Archived: Newton House Care Home

Newton House Care Home is a residential care home which provides accommodation for up to 12 people who require personal care in one adapted building. At the time of the inspection there were 11 people living at the service, some of whom were living with dementia.

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

The provider had developed an auditing process to check the quality of service being provided. These audits enabled them to monitor all areas of the service being provided and make any necessary changes to the benefit of the people living there.

People felt safe living at Newton House Care Home and felt safe with the staff who supported them. Risks associated with people’s care had been assessed and managed. People’s medicines were handled safely, and new staff had been appropriately recruited into the service. There were overall, enough suitably trained staff to meet people’s needs. The provider's infection control procedures were followed, and lessons were learned when things went wrong to improve the service moving forward.

People’s needs had been assessed prior to them moving into the service and plans of care had been developed. Staff had the appropriate skills and knowledge to be able to meet people’s needs and they made sure people could access healthcare professionals when they needed them. People were supported to eat and drink well and staff ensured they obtained people’s consent to care.

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. People were provided with a comfortable place to live and people’s rooms were personalised.

People were treated with respect and their privacy and dignity were promoted. People were supported by kind and caring staff who involved them in decisions about their care.

People’s care was centred on them and they were supported to enjoy activities of interest. People knew who to talk to if they had a concern of any kind and felt they would be listened too. Staff had received training on how to look after a person at the end of their life, and people’s wishes were being explored.

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 19 August 2019) and there were seven 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

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Newton House Care Home is a residential care home which provides accommodation for up to 12 people who require nursing or personal care in one adapted building. At the time of the inspection there were 12 people living at the service, some of whom were living with a dementia.

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

The service was not well led. The provider failed to have sufficient oversight of the home and on-going breaches of regulations were identified. The action plan devised by the provider in response to the findings at our last inspection had not driven improvement.

Risk assessments and care plans varied in the amount of detail they contained. Action had not always been taken to mitigate known risks to people. A legionella risk assessment was not in place at the time of the inspection. Infection control procedures did not always follow best practice guidance and placed people at risk of avoidable harm.

People did not receive consistently safe care and medicines were not always managed safely. Staff had not taken appropriate action in response to incidents of a safeguarding nature. Incidents had not been reported to the relevant authorities and had not been notified to the Care Quality Commission (CQC). Accident and incidents had not been analysed to determine if there were any trends or if measures could be put in place to reduce the risk of repeat incidents.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Consent to care and treatment was not always sought in line with the principles of the MCA.

Some aspects of the environment did not always meet best practice guidance for people living with dementia. We have made a recommendation about this.

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.

Safe recruitment procedures were not followed. This placed people at risk of harm as the provider had not carried out a robust assessment of each individual employee prior to them commencing employment. We observed staff to treat people in a dignified manner and people and their relatives told us staff were caring, supportive and kind.

People had access to a range of health and social care professionals to support them. An activity co-ordinator was in post. However, there was a lack of meaningful activities for people who were nursed in bed.

Staff told us they felt supported by the provider and deputy manager. However, supervision records did not demonstrate staff competency was assessed by the management team. Training records did not demonstrate staff had completed all the relevant training deemed mandatory by the provider and training for conditions specific to individuals had not been provided.

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

Rating at the last inspection and update

The service was rated as requires improvement (the report was published in May 2018) and there were breaches of regulation. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

Enforcement

At this inspection we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to staffing, the need for consent, safe care and treatment, safeguarding, good governance, fit and proper persons employed and failure to display performance ratings. Please see the action we have told the provider to take at the end of this report. We also identified one breach of the Care Quality Commission (Registration) Regulations 2009. Notification of other incident. We are following this up outside of the inspection process and will report on any action once it is complete.

Follow up

We will meet with the provider following the publication of this report to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home had an owner who was also the registered manager. 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 we rated the service ‘Good’, with the well led domain rated as requires improvement, at this inspection we saw improvements had not been made and the safe domain also required improvement. This is the first time the service has been rated requires improvement.

The provider did not always notify us of events which reflected when people were at risk of harm. Audits had not been consistently completed and when audits had been done it was unclear if the actions had been followed up and the improvements made.

Medicines had been managed safety; however some documentation was not available to provide information to support people who had ‘as required’ medicine. During the day there were enough staff to support people’s needs, however during the night there was concern in relation to meeting people’s increased needs and we could not be sure there was enough staff throughout the night time. .

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were able to make their preferences known, which had been documented in the care records. People were encouraged to make choices about how they spent their day. There was a complaints procedure and people felt able to raise any concerns.

People had established relationships with staff and felt cared for. People told us staff treated them with dignity and respect. Relationships and friendship that were important to people were maintained. People were protected from the risk of infection and staff understood the precautions to take in using protective wear.

Risk assessments had been completed and guidance provided. The provider ensured appropriate checks before people worked at the service. The fire procedures had been completed and each person had their own evacuation plan. People were able to personalise their space and people felt the home had a friendly feel.

We saw people had a choice of food and when required support and advice around health and nutrition had been considered. Support from health professionals was requested and available when needed. We saw that the previous rating was displayed in the reception of the home and on the website as required.

Staff felt supported and had been able get involved in projects to develop their knowledge. This had resulted in the home receiving some awards and praise from health care professionals

We found breaches 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.

The service had a registered manager in place at the time of our 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.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff listened to them and cared about the individual they were supporting. People were supported to maintain and develop their hobbies and interests. There was a complaints process for people to follow and people knew how to raise concerns.

The systems designed to monitor the quality of the service were not fully effective. People were involved in giving their views on how the service was run and lived in an open and inclusive environment.

We found people gave consent to their care. A person who used the service told us, 'I think we have our own lives here, we say how we want it.' People were provided with a varied and nutritional diet. A person told us, 'There is a good variety, you can't please everyone all the time, but they please me most of the time.' We saw people were regularly offered and given drinks throughout our visit.

We found that suitable arrangements were in place to manage people's medication and ensure they received any medication they needed. We found there were sufficient staff to meet people's needs and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, 'Our staff are very good, you can go to them anytime and they will always talk to you.'

People told us that they had enough information to tell them about what the home provided when they moved in. They also said they could express themselves in the way they wished and were encouraged to make their own choices.

When we asked people about the individual support they received one person told us that, "I know that I have a care plan. I know it contains my picture and important information about my personal needs. This helps them (staff) provide the care I need."

People said they felt safe living at the home. They told they were confident that staff had the right skills and experience for the job and that they were honest and trustworthy. One person said, 'I really think they (staff) go out of their way to make sure it is a safe place to live.'

We found that people and staff felt confident taking any suggestions or concerns to the deputy manager and the manager. A relative of one person told us that, "I find the manager and staff approachable and they listen to us if we need to check on anything, which is great."