best possible care. There were excellent relationships between staff and people with staff putting people at the centre of their care.

Staff worked creatively to enhance people’s enjoyment of life; including tailoring activities to people’s needs and creating opportunities for people to be involved in their local community. The provider ensured staff had sufficient time to provide compassionate and attentive care and people experienced that they were supported with the things that mattered to them. People were supported to attend family holidays.

The service was outstandingly responsive to people’s changing needs. People were supported by care and nursing staff who were attentive to their needs and knew when they were feeling unwell. The service had worked with healthcare professionals to reduce unnecessary hospital appointments and ensure people’s health and wellbeing were maintained.

People were safe living at Newlands. There were enough staff deployed to ensure people’s needs were being met. People received the support they required to meet their health and wellbeing needs.

People received their medicines as prescribed. The risks associated with people’s care was managed well and people were supported to take positive risks and maintain their independence.

Care staff treated people with dignity and ensured their nutritional needs were met. Hospitality, nursing and care staff were aware of and met people’s individual dietary needs. Staff spoke positively about the support and communication they received. Care staff felt they had all the training and support they required to meet people’s needs.

The service was highly responsive to people's needs. People were supported to live their life to the fullest and enjoyed a wide range of activities and events. People benefitted from engagement and activities which were tailored to their individual needs and preferences. People were extremely happy living at Newlands. Care, nursing staff and the registered manager took effective action to ensure people’s changing needs were met and that people received exceptional person-centred care.

Care staff were caring and were aware of people’s health needs. People were heavily involved in the day to day running of the home. People and their relatives concerns and views were listened to and acted upon. Relatives told us the management team was incredibly responsive and approachable.

The registered manager and provider had implemented systems to monitor and improve the quality of service people received at Newlands. The registered manager had a clear vision of how they wanted the service to develop and improve, with a focus on providing people with varied and personalised activities.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

We carried out an unannounced comprehensive inspection of this service on 19 April 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection on 24 May 2017 to check that they had followed their plan and to confirm that they now met legal requirements in relation to a breach of regulation 17. This report only covers our findings in relation to these issues. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Newlands Nursing Care Centre on our website at www.cqc.org.uk”

At our last inspection on 19 April 2016 this service was rated as requires improvement overall. We asked the provider to take action to make improvements to:

• maintaining accurate and relevant care plans to guide staff about people’s care and treatment

and these actions had been met.

We also recommended improvements were made to the way in which people’s capacity to make decisions about their care and support was assessed and recorded. Guidance was also given about ensuring evidence was available in the home with respect to the dealing of complaints. These actions had also been met.

People’s capacity to make decisions about their care and treatment was considered in line with the Mental Capacity Act 2005. Records had been maintained which confirmed when decisions had been made in people’s best interests. People’s care records were personalised and reflected their individual preferences and the way they wished to be cared for. People’s care records were amended, when there were any changes in their needs, to make sure they reflected the care and treatment being provided. People’s complaints were thoroughly investigated and copies of these were kept in the home.

The service had a registered manager in position. 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.

During this inspection we found one area of regulation not fully met in relation to the records kept about people’s care and treatment. You can see what action we told the provider to take at the back of the full version of the report. People received support which was tailored to their individual needs and care was delivered with kindness and compassion. People’s end of life care was well planned and their families involved and supported. However, care plans did not always provide staff with accurate and sufficient information about people's care and treatment. The risk to people from this was reduced because care staff received exceptional support and guidance from senior nursing staff. Senior nursing staff were very hands on in the delivery of people’s care and worked alongside care staff so the appropriate care was delivered. However, care plans must accurately reflect and record what care people need and how their care and treatment is to be provided. Shortfalls in accurate and relevant care records can potentially put people at risk of receiving unsafe and inappropriate care.

We also recommended that the service seek appropriate advice with regard to the principles of the Mental Capacity Act 2005 and how better to reflect these were being followed in people's care records. We observed people's care being delivered with their consent, although a desire to protect people from risk had resulted in a decision being taken for one person, which they objected to and which they had not provided consent for. Staff were aware of the need to protect those who were unable to make decisions about their care and treatment independently. However, the process of recording their considerations under the appropriate legislation for another person and the practice of assessing everyone's general capacity on admission required review and improvement.

People’s risks were identified and managed and they were kept safe from harm because staff knew how to report any concerns they may have. There were enough staff to meet people’s needs and robust recruitment practices protected people from those who may be unsuitable. People received their medicines safely and were provided with explanations about these when they asked. Staff had been trained and were well supported. Staff competencies were reviewed and assessed but this process was not recorded. Staff training was on-going.

People were helped to maintain and a healthy diet and when there were concerns about this appropriate monitoring and support was provided. People had a choice of food and drink and there were well appointed restaurants to eat in and to entertain friends and family. People had opportunities to take part in social activities and they were supported to go out. Newlands did not provide transport which was adapted to accommodate wheelchair users however, we were told transport which was adapted could be hired. Arrangements were in place for people to raise a complaint and to have these responded to.

The service was managed well despite the registered manager not being present in the home as much as people would like. Some people told us this hampered communication but people also told us the registered manager was very approachable. Following the inspection the provider informed us the time spent in the home by the registered manager had increased. The views of people, their relatives and staff were sought and a summary of their feedback made available to each group to read. Quality auditing processes were in place to assess, monitor and identify shortfalls although the improvements required in care planning records had not been identified. When we fed our findings back to the management staff they told us ways to improve this would be found.

People who used the service told us they were very satisfied with the service they received. People felt the staff supported them and met their needs. One person who used the service said "I'm very lucky to be here."

People told us that staff treated them with dignity and respect. One person said 'I am well respected.' We saw staff speaking and responding to people in a kind and respectful manner.

The care records showed us that people's health needs had been assessed before they came to live in the home. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

Recruitment records showed that new staff had been checked to make sure they were suitable to work with vulnerable people. The home trained their staff and had the procedures which protected people from any form of abuse. People told us they did not have any complaints but would speak to the manger or staff if they had any concerns. One person said 'I would go and see the managers.'

The service and the building were monitored and risk assessed to ensure they were suitable for the people who used them.

The evidence we collected showed us the service kept people safe and met their care needs.

There were arrangements in place to protect people from abuse and staff understood their individual responsibilities in relation to this. There were enough staff on duty to meet people's needs and to allow the service to run smoothly. Staff were provided with appropriate training and support in order to carry out their tasks safely and to professionally develop.

We saw evidence of effective monitoring of services provided and actions being taken to improve them. There were arrangements in place to assess, manage and re-evaluate risks.

People could make complaints and where concerns and dissatisfaction had been expressed this had been taken seriously and acted on.