Archived: The Newlyn Residential Home

The Newlyn Residential Home provides the regulated activity accommodation for persons who require personal care to up to 13 people. The service provides support to older people, people living with dementia or a sensory impairment and people with a physical disability. At the time of our inspection there were six people using the service. The service is a large, converted property. Accommodation is arranged over two floors and there is a stair lift to assist people to get to the upper floor.

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

There was a lack of strong leadership at the service and despite a reduced number of people living at the service and the support of a manager, the provider had failed to make the required improvements to the service in the six months since our last inspection. Shortfalls at the service continued to place people at risk of harm.

The provider did not have a clear vision for the service or set of values for staff to work to. Checks had not been completed on some high risk areas of the service, such as diabetes care. Audits of the quality of other parts of the service had not identified the shortfalls we found. Robust systems were not in operation to gather and act on the views of people, relatives staff and other stakeholders. Where people had shared their views, these had not been used to improve the service. The provider did not have a detailed action plan in place to drive improvements and had relied on visiting professionals to identity shortfalls and guide them in how to address these.

People continued to be at risk because hazards to them had not been assessed and mitigated. Where risks had been identified action had not been consistently planned to protect them from harm. There was a lack of guidance of staff about how to keep people as safe and well as possible.

The management of medicines had improved, however further improvements were required. Medicines were not always returned safely and some medicines had not been returned. Again, we found medicines were not always stored at a safe temperature and there was a risk they would not be effective. Guidance was not in place around how to administer some when required medicines.

Effective systems were not in place to learn lessons when things went wrong. Accidents had been recorded and analysed. However, action had not been taken to reduce the risk of accidents happening again and they continued.

Staff deployment was not based on people’s needs and there were times when only one staff member was available to support people. Some staff had not completed practical training in core skills such as first aid and moving and handling and the provider had not assured themselves staff had the skills, they needed to keep people safe. Staff recruitment had improved, and the required checks of staff conduct and character had been completed.

Action had been taken to reduce the risk to people of the spread of infections including Covid-19. We observed staff were wearing masks correctly. People were supported to see visitors when and where they wanted. Staff knew how to identify safeguarding risks and the provider had reported any concerns to the local authority safeguarding team for their consideration.

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.

Following our inspection the provider closed the service.

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 inadequate (published 13 January 2022). 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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 14 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve medicines management, safe care and treatment, staff recruitment, learning lessons, infection prevention and control, records, checks and audits and obtaining and acting on feedback.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Newlyn Residential Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, medicines management, learning lessons, staff deployment, checks and audits, records and acting on feedback at this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The Newlyn Residential Home was providing personal care to 11 people aged 65 and over at the time of the inspection. The service can support up to 13 people in one adapted building.

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

People told us they felt happy and safe living at The Newlyn Residential Home. However, we found the service was not well led and people were at risk of harm. The provider was working shifts at times this had taken them away from leadership tasks. They did not have a good oversight of the service, checks and audits had not been completed and shortfalls had gone unnoticed. A manager had been appointed shortly before our inspection to support the provider.

People’s medicines were not managed safely. Medicines had not always been stored, administered or disposed of safely. Care had not been planned to keep people as safe as possible. Some risks had not been identified and guidance had not been provided to staff about other risks. Accidents and incidents had not been kept under review to identify any patterns or trends. Records of people’s care were not always complete.

Staff had not been recruited safely. Some important checks had not been completed and the provider was unaware of staff’s practice in some previous social care roles. There were enough staff on duty to meet people’s needs but frequent staff absences put pressure on other staff and the provider who were busy and tired.

People were not always protected from the risk of the spread of infection. We found staff were not following national guidance around the correct wearing of face masks and this increased risks to people.

People, their relatives and staff were not fully involved in what happened at the service. Views obtained through surveys had not been analysed and used to improve the service. Staff meetings were not held often to keep staff informed of any changes and gather their feedback. However, people and their relatives told us they were confident to raise any concerns with the provider and these had been addressed. People’s relatives told us they were kept informed about any changes in their loved ones health and wellbeing.

People were protected from the risk of abuse. Staff knew how to recognise the signs of abuse and were confident to raise concerns with the provider or blow the whistle outside of the home. Staff felt supported and appreciated by the provider. They had a shared goal of providing dignified and respectful care to people while maintaining their independence.

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 25 December 2020) and there were three 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to infection control procedures, recruitment processes, staff deployment and care planning. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of risks to people, safe medicines management, staff recruitment, infection control, obtaining and acting on people’s views and ineffective checks and audits and incomplete records at this inspection.

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.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The Newlyn Residential Home was providing personal care to 10 people aged 65 and over at the time of the inspection. The service can support up to 13 people in one adapted building.

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

People told us they felt safe at the service and were comfortable and content. One person described The Newlyn as, “A home from home”. The manager had developed a person-centred culture and people received care and support to meet their individual needs and preferences.

Staff had not been recruited safely and this posed a continued risk to people using the service. Following our inspection, the provider took action to address the shortfalls.

People’s needs had been assessed and care had been planned with them. People’s care plans and risk assessments had been reviewed and rewritten. Most reflected people’s needs but some were not up to date. This had not impacted on people’s care because staff knew people well.

Medicines management had improved and medicines were now stored and administered safely. Records in relation to some medicines had not been maintained and this posed a risk to people.

People were protected from the risk of abuse. Staff knew how to identify risks and were confident to raise any concerns with the manager and provider. Any concerns had been shared with the local authority safeguarding team so they could be investigated.

Staff supported people to remain as healthy as possible. People told us they enjoyed the food at The Newlyn and were involved in planning the menus. Meals reflected people’s needs and preferences.

The culture in the staff team had improved. Staff were motivated, felt supported and worked as a team. They now met regularly with the manager to discuss their role and completed regular training.

People, staff and professionals had been asked for their feedback on the service and this had been positive. People were supported to share their views and make suggestions and these were acted on. They were confident to raise any concerns they had and these were acted on. The manager and provider worked with others to share opportunities, best practice and learning experiences.

The service was clean and the risks of Covid 19 were managed. The layout of the building had been designed to meet people’s needs. Checks on the building were completed to make sure it remained safe.

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.

Accidents and incidents were analysed to check for any patterns and trends.

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 18 December 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. At this inspection some improvement had been made but the provider was still in breach of three regulations. The service remains rated requires improvement.

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Newlyn Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe staff recruitment, medicines and care records and some checks and audits at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published 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 Newlyn Residential Home is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 13 people.

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

People’s views of the service varied, some people told us staff were caring and they were happy at the service. Other people were not completely satisfied with the care they received. One person told us, “It is so variable. You have the understanding type (of staff) and some that don’t have the natural instinct to do the job”. We found leadership at the service was poor and staff had not been supported to provide consistently safe and effective care. We did not find harm had come to people but people were at risk.

The provider did not have oversight of the service. They were not working at the service at the time of our inspection. Regular comprehensive checks had not been completed on the quality of the service. The provider was unaware of the shortfalls we found at the service and they had continued.

The provider was isolated and had not taken up opportunities to develop themselves and the service. They understood their legal responsibilities but had not ensured we were notified of significant events that happened at the service. People and staff had not been asked for their views, some staff felt they were not listened to.

People’s medicines were not managed safely. Guidance was not available to staff about some medicines. Medicines records were incomplete.

Risks to people had not been fully assessed. Some risk assessments were the same for everyone and did not reflect people’s individual needs and wishes. Risk relating to people falling or developing pressure ulcers had not been assessed.

People were not protected from the risk of fire as some staff were not confident to use evacuation equipment and equipment was not checked regularly. Processes were not in operation to learn lessons when things went wrong.

People were not fully protected from the risks of harm and abuse because some staff did not know how to raise concerns to authorities outside of the service. There was a risk people who choose to remain in their bedroom were isolated. Robust assessments of people’s needs had not been completed and used to plan their care.

Staff had not been trained to provider oral hygiene care. Guidance was not in place for staff and people did not see a dentist regularly. Guidance was not in place about everyone’s health care needs. Staff promptly contacted healthcare professionals when people’s needs changed.

Staff were not recruited safely and did not complete a comprehensive induction. Staff had not been supported to develop all the skills they needed. There were enough staff to meet people’s needs.

People were not always referred to respectfully. They had not been asked about their lifestyle and equality needs and choices so they could be understood and respected. We have made a recommendation about person centred care, communication, occupation and risk assessments.

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.

People had privacy but were not always referred to in respectful ways. Information had not been obtained about people’s equality and diversity needs to ensure they were supported in respectful ways.

People had not been offered the opportunity to discuss their end of life preferences. Some people did not know how to complain about the service. One person’s complaint had not been resolved.

People were supported to eat and drink enough.

The service was clean and people were protected from the risk of infection. The environment had been designed to meet people’s needs.

People were supported to remain independent and were involved in caring for pets. Staff treated people with caring and compassion

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 good (published 25 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to governance and leadership, staff development and support, medicines, person centred care, complaints handling, recruitment and notification of significant events at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published 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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Newlyn Residential Home is a care home for older people who require residential care. It is registered for 13 people. On the day of the inspection there were 10 people living at the service. The service, in a residential area of Ramsgate, provides residential accommodation and communal areas over three floors. Some bedrooms have en-suite bathrooms, with shared bathrooms and toilets for the rest of the rooms. The service is run by the registered provider and a manager. Both were present on the day of the inspection. The registered provider is a ‘registered person’ who has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This was the first inspection of this service under this provider.

People were protected from the risks of abuse, discrimination and avoidable harm. Risks to people were assessed and there was guidance for staff on how to reduce risks. People said they felt safe living at the service. Staff were confident that any concerns raised would be investigated to ensure people were kept safe. They knew how to whistle blow and take concerns to agencies outside of the service.

Recruitment processes were followed to make sure staff employed were of good character. There were sufficient staff on each shift and this was regularly reviewed by the provider. There were contingency plans to cover a shortage of staff in an emergency.

People received their medicines safely and on time. Medicines were stored, managed and disposed of safely and in line with guidance. The management team worked closely with their local pharmacist.

People received effective care from staff who had the knowledge and skills to carry out their roles.

The provider was aware that some staff were due to refresh their training, as their training had lapsed, and courses were booked as needed to meet this. Staff were knowledgeable and were able to tell us how they put their training into practice.

Staff knew the importance of giving people choices and gaining people’s consent. Staff understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications for DoLS had been made in line with guidance.

People were offered a choice of healthy meals. People’s comments about the food were all positive. Staff monitored people’s weights to make sure they remained as healthy as possible. People were supported to maintain good health and were referred to health professionals when needed. People told us that staff helped them with appointments to see the doctor and other health professionals and that they were well supported with their health needs.

People told us they were treated with kindness, compassion, dignity and respect. Their privacy and dignity were respected. Staff knew people well and spoke with them in a patient, kind, and caring way.

People’s confidentiality was respected and their records were stored securely. Staff understood that it was their responsibility to ensure confidential information was treated appropriately and with respect to retain people’s trust and confidence.

People and their relatives were involved in planning their care and support. People received care and support that was individual to them and their needs and preferences. The provider had identified shortfalls with the care plans and sought advice from the relevant health professionals. They were following this guidance and developing new, more detailed care plans. This did not have an impact on people as staff knew people and their needs and preferences very well.

People told us they were supported to follow their interests and take part in meaningful social activities. An activities person attended the service five days a week and people said how much they enjoyed this.

People knew how to complain or raise concerns and were confident they would be listened to by the provider. The provider had a complaints policy and procedure, a copy was given to each person at the service.

The management team worked with staff each day and encouraged an open and transparent culture. Staff had confidence in the management team. People, their relatives, staff and health professionals were encouraged to feedback any ideas to aid developing the service.

Regular and effective audits were completed. Action was taken when shortfalls were identified. Notifications had been submitted to CQC in line with guidance.