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Archived: Newstead House

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Reports


Inspection carried out on 20 May 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

The people who lived in the home and their relatives told us they were pleased with the care provided. They felt that their views were respected and listened to.

People told us they felt safe. We saw that people were free to go about their daily routine. One person told us, �I feel safe here�. A relative of someone who lived in the home told us, �Eleven out of ten for care�.

We saw that there were enough staff available to meet the needs of the people being cared for.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us that they were satisfied with the care they received. They told us that the registered manager and the staff had asked them what their needs were and how they would like them met. One person said, �They asked lots of questions about what I wanted from them�.

Care records confirmed people�s needs and preferences had been recorded and care and support had been provided in accordance with their wishes.

People and their relatives were involved in the assessment of their needs. One person said, �We discussed what *** needed and it went into his plan�.

People told us staff obtained help for them if they were unwell. This meant people were supported to keep in good health, have access to health care services and received ongoing support.

We found that the staff received the support and training that enabled them to meet the needs of the people living in the home.

Is the service caring?

People we talked with told us their wishes were respected and they were able to live their lives as they wished. Staff took the time to find out about people�s background. Staff knew people�s needs well and how they wished to be cared for. This meant that staff cared about the person as an individual and were concerned about their well-being.

People and their relatives were encouraged to make their views known about their care. People that we talked with told us that they found the registered manager and the staff easy to approach about any issues they had. A relative told us, �(Registered manager) and (deputy manager) always said go to them if I had a problem and I feel I could. I could approach any of the staff�. This meant that people were listened to and they felt that their views mattered.

Is the service responsive?

People had been assessed before they moved into the home so that arrangements could be made to meet their needs.

People and their relatives told us they talked with the registered manager and the staff about what was important to them. They talked the about activities they took part in and their meals. They told us that their care packages had been changed as a result.

Is the service well led?

The management and staff demonstrated values that included involvement, compassion, dignity, respect and independence. Staff we talked with showed they understood those values as they discussed their role and responsibilities. This meant the service promoted an open culture that was centred on the individual and empowered them to take control of their life as much as they were able.

The provider had systems in place to assess and monitor the home so that potential improvements in meeting people�s care needs could be identified and put into place.

Inspection carried out on 10 January 2014

During an inspection in response to concerns

We spoke with people living at the home about their experience of the care and support that they received. People told us, "the staff are lovely and kind" and, "they can't do enough for you". Some people said that they had seen great improvements over the past year.

We found that people were generally receiving care and support which met their needs. There had been some occasions recently where people had been put at risk. The home had worked with other professionals to make sure that people were safe and that lessons had been learned.

Some staff had not had all the training they needed to do their work. Records generally provided a complete and accurate picture of the care and support provided to people living at the home. Records were stored securely and could be accessed promptly when needed.

Inspection carried out on 24 May 2013

During a routine inspection

We spent time in some of the communal areas of the home, such as the lounges, so that we could see how staff supported people. We also visited some people in their bedrooms, and spoke with them about their experience of living at the home. People told us, "they're very kind to me here" and, "I'm happy with how they look after me".

We saw that staff were kind and caring in the way that they supported people. They took time to make sure that people had all that they needed, such as a drink and their call bell. People were dressed appropriately for the time of year, and we saw that care had been taken to make sure that people looked their best.

Some people needed regular care to make sure that their skin did not develop pressure damage. Staff had recorded whenever they supported people to change position. Pressure relieving equipment was being used in accordance with the manufacturer's guidelines. This meant that staff were doing all they could to minimise the risks of people developing pressure damage to the skin.

There were effective systems in place for health and safety checks. There was evidence that people's views were used to make changes to the service. For example, people living at the home had been asked for their views about the menu options. The home had made changes to the meals provided and the way that meals were chosen as a result of people's views.

Inspection carried out on 13 November 2012

During an inspection looking at part of the service

At our previous inspections over the past year, we have had concerns about aspects of the service, which were putting people at risk of poor outcomes. At this inspection, we found that the service had made significant improvements. People were receiving a service which met their needs and protected their rights.

People told us that they were happy at the home. One person said "it's a safe place to be when you need help" and another told us "they've given me my life back, I've got so much better since being here".

Care records were detailed and accurate. They contained the information that staff needed so that people received the care and support they required. People told us that the staff were "wonderful, always so patient" and "just lovely".

People were able to choose from a nutritious and varied menu. Drinks were accessible at all times, and staff were encouraging people to drink frequently. Staff understood the importance of a balanced diet and the need for adequate hydration.

There was a clear management structure in place. We saw that effective systems were in place for monitoring the quality of the service. People told us that they knew that they could raise any concerns with the manager or her deputy. They said that they were confident that action would be taken as necessary.

Inspection carried out on 9 July 2012

During an inspection looking at part of the service

We have carried out six inspections at Newstead House since May 2011. At each inspection we have identified shortfalls which meant that the home was not complying with the essential standards of quality and safety. We have begun to see some improvements, but the pace of change has been slow.

We spent a day at the home carrying out an unannounced inspection of some aspects of the care provided for people. This included observing staff as they supported people. We spoke with six people who were living at the home, relatives who were visiting, staff and the manager. People were positive about the home. One person told us �it�s the most wonderful place I�ve been in since I got ill� and �I can�t speak highly enough about it�.

Many people stayed in their bedrooms for most of the time, so we spent time visiting people in their rooms and talking with them. Many of the people who were living at Newstead House had a dementia type illness, and so were not always able to talk to us about the care and support provided. We spent time in some of the communal areas of the home so that we could see how staff supported people.

Although some people told us that they enjoyed the food at the home, other people said �it�s not to my taste� and �I never remember what I�ve ordered�. There was a lack of meaningful choice of food for people with dementia. This was because people were asked to make their selection up to a week in advance. Kitchen staff were not aware of some people�s specialist dietary needs.

Medication was managed safely at the home. Arrangements were in place for the safe and secure storage of people�s medicines. Appropriate arrangements were in place to ensure that medicines were available and checks could be made.

There were enough staff on duty to meet people�s needs. People told us that the staff were �lovely�, �really kind� and �always willing�.

The home�s systems for monitoring the quality of the service were not effective. This meant that some risks were not identified and managed appropriately. Some records were inaccurate and inconsistent, and this could have meant that staff did not have the information they needed to provide the care that people needed.

Although the provider had not made all the improvements which were necessary in order for the home to be compliant with the Regulations, we have seen that the home had slowly improved over the past months. We have been sharing information with Herefordshire Council and the Primary Care Trust (PCT) under local multi agency procedures for protecting vulnerable adults. The PCT has carried out assurance visits to the home. The information from these visits, together with our own evidence, indicated that people were not at imminent risk of harm and that in general, outcomes for people were good. However, the shortfalls we have identified indicate a risk of poor outcomes for people. We have decided to reissue compliance actions as the most proportionate way for the home to achieve compliance with Regulations.

Inspection carried out on 6 March 2012

During an inspection looking at part of the service

We visited Newstead House to check whether the home had made the improvements we required following an inspection on 10 January 2012. We visited the home on 6 March 2012 and 2 May 2012. At these visits we found that there had been significant improvements in the way in which the home managed people�s care and welfare needs. We shall return to the home again to check that improvements have been made in other areas. This report only refers to Outcome 4: Care and welfare of people who use services.

We spoke with three people who live at the home and a relative who was visiting. We spent some of our time sitting in the lounges. This was so we could see how people spent their time and how staff provided care and support. People were positive about the staff and described staff as �approachable and discreet� and said �they really do their best and work very hard�. One person told us how pleased they were with the recent improvements. Comments included �very, very positive changes�, �it�s brilliant� and �overall, really happy now�.

Some care records contained inconsistent or misleading information. This meant that there was a risk that staff might not have the information they needed to ensure that people received care which met their needs.

Inspection carried out on 10 January 2012

During an inspection looking at part of the service

We visited the home to check if they had made the improvements which we had required them to make following a review in September 2011. We found that there had been some improvements but in some cases people were still at risk because the home was not ensuring that their needs were fully met.

We spoke with five people living at the home and some of their relatives. Most people told us that staff treated them with respect and that they felt that their privacy and dignity were promoted at the home. Staff were kind and caring in the way they spoke to people, and we saw that staff did not rush people, but allowed them as much time as they needed.

There was evidence that some people�s care needs were not being fully met at the home and this put them at risk of poor outcomes.

We saw that people had drinks in front of them, and each person had at least one jug of drink within reach. We saw that staff were encouraging people to drink, but records indicated that some people were not being given enough to drink. People were at risk of not receiving enough to eat or drink at the home, because hydration and nutrition were not managed safely.

Medication was not being managed safely at the home.

We found that staffing levels within the home had been increased and people told us that staff came quickly when they needed them. People spoke highly of most of the staff at the home, and said that they were �kind�, �always cheerful� and �good at their jobs�. The fact that some basic aspects of care, such as the safe management of a pressure ulcer, had not been addressed by the nurses was a concern. There were sufficient numbers of staff, but lack of action on the part of some staff meant that people could be at risk of not having their needs met.

People told us that they appreciated the opportunities which they had been given recently to put forward their views at meetings. The systems in place for making sure that the home was run in people�s best interests were not effective.

Inspection carried out on 22 September 2011

During an inspection looking at part of the service

We visited Newstead House to check whether the home had made the improvements which we had required following a review in July 2011. We found that some of the improvements had been carried out, but in some other key areas, there had been a deterioration in standards, which had led to people receiving an unsafe standard of care.

We spoke to some people who live at the home and some relatives whose family members live at the home. Most of the people we spoke to were not happy with the service at Newstead House. They told us about times when people�s privacy and dignity were not respected or promoted. Although people spoke highly of some of the staff, saying that they were �kind� and �very helpful when they have time�, other people told us that they felt that the staff were too busy to spend time with them.

We saw that people�s care needs were not always being met, and there was evidence that the home was not providing a safe standard of care to meet people�s assessed needs.

People were at risk of not receiving enough to eat or drink at the home, because hydration and nutrition were not being managed safely. We saw that drinks were out of people�s reach, and a relative told us that their family member was �always thirsty�.

There had been improvements in the management of infection control risks, and also in the way in which equipment was maintained and serviced.

People were at risk of not receiving their medication as prescribed, because the home was not ensuring that records were accurate and that staff completed them fully.

There were not enough staff on duty at all times to meet people�s needs in a timely manner. There was only one nurse on duty to meet the nursing needs of 32 people.

The home was not providing safe quality care and support, because the systems for monitoring the quality of the service were not effective.

Inspection carried out on 19 May 2011

During an inspection in response to concerns

People told us that Newstead House is a �nice place to live�. One person expressed satisfaction with her bedroom adding �This place is great�. People spoke highly of the staff team and of the food provided.

We observed staff throughout the time we were at the home and found them to be kind and caring.

Many of the people residing at Newstead House were not able to tell us much about their experience at the home due to their condition but those who could were happy with the care provided. Nobody told us of any concerns they have during our visit.

We found that improvements are needed in some areas including record keeping, cleanliness of commodes, the management of medication and systems to ensure equipment is maintained.