You are here

The New Inn Requires improvement

Reports


Inspection carried out on 27 November 2019

During a routine inspection

About the service

The New Inn is a residential care home providing accommodation and personal care to seven people with learning disabilities, autism, and other complex needs, at the time of the inspection. The service can support up to 10 people. The New Inn is in a detached building on the outskirts of Uckfield. The accommodation comprises a large, communal, open-plan sitting, dining area with access to a rear garden. There are two shared lounges and people have their own bedrooms with en-suite facilities.

Our inspection in April 2017 was prompted in part by a notification of a specific incident. This incident is still subject to a criminal investigation and as a result neither inspections examined the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about how the risk of choking was managed. Both inspections examined those risks and other potential risks to people.

Outcomes for people did not consistently reflect the principles and values of Registering the Right Support as some people experienced a lack of choice and control. Other outcomes reflected the principles of Registering the Right Support such as people’s independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Quality audits had not consistently highlighted or put right issues we found at this inspection. The service has not been rated Requires improvement in Well-led for four consecutive inspections.

Some risks were not consistently assessed. For example, we found some staff were working long hours. Doing consecutive shifts to cover other staff absence, but there had been no risk assessment.

Some staff language and approach was not always person centred or appropriate. Two entries in a ‘telephone log book’ book were not appropriate and one staff’s approach to another person was abrupt.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. One person had a condition that meant their ability to make decisions changed and this was not planned for. We have made a recommendation about this in the main body of the report.

There were enough staff deployed to meet people’s needs safely. The service was clean and free form the risk of infection. Where things had gone wrong, such as incidents, learning was shared, and lessons embedded into practice.

Staff were trained and supported to fulfil their roles. People had enough to eat and drink to maintain good health and their healthcare needs were met by staff who monitored people’s health. The building was accessible and met peoples’ needs.

Staff supported people to be independent and respected people’s privacy. People were involved in their care and staff knew peoples’ communication needs.

People had a range of personalised activities they accessed and told us that they had lots to do. People and relatives knew how to make a complaint if they needed to. There were no people receiving end of life care, but people had care plans for how they would like to be supported during their final days

The registered manager was a visible presence in the service and had a good understanding of the challenges the service faced and how to overcome them. The management team understood their responsibilities in reporting significant events and had worked closely with partner agencies.

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 (June 2018).

At this inspection we found improvements had not been sustained and there was a breach of regulation relating to good governance.

Why we inspected

Inspection carried out on 27 June 2018

During a routine inspection

This inspection took place on the 27 June 2018.

The last Inspection took place on 19 and 20 April 2017 and was unannounced. This was prompted in part by a notification of an incident following which a person died. This incident is still subject to a criminal investigation and as a result neither inspections examined the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about how the risk of choking was managed. Both inspections examined those risks and other potential risks to people.

The New Inn is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Care and support is provided for up to ten people with a learning disability, autism and/or other complex needs. At the time of our inspection, there were eight people living at the service. The service is in an older, detached building on the outskirts of Uckfield. The accommodation comprises a large, communal, open-plan sitting, dining area with access to a rear garden. People have their own bedrooms with en-suite facilities. This service is one of three services in East Sussex owned by the provider.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. So that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in post; however, they were not currently in charge of the day to day running of the service. 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 provider had taken an active role in the service. They had appointed the deputy manager from another of the provider’s service to work as the manager during the registered manager’s absence. There was also a service manager to oversee and support all three of the provider’s services.

At the last inspection on 19 and 20 April 2017 the service was rated overall Requires Improvement. This was because risks were not consistently managed safely as assessments were out of date and lacked some detail. Safety checks, such as food temperature and fire safety checks had not always been completed. Staff were not always trained with the right skills and knowledge to provide people with the care and assistance they needed. Training was out of date for some staff. Staff had not always been able to meet with their line manager for supervision on a one to one basis. When staff were recruited they were not consistently subject to checks to ensure they were safe to work in the care sector or inducted to work in the service. Where people did not have the capacity to understand or consent to a decision, the provider had not always followed the requirements of the Mental Capacity Act (2005). Some mental capacity assessments were completed incorrectly and did not clearly record the outcome. There was a lack of meaningful and structured activities on offer to people and there was a lack of therapeutic input to people’s activities. People had access to a range of healthcare professionals but were at risk of not having their health needs met as care plans were not updated to reflect guidance provided. Some health action plans contained out of date information or had not been updated regularly. There had not always been sufficient leadership in the service. Quality auditing systems had not always been effective. The registered provider had s

Inspection carried out on 19 April 2017

During a routine inspection

The Inspection took place on 19 and 20 April 2017 and was unannounced. This inspection was prompted in part by a notification of an incident following which a person died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of the risk of choking. This inspection examined those risks and other potential risks to people.

The New Inn is a care home registered to provide accommodation and personal care for a maximum of ten people with learning disabilities. At the time of our visit there were nine people living in the home. The service had a registered manager in post; however, they were not currently in charge of the day to day running of the service. The registered provider had taken an active role in the service and had appointed the deputy manager from another service to fill in as an acting manager and the deputy manager of The New Inn had been given extra support. 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.

At our last inspection on 1 and 2 June 2016, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities). This breach was in relation to good governance around cleanliness of the premises. At this inspection we found that improvements relating to cleanliness had been made but that quality auditing systems to identify other improvements had not yet been embedded in to practice, meaning this remained a breach of the regulations.

The provider had systems in place to protect people against abuse and harm. The provider had effective policies and procedures that gave staff guidance on how to report abuse. Staff were trained to identify the different types of abuse and knew who to report to if they had any concerns. Medicines were managed safely and people had access to their medicines when they needed them.

Risks were not consistently managed safely as assessments were out of date and lacked some detail. Safety checks, such as food temperature and fire safety checks had not always been completed. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient numbers of staff to support people safely. Staff were not always trained with the right skills and knowledge to provide people with the care and assistance they needed. Some training was out of date for some staff. Staff had not always been able to meet their line manager on a one to one basis regularly. When staff were recruited they were not consistently subject to checks to ensure they were safe to work in the care sector or inducted to work in the service. We have made a recommendation about this.

Where people did not have the capacity to understand or consent to a decision, the provider had not always followed the requirements of the Mental Capacity Act (2005). Some mental capacity assessments were completed incorrectly and some did not clearly record the outcome. You can see what action we told the provider to take at the back of the full version of the report.

There was a lack of meaningful and structured activities on offer to people and there was a lack of therapeutic input to people’s activities. The registered manager had recruited people who were yet to start and had plans to recruit other staff members. We have made a recommendation about this in our report.

People had access to a range of healthcare professionals but were at risk of not having their health needs met as care plans were not updated. Some health action plans contained out of date information or had not been updated regularly.

Inspection carried out on 29 June 2016

During a routine inspection

The Inspection took place on 29th June 2016 and was unannounced.

The New Inn is a care home registered to provide accommodation and personal care for a maximum of ten people with learning disabilities. At the time of our visit there were 9 people living in the home. At the time of our inspection there was a registered manager at the home. 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.

Audits did not always identify actions to improve the service. During the inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people’s safety had been assessed and actions taken to protect people from the risk of harm. The provider also had systems in place to reduce the risk of people experiencing abuse. When concerns were raised, the provider had investigated these thoroughly and action had been taken to protect people when necessary.

Medicines were managed safely and people had access to their medicines when they needed them. However, as required medicines were not clearly audited when counting stock from one month to the next. We recommend that the registered manager reviews the procedure for stock checking all medicines

Staff were well trained and there were enough staff with the right skills and knowledge to provide people with the care and assistance they needed. They knew the people they cared for well and treated them with kindness, compassion, dignity and respect. Staff met together regularly and felt supported by the manager. Staff were able to meet their line manager on a one to one basis regularly. New staff were inducted in the service when they started working there but the process was not consistent. We recommend that the registered provider implements a consistent induction programme for all new staff.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff sitting and talking with people as equals. People could have visitors from family and friends whenever they wanted.

People received a person centred service that enabled them to live active and meaningful lives in the way they wanted. People led full and varied lives and were active in their community.

Support plans ensured people received the support they needed in the way they wanted. Peoples health needs were well managed by staff so that they received the treatment and medicines they needed to ensure they gave consent. Staff respond effectively to people’s needs and people were treated with respect. Staff interacted with people very positively and people responded well to staff.

Complaints were responded to appropriately however not all complaints were recorded. We recommend that the registered manager reviews the complaints recording process.

The culture of the service was open and person focused. The registered manager provided clear leadership to the staff team and was an active presence in the home. The manager provided active cover on the rota however this sometimes meant that they did not have sufficient time to fulfil their management role. We recommend that the registered provider reviews the management hours available.

Inspection carried out on 5 February 2014

During a routine inspection

At this inspection we met with the provider and four members of staff. We spoke with two people who used the service and observed other people in their daily lives. People appeared generally relaxed and comfortable. One person told us "I'm very happy here. There is nothing I don't like". Comments from staff included "We treat each person as an individual", "People are looked after well" and "It's improved a lot since the new manager started".

We found that people were supported to make choices and give their consent before any support or treatment. Staff were aware of the legal requirements of the Mental Capacity Act 2005 which meant that people�s legal rights were protected.

People received care and support which met their needs and which ensured their safety and well being. Staff had access to detailed, up to date information and guidance about how to support each individual.

We found that the environment was kept clean and that there were suitable systems in place to maintain standards of hygiene and infection control. Staff had access to personal protective equipment if needed.

There were enough qualified, skilled and experienced staff to meet people�s needs. There was a stable staff team in place who had a good awareness of the needs of each person that used the service. There were systems in place to cover staff absence in the event of sickness or annual leave.

We found that people who used the service were supported to make comments or complaints and that these were taken seriously. Staff understood how to identify if people who had communication difficulties were unhappy about the care and support they received.

Inspection carried out on 30 November 2012

During an inspection to make sure that the improvements required had been made

This inspection was a follow up to look at improvements made to the service after we identified concerns in a previous inspection on 5 July 2012.

We spoke to four people who used the service. They all told us that they were happy with the improvements that had been made to the environment. One person said "It's nice". We observed that people appeared relaxed and comfortable within the home. All areas were clean and tidy. We found that three people had had their bedrooms redecorated. One person told us they were "Happy with my room and the lounge".

We spoke with the new manager who discussed some of the changes she had implemented since being in post in order to make sure the service was compliant with the Regulations.

We found that there was a new system for managing the maintenance of the home and that this was effective in ensuring that repairs were carried out within reasonable timescales.

We were satisfied that arrangements had been made to ensure that recruitment records for staff were robust and contained all the information required so that people at the home could be confident they were safely supported by skilled and experienced staff.

Inspection carried out on 5 July 2012

During an inspection to make sure that the improvements required had been made

Because the people using the service had complex needs they were not all able to tell us their experiences.

One person told us that they liked living at the home, but that it was sometimes noisy. Another person said that staff supported them and they were happy there.

This inspection was a follow up to our visit on 5 March 2012 where we identified some concerns. We found that improvements had been made to care plans but that there were still problems with the environment and general repairs. We found that there was good support for people at the home and that staff were knowledgeable about the needs of people that lived there. There were good systems in place to ensure that care was provided safely and was supportive of people�s welfare.

Inspection carried out on 5 March 2012

During a routine inspection

People told us that they liked living at the New Inn. One person said they got on well with the staff. Another person said that they got on well with all the other people they lived with and was looking forward to a group holiday in April. One person said that it is a nice home and they were happy there.