Newlands Hall

Newlands Hall is a residential care home providing nursing or personal care to up to 30 people, some of whom are living with dementia. The home has communal living areas on the ground floor and bedrooms are located on the ground and first floor. At the time of our inspection there were 22 people using the service.

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

Improvements were required in how the service assessed and managed risk to ensure risks were monitored or managed in relation to people's health and wellbeing. Staff were not consistently recording when they had met a person's care needs such as postural changes, oral care and personal hygiene needs. This meant the service was not able to evidence care had been provided on each occasion or that an accurate record was maintained.

Medicines were not always administered as prescribed and records did not always reflect the medicines received by people. People at risk of sore skin did not receive their topical medicines as prescribed.

Staff had been recruited safely and had received an induction into the service. Staff received training and supervision to ensure they were equipped for their roles. However, some induction training records had not been 'signed-off' by staff to verify that induction had been completed. Staff we spoke with were knowledgeable and were supported by the home manager.

People and their relatives felt they were safe and well cared for by staff. They told us their needs were met and they were able to make choices about their care. People were observed to be treated with respect and kindness.

Infection control processes were not always effective in minimising the risk of infection. We observed a clinical waste bag not properly disposed of and left unattended in a bathroom.

People had access to a balanced and healthy diet. People told us they enjoyed the meals provided by the home and they were offered choice of food options. Records were not always completed to show people at risk of poor nutrition were being supported to eat and drink.

People were encouraged to participate in different activities and spoke highly of the activities coordinator. Formal complaints were reviewed and responded to in line with company policy. People were supported to access healthcare professionals when required.

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.

The provider had updated their quality assurance monitoring procedures. Audits and checks were carried out; however, these were not always effective in identifying areas which needed to be improved. Further improvements were required to ensure these were robust and effective so that areas for improvement were identified and addressed.

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 requires improvement (published 22 October 2019). The service remains rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

This report only covers our findings in relation to the Key questions Safe, Effective and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Newlands Hall on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified 2 breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report

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.

Newlands Hall 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. Newlands Hall provides accommodation for up to

30 older people, some of whom are living with dementia. The home has communal living areas on the

ground floor and bedrooms are located on the ground and first floor. There were 29 people living at the service.

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

Some improvements were required in how the service assessed and managed risk, as some risks assessments were detailed but others required more information ensure the necessary risk reduction measures were in place.

Medicine management procedures were in place. Staff were appropriately trained and had their competency levels checked.

The home was a converted home, with many original features which posed some difficulties in terms of accessibility and infection control. The service was working to an action plan to improve the control of infection and there was a refurbishment plan in place to upgrade some areas of the home.

Staff had been recruited safely and received an induction into the service. Ongoing training was provided to help staff to develop but there were areas of care staff required training to ensure their skills were updated.

People told us they liked the food and were offered choice of food options. They were supported to eat and drink to maintain their wellbeing.

The home had referred people who had restrictions on their liberty to the relevant authorities. 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 and their relatives spoke highly of staff at the service who they described as caring and compassionate. They reported the homely environment and feel of the service.

Improvements had been made to care records and people’s care files. Activities were on offer to people at the home and an activities coordinator was employed to lead this area of care.

Improvements were found in the management and leadership of the home. These were ongoing at the time of the inspection, with the registering manager prioritising the areas we were most concerned with at our last inspection. Plans were in place to continue improving the quality of the service provided.

Rating at last inspection and update: The last rating for this service was inadequate (published 16 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been in Special Measures since the last inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

Newlands Hall 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. Newlands Hall provides accommodation for up to 30 older people, some of whom are living with dementia. The home has communal living areas on the ground floor and bedrooms are located on the ground and first floor. There were 29 people were living at the home on both days of the inspection.

The service had 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 but we found some aspects of the service needed to be improved to ensure people were safe.

The manager was in the process of reviewing and updating peoples care records. However, we found many of the records we looked at were not reflective of people’s current care needs. Care plans for end of life care wishes were not always completed. Where people needed staffs support with moving and handling, records were not always an accurate reflection of current need and did not always provide a sufficient level of detail.

Records of people's food and fluid intake were not always completed and did not evidence they were provided with the appropriate consistency of diet and fluids people had been assessed as needing. However, feedback about the meals at the home was positive.

There were sufficient numbers of staff on duty but safe recruitment procedures needed to be followed. New staff received induction. There was a programme of supervision in place for all staff but not all staff training was up to date.

Medicines were stored safely and administered in a caring manner. Where people were prescribed creams and “as required” medicines, improvements were needed to ensure they were administered in a safe and consistent way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, records did not evidence the service was complaint with the Mental Capacity Act 2005.

People were enabled to access other health care professionals as their needs changed.

People were protected from the risk of infection.

People were treated with kindness. Staff respected people’s right to privacy and maintained their dignity. People spoke positively about the activities provided for them to engage in.

There were systems in place to gather feedback about the service people received. Feedback from people who lived at the home and visitors was without exception, positive. Where a complaint was raised, this was dealt with, although we did not see information on how to complain visible within the home.

The registered provider had a range of audits which the manager and senior care worker completed at regular intervals. However, these had not been effective in identifying where improvements need to be made or action to be taken. Where matters were identified, there was not always evidence the issues had been addressed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014, related with safe care and treatment, nutrition and hydration, staff training and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection of Newlands Hall took place on 15 and 18 January 2018. We previously inspected the service on 14 and 19 June 2017; at that time we found the registered provider was not meeting the regulations relating to consent, safe care and treatment, staff recruitment, supporting staff and good governance. We rated them as inadequate and placed the home in special measures. Following this inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions; Safe, Effective, Responsive and Well-led to at least good. The purpose of this inspection was to see if significant improvements had been made and to review the quality of the service currently being provided for people.

Newlands Hall 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. Newlands Hall provides accommodation for up to 30 older people, some of whom are living with dementia. The home has communal living areas on the ground floor and bedrooms are located on the ground and first floor. There were 28 people were living at the home on both days of the inspection.

At the time of our inspection a registered manager was in post. 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 living at Newlands Hall. People said there were sufficient staff on duty to meet their needs and we found staff recruitment procedures to be safe.

Improvements had been since the last inspection regarding risk assessments although some records lacked sufficient detail regarding the hoist and slings to be used. People had a Personal Emergency Evacuation Plan in place although where people were not independently mobile, the equipment required to enable staff to evacuate them was not recorded. External contractors were used to service equipment and we saw regular internal checks were completed on the fire alarm system.

Medicines were stored safely and records evidenced people had received their medicines as prescribed. Staff who were responsible for administering people’s medicines had received training and an assessment of their competency.

Staff received induction, on-going training and supervision although we noted some supervision were not always for the purpose of enabling staff to raise concerns, reflect on practice and discuss areas of future development.

People were complimentary about the meals. Lunchtime was relaxed with staff supporting people to make choices and regarding the meals they were served. Improvements had been made to staffs recording of people’s diet and fluid intake but further work was needed to ensure adequate details were consistently recorded.

Staff communicated well as a team and we saw people had access to other healthcare professionals as the need arose.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had received training in the principles of the Mental Capacity Act 2005 and we saw staff encourage people to make choices and decisions regarding their lives. However, the requirements of the Mental Capacity Act had not been met as assessments of capacity pertaining to specific decisions were not always completed. A record of consent was not evident in all the care files we reviewed.

People were treated with kindness, relationships between staff and people who lived at the home were friendly, relaxed but professional. Staff were respectful of people’s individuality, people’s privacy, dignity and independence were respected and information was stored confidentially.

There were a range of activities provided for people to participate in as well as trips out.

Care plans were person-centred and contained information to enable staff to provide deliver peoples care. Although we identified one care plan which did not provide relevant information regarding a person’s particular preferences.

People did not raise any complaints with us but said they would be happy to raise a complaint if they were not happy with the care provided.. The registered manager told us they had not received any complaints since our last inspection.

The registered manager was aware of how to access relevant support and advice from other healthcare professionals as a person entered their final days. However, advance care plans were not in the care plans we reviewed. We have made a recommendation in regard to end of life care planning and record keeping.

Since the last inspection the registered manager had received support and mentorship from an operations manager. Audits had been completed on a regular basis and a new system of governance was being implemented. An action plan instigated by the registered provider documented the progress the home was making in achieving regulatory compliance.

Regular meetings had been held with staff and people who lived at the home.

This service had been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, we found a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 regarding safe care and treatment, consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Newlands Hall provides accommodation for up to 30 older people, some of whom are living with dementia. The home has communal living areas on the ground floor and bedrooms are located on the ground and first floor. There were 27 people were living at the home on both days of the inspection.

The service had 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.

During this inspection, we identified there were breaches to regulations related to people’s safe care and treatment, recruitment of staff, staffing, consent to care, records and good governance.

People told us they felt safe however, we found aspects of the service were not safe.

We could not evidence all staff had attended a fire drill. Internal checks on the fire system did not include ensuring the fire alarm would be activated in the event a fire alarm point was pressed. The registered manager did not check fire doors closed effectively and means of escape were accessible.

Where people needed assistance with aspects of their mobility, their records did not contain sufficient information. There was no information within the care plan for a person who had experienced a number of falls, as to how staff were to assist them to get up from the floor. We observed two occasions where staff attempted to use poor moving and handling practices with people.

The system to ensure repairs and maintenance issues were reported and addressed in a timely manner was not effective.

When we checked people’s medicines we found stock balances tallied with the number of recorded administrations and there was a system in place to manage controlled drugs and variable dose medicines. Staff had not consulted with a pharmacist to ensure a person whose tablets were crushed, received them safely.

We could not evidence all relevant staff had received medicines training and there was no system in place to ensure relevant staff had been assessed as competent to administer people’s medicines.

When we reviewed staff recruitment records we found one staff member did not have a reference from their most recent employment and interview records were not always completed in full.

Induction records were incomplete for one member of staff and there was no record of induction in the second staff file. We reviewed the supervision records for four staff and found they had not received regular management supervision to monitor their performance and development needs. Two of the files we reviewed contained no evidence of supervision.

The home was not compliant with the requirements of the Mental Capacity Act 2005. A care plan contained a generic capacity assessment with no evidence of best interest decision making. A person who received their medicines covertly did not have a capacity assessment in place regarding this decision and there was no evidence other relevant people had been involved in the decisions making process to ensure it was in the persons best interests.

There were eight people who lived at the home who were subject to a Deprivation of Liberty Safeguards (DoLS) authorisation.

People spoke positively about the meals at Newlands Hall and the cook was knowledgeable about people preferences and needs. At lunchtime people were provided with a choice of meal and people were supported by staff in a timely manner.

People told us, and we saw evidence in people’s care records, that they received input from external health care professionals.

Everyone we spoke with told us they were happy with the care provided at Newlands Hall. We saw staff encouraging people to make choices about their daily lives, for example, what to eat and drink. We also saw people were encouraged to be independent where possible, for example, using eating aids to enable them to eat without staff assistance. Staff were able to tell us how they maintained people’s dignity and privacy. The care plans we looked at contained a care plan review form, although they had been completed. We were unable to establish if they had been completed by the person or their relative.

The home had a dedicated activity co-coordinator who was enthusiastic about their role. People told us there was a range of activities provided.

Care plans were written about the needs of each individual but they were not always an accurate reflection of people’s needs. Some records were not an accurate reflection of the time people’s care and support was provided to them.

People we spoke with had not raised any complaints, but told us if they were dissatisfied they would speak with the staff or the registered manager.

The systems of auditing and governance were ineffective. Concerns raised as part of this inspection had not always been identified as part of the registered providers governance process and where issues were identified the method for ensuring they were addressed in a timely manner and to the required standard was inadequate.

Policies were not all relevant to Newlands Hall and gave incorrect information and guidance.

Although meetings were held with people who used the service, we were unable to establish with the registered manager or from the quality visit reports, if surveys of people, families or relevant health care professionals had been done.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post. 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.

Newlands Hall was previously registered to another provider. A new provider, Regency Health Care, had taken over the service in 2015.

Building work was ongoing at the time of our inspection, to improve the premises for people. Risk assessments were in place but these were not always clearly illustrated for people.

Staffing levels were appropriate for people’s needs and staff were suitably trained and felt confident in their roles and responsibilities.

The safe management and recording of medicines was not robustly in place.

Staff understood the legislation around Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although documentation relating to this was inconsistent.

People enjoyed the food and the dining experience was sociable and pleasant, although nutritional assessments were not consistently well completed.

Staff demonstrated a friendly, caring approach and there was a happy atmosphere in the home. Staff knew people well and used this knowledge to develop caring relationships.

Care records contained regular updates of information about people’s needs, although sometimes this was contradictory and unclear.

People had opportunities to engage in social activities, although not everybody said they enjoyed these. There were activities staff who had knowledge of people’s social histories and preferences.

There was visible management of the service and an open door policy for staff, people and visitors to approach the registered manager at any time. Staff said morale was high and there was effective teamwork in place to meet people’s needs.

Some quality assurance systems were in place although these were gaps in audits of key aspects of people’s care and support.

You can see what action we told the provider to take at the back of the full version of the report