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Newport Residential Care Limited Good

The provider of this service changed - see old profile

We are carrying out a review of quality at Newport Residential Care Limited. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 25 April 2017

During a routine inspection

This inspection took place on 25 and 26 April 2017 and was unannounced. The home provides accommodation for up to 31 people, most of whom had mental health care needs. There were 31 people living at the home when we visited.

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.

The home was split into two inter-connecting units. Previously, support staff in the main part of the home supported younger adults with mental health care needs and care staff in the lower part of the home supported older adults, some of whom were living with dementia. The provider had recently taken the decision to focus entirely on accommodating younger adults with mental health needs. As vacancies arose, these were gradually being filled by people with mental health needs. At the time of our inspection, only three older people living with dementia were still being accommodated.

At our last inspection, in October 2015, we identified breaches of two regulations. Risks to people were not always managed appropriately; medicines were not always managed safely; and legislation designed to protect people’s rights was not always followed.

At this inspection we found action had been taken and there were no longer any breaches of regulation; however, some further improvement was still needed to help ensure people’s safety. The service had created new systems to gather additional information from external agencies about potential risks to people before they moved to the home. However, the information was not always accurate and staff had not made further enquiries to clarify inconsistencies. This meant the risk assessments were not always effective.

Other aspects of risk management were effective. Staff understood the factors that put people at risk of harm and people were involved in discussions about risk. A new fire alarm system had been installed to make it easier for staff to identify the source of a fire and this had reduced evacuation times during fire drills.

Medicines were managed safely and systems were in place to help ensure people received their medicines as prescribed. Staff knew how to protect people from the risk of abuse. There were enough staff to meet people’s needs and safe recruitment processes were followed.

People’s needs were met by staff who were trained and appropriately supported in their role. They were particularly skilled at supporting people with complex mental health needs and followed legislation designed to protect people’s rights.

People praised the standard of care and the level of support their received. They enjoyed the meals and said their dietary needs were met. When people needed support to eat, they received this in a dignified and supportive way. People were supported to access healthcare services when needed and to attend hospital appointments.

People were cared for with kindness and compassion. Staff created a calm atmosphere and interacted with people in a positive, supportive way. They spoke about people warmly and demonstrated a detailed knowledge of them as individuals.

Staff encouraged people to remain as independent as possible. They respected their privacy and dignity. They involved then in decisions about the care and support they received.

People were encouraged to make choices about every aspect of their daily lives. They received personalised care and support that met their needs. Staff understood the signs that could indicate a person’s mental health was deteriorating and responded promptly by providing additional support.

Care plans provided staff with detailed information about how they should support people in an individualised way and were reviewed regularly. For peopl

Inspection carried out on 29 & 30 October 2015

During a routine inspection

This inspection took place on 29 and 30 October 2015 and was unannounced. The home provides accommodation for up to 31 people, including people living with dementia and mental health care needs. There were 30 people living at the home when we visited.

At the time of our inspection the manager had applied to be registered with CQC and their application was being processed. 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.

The home was split into two inter-connecting units. Support staff in the main part of the home supported younger adults with mental health care needs; care staff in the newer part of the home supported older adults, some of whom were living with dementia or had mental health care needs.

Risks to people living in the unit caring for younger adults were not always assessed and managed effectively as staff did not always have sufficient information about them. Individual risk assessments had not been completed for all people who smoked.

Arrangements to manage medicines safely were not robust. This meant it was not easy for staff to account for all medicines and medicine administration records were not always accurate. In some cases, there was a lack of information about when staff should administer ‘as required’ medicines.

Decisions taken on behalf of people in the unit caring for older people were not always documented in accordance with legislation designed to protect people’s rights. However, staff were following the legislation that protected the liberty of people living at the home.

People living in the unit for younger adults were required to comply with a set of house rules, which included agreeing to daily room checks. These were not conducted on the basis of risk, so could compromise people’s right to privacy. However, people were treated with dignity and respect at all times.

People were involved in assessing, planning and agreeing the care and support they received. Whilst some care plans were personalised and detailed people’s individual needs, the care plans for people with mental health care needs sometimes lacked information about people’s goals or objectives.

The manager conducted a range of audits on a monthly basis to assess, monitor and improve the quality of service provided. Where improvements were identified, prompt action was taken. However, the systems were not robust as they had not identified that some care plans and risk assessments lacked information; or that medicines were not always managed safely. Management arrangements were not resilient, although plans were in place to develop and appoint more senior staff.

People, staff and professionals felt the home was organised, well-led and praised the manager, who they described as “approachable” and “supportive”. Staff understood their roles and worked well as a team. They were motivated, enjoyed working at the home and had good working relationships with external professionals.

Staff were responsive to changes in people’s needs and supported them in a way that prevented unnecessary admissions to hospital. Reviews of care were conducted regularly and care records showed that people’s needs were met. The provider sought, and acted on, feedback from people, for example in changing the activities they supported people to take part in.

People received effective care and support from staff who were suitably trained. Staff were encouraged to gain formal qualifications in health and social care and received appropriate support and supervision in their roles.

Staff used appropriate methods to help communicate with people who had difficulty expressing themselves verbally. They promoted a relaxed atmosphere and we observed positive interactions between people and staff.

Risks such as pressure injuries, malnutrition, falls and confusion, were recorded, monitored and managed effectively. People praised the quality of the meals and were supported to eat and drink well. The chef sought feedback from people and changed the menu to suit their needs and preferences. People were supported to attend health care appointments and saw doctors, psychiatrists, nurses and other health professionals when needed.

Staff were knowledgeable about the signs of abuse and how to report their concerns. There were sufficient staff to meet people’s needs safely and checks were carried out on staff suitability before they started working in the home.

Appropriate arrangements were in place to deal with foreseeable emergencies, such as a fire. People had individual evacuation plans in place and took part in regular fire drills. Accidents were analysed and effective action taken to minimise the risk of recurrence.

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

Inspection carried out on 17 September 2014

During an inspection to make sure that the improvements required had been made

The purpose of this inspection was to check whether Newport Residential Care had complied with compliance actions we had made in May 2014 in relation to staff recruitment and notification of incidents to the commission. The inspection was carried out by an adult social care inspector. We considered all the evidence we gathered under the two outcomes we inspected. We used the information to answer these questions:

Is the service safe?

Is the service well-led?

Is the service safe?

We found the service was safer because action had been taken to improve the recruitment procedures and ensure pre-employment checks were completed. We saw written references and other pre-employment checks had been obtained prior to new staff commencing employment.

Is the service well led?

We found the service was well-led as the manager had taken action to ensure procedures were in place to ensure we were notified appropriately about incidents which occurred.

Inspection carried out on 15, 19 May 2014

During a routine inspection

We considered how the service was meeting the following eight outcomes.

Outcome 2 consent to care and treatment

Outcome 4 care and welfare of people who use services

Outcome 9 Management of medicines

Outcome 10 safety and suitability of premises

Outcome 12 Requirements relating to workers

Outcome 14 Supporting workers

Outcome 16 Assessing and monitoring the quality of service provision

Outcome 20 Notification of other incidents

We spoke with 14 of the 27 people who lived at the home and five relatives. We also spoke with staff on duty, the registered manager and provider. We viewed four care plans and records relating to medication and staffing.

We considered all the evidence we had gathered under the outcomes inspected and used the information to answer the five questions we always ask.

Is the service safe?

People said they had consistent care staff who knew what support they required and that they felt safe. Relatives were also all positive about the service and said they felt their relatives were safe. Staff had completed safeguarding and other essential training and were able to tell us what they would do if they had any concerns about people’s safety or welfare.

Risks to people's health and safety had been assessed and management plans were in place to reduce these risks. We saw specific equipment identified in people’s care plans was in place to reduce risks and keep people safe. This included equipment such as pressure mattresses and moving and handling equipment for people in the older persons unit. Staff told us they had received training to use equipment.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found the registered manager and staff were aware of this legislation and how it applied in their service. We found people's rights were protected and nobody was deprived of their liberty.

There were systems in place to ensure only suitable people with appropriate skills and knowledge were employed however, these had not been consistently followed. New staff had commenced working at the home prior to references being received and there was no formal evidence that Disclosure and Baring Service (DBS) checks had been completed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the recruitment of staff.

Is the service effective?

Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills necessary to care for people. The registered manager and staff were aware of who to contact for specialist advice and when this may be required. Care plans contained a section detailing relapse indicators which would help ensure people received additional mental health support when required. We saw where necessary external health professionals were appropriately contacted. We heard a telephone conversation between a staff member and Community Psychiatric Nurse (CPN) which showed staff were aware of when people may require additional support. Staff would therefore be able to access support to ensure the care they provided was effective to meet people's needs.

We spoke with people and visitors, all of whom were positive about the service provided. Visitors said their relative’s health needs were met and they were kept informed when medical professionals had attended.

Is the service caring?

People were supported by kind and attentive staff. People said they were treated with respect and dignity by the care staff. People also told us the staff were very kind and helpful and they were happy with the way they were cared for. One person told us “You're wasting your time here, you won’t find any problems”. Another person said “We are all very well looked after, the staff really do help us” We spoke with five visitors. One said their relative “always looks clean and looked after”, another said, “the staff care and it’s always the same staff so they know them”. A third said they had been “impressed with the care provided” when their relative had required additional support. Similar comments were made by other visitors.

Staff said they had time to meet people’s identified needs and could provide care at times people wanted it. Staff were aware of people’s rights to refuse care and stated they would respect this. Records of care provided showed people had received care as detailed in their care plans.

Is the service responsive?

The service could be flexible and responsive to people's changing and urgent needs. For example, we saw staff noticed that one person’s physical health was causing concern. Staff took all necessary action to ensure the person received prompt medical attention. We also saw staff were providing additional support for a person who had suffered a significant injury following a fall. Arrangements were in place to meet the person’s additional personal care needs.

Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. A comprehensive contingency plan was in place which covered all possible emergencies. The registered manager described how they had used this when there had been an incident at the home in 2013.

Is the service well-led?

There were procedures in place to monitor the quality of service provided with audits, such as for care plans and medication, being completed. We saw people felt able to express their opinions to the registered manager and provider. A survey of the views of people, visitors and external professionals had been completed in October 2013. This had shown people and external professionals were happy with the service provided. Relative’s comments had been considered and improvements to the environment were in progress. Systems were in place to ensure accidents and incidents were managed correctly to safeguard people from repeat incidents. People and relatives had information about how to complain and there were systems to ensure complaints would be investigated by the registered manager or provider. Staff stated they could rely on the registered manager for support at all times.

We identified that we had not been notified about all incidents which the registered person was required to inform us about.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring we are kept informed about all notifiable incidents.

Inspection carried out on 17 April 2013

During a routine inspection

We spoke with nine of the 25 people who were living at the home. They said they were “happy” with their care and the staff “knew how to care for them”. People also said staff were “available when I need them” and that staff would sort out any problems for them. Everybody said they were happy with the meals that were provided and told us choices were available. We spoke with a visiting health professional who said they were contacted appropriately and staff acted on their requests and guidance. They had no concerns as to how people’s health or care needs were met.

We also spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. Staff knew what care and support people needed and they respected their wishes. We viewed four care plans and related records. The care we observed corresponded with care plans.

We found sufficient staff were available to meet people’s needs and people received a varied diet with a choice provided at each meal. The environment was suitable for people, well maintained and clean. There were a number of systems in place for the quality of the service to be monitored. People’s views were sought as part of the quality assurance procedures.

Inspection carried out on 31 July 2012

During a routine inspection

We spoke with 15 people who lived at the home. We met other people and spent some time in the home’s communal areas observing people and the way they were cared for. People told us that they could make decisions and that the staff were nice. The younger people told us that they could decide where to go when they went out. They told us ‘you have to sign the book to say you are out and if you are going to be back after 10pm you need to make sure you have a front door key’. People said that they had no concerns about how their care needs were met. They also told us that if they were unwell then staff would contact a doctor for them and that staff would take them for medical appointments. We were told that staff were available when people needed them and knew what care they required. One person said ‘the staff are wonderful, I give them 100%’. Another agreed with this adding ‘the staff are always there and work really hard’. People told us they had care plans and could see these if they wanted to do so.

We spoke with a health professional involved in the care of people. They stated that they had no concerns about how people’s health and care needs were met and were complimentary about the way the service met people’s needs.

Everyone we spoke with confirmed that people’s privacy and dignity was maintained at all times. People told us staff always knocked on their bedroom doors and waited for a response before entering. People told us the staff were wonderful and that they felt safe and happy at the home.

People said that if they had any concerns or complaints they would raise these with the manager.