Newline Care Home

Whole home testing was taking place with both people and staff being part of this regular programme of testing. We observed staff consistently wearing PPE appropriately throughout the premises. Designated areas were set aside for staff to be able to change in and out of their uniform to reduce the possibility of spreading infection in the home. Staff were knowledgeable around their infection control responsibilities as they had received training and guidance.

A robust system for managing visitors was in place. They were required to undertake a COVID test, wear appropriate PPE, have their temperature checked and sign into a track and trace system. Various ways of visiting were available and included visits inside the home, access to a visiting pod and a gazebo had been set up outside the home for outdoors visits. There was ample infection control signage around the home providing information for both visitors and staff to follow. Where visitors were unable to get to the home, video technology was used effectively to keep relatives and their loved ones in contact.

The premises were clean and hygienic and well ventilated. Spot checks of the laundry and bedrooms were taking place. The provider had an infection control policy and had completed regular infection control audits. People had a COVID-19 risk assessment and care plan. Additional hours for domestic staff had been introduced during the pandemic. Staff were aware of the importance of cleaning frequent touch points such as door handles, handrails and switches.

The provider had been pro-active in contacting various agencies to ensure they were always following good infection control practice. For example, the housekeeper attended fortnightly meetings with the local authority infection control team. The business support manager was part of a network of care services in the area which discussed updated infection control guidance and shared good practice.

Newline 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 we looked at both during this inspection. Newline accommodates 28 people in one adapted building. .

At the last inspection in November 2016, the provider was in breach of three regulations. These related to person centred care (Regulation 9), safe care and treatment (Regulation 12) and good governance (Regulation 17). Following that inspection the provider send us an action plan which showed what they would do to improve the key questions of safe, effective, responsive and well led to at least ‘good’. During this inspection, we found the provider had made the required improvements and there were no breaches of regulation.

There was a registered manager in place. 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 told us they felt safe. Staff knew how to recognise and report any concerns about people’s safety and welfare. The registered manager followed the correct safeguarding procedures.

There were enough staff and all the required checks were done before new staff started work. This helped to protect people. Staff were trained and supported and this helped to make sure they had the right skills and knowledge to support people.

Risks to people’s health, safety and welfare were identified and managed.

People received their medicines as prescribed.

The home was clean and safe. The provider had a refurbishment plan in place. People who used the service and relatives had been asked for ideas and suggestions about changes to the make the home more ‘dementia friendly’.

People’s needs were assessed before they moved in and this information was used to develop individual plans of care. People’s care plans had information about their needs and preferences. People were supported to plan for how they wanted to be cared for at the end of life.

People were supported to meet their nutritional needs and to have a varied diet.

People’s rights were promoted and protected and staff had an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.

Staff worked well with other health and social care professionals to make sure people received effective care and treatment. People had access to the full range of NHS services.

Staff supported people with kindness and compassion. People were treated with respect and encouraged to maintain their independence. Staff knew people well and supported people to make decisions about their care and treatment.

The service offered a range of social activities inside and outside the home.

People knew how to make a complaint if they needed to but none of the people we spoke with had any need to complain.

There were systems in place to check the quality and safety of the service and the provider was continuously looking at ways to improve the service. People who used the service, relatives and staff told us the registered manager was approachable and supportive.

The home had a 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.

Newline Care Home provides care and accommodation for up to 28 older people and / or older people living with a dementia. People are accommodated over two floors and there are 22 bedrooms for single occupancy and three double bedrooms. The service is close to pubs, shops, supermarkets and restaurants. At the time of the inspection there were a total of 27 people who used the service.

Risks assessments for people who used the service were insufficiently detailed. This meant that staff did not have the written guidance they needed to help people to remain safe. Care plans were insufficiently detailed to ensure that care needs were met. Care plans and risk assessments had not been reviewed and updated on a regular basis.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. Audits were minimal and infrequent and did not identify the concerns we identified at the inspection of the service. The accident audit did not check for any patterns or trends, which would enable measures to be put in place and avoid re-occurrence.

Personal emergency evacuation plans were not in place for people who used the service. This meant that staff and emergency services did not have written guidance about how they can ensure an individual’s safe evacuation from the premises in the event of an emergency.

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. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. People subject to DoLS had this recorded in their care records. However, mental capacity assessments were not decision specific. Best interest decisions were not recorded in care plans.

Improvement was needed in the management of medicines to ensure people got their medicines as prescribed. The temperature of the room in which medicines were stored was not recorded. People were prescribed medicines on an ‘as required’ basis, however 'as required' guidelines had not been written for these.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We saw records to confirm water temperature of baths, showers and hand wash basins were taken and recorded on a regular basis to make sure they were within safe limits. We saw that on occasions the water temperatures were set too high at 45 degrees Celsius. If hot water for showering or bathing is above 44 degrees Celsius there is an increased risk of injury. We pointed this out to the registered manager who has told us they have since taken action to reduce the water temperatures.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. There were some gaps in training for Safeguarding, the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards, however the registered manager had identified this and arranged additional training sessions for October and November 2016. Staff had received supervision and had completed a self assessment of their own performance in preparation for their annual appraisal.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People’s independence was encouraged. Activities, outings and social occasions were organised for people who used the service.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

The service has recently been accredited with the Gold Standards Framework, which is a national training and end of life accreditation programme. This meant the service was committed to ensuring people and their family were supported well at the end of life.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.