Newlands Nursing & Residential Home

Newlands Nursing and Residential Home is located in the residential area of Heaton Moor, Stockport. At the

time of our inspection there were 46 people living at the home. The service is registered to accommodate up to 72 people. Accommodation is provided across four separate units, each unit provides either residential or nursing care. Each of the units had been adapted, with aids and adaptations throughout.

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

Staff completed a variety of training, including infection control and safeguarding, and their competency was assessed. The service had a variety of assessments in place to assess risk. Accidents and incidents were investigated by the management team, and steps taken to learn lessons and reduce future risk. Recruitment checks were in place and there were enough staff to meet people’s needs on the day of inspection. We have made a recommendation about the assessment of staffing levels.

The registered manager had made a positive impact on staff morale and staff felt supported in their role and able to raise concerns. When complaints had been made, the management team investigated and took action to address the concerns. A variety of checks and audits were in place to drive improvement within the service and an action plan was in place.

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 good (published 20 December 2017).

Why we inspected

We received concerns in relation to staffing levels, infection prevention and safeguarding. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed and the service remains good. 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 Newlands Nursing and Residential Home on our website at www.cqc.org.uk.

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 Nursing and Residential Home is registered to accommodate a maximum of 72 people for nursing and residential care. However we were told the service would only accommodate 69 people as double rooms were not routinely used. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Newlands Nursing and Residential Home is located in the residential area of Heaton Moor, Stockport. At the time of our inspection there were 65 people living at the home. Accommodation is provided across four separate units, with residential care being provided on the basement level (Oak), nursing care on the ground and first floors (Cedar and Willow), and intermediate care on the top floor (Beech). Beech provided primarily nursing care to up to 19 people, often to allow earlier discharge from hospitals. Each of the units had been adapted, with aids and adaptations throughout.

Following an inspection in August 2016 the service was rated as inadequate and placed in special measures. We carried out a further inspection in February 2017 where we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to unlawful restrictions, assessment and management of risk, management of medication, dignity, clean and well maintained environment, seeking feedback from people who use service, supervision of staff, sufficient numbers of staff and quality monitoring systems. Due to the breaches found the service was rated Inadequate in the Safe, Responsive and Well-led domains and Requires Improvements in the Effective and Caring domains. The service was given an overall rating of Inadequate and remained in Special Measures. Following the inspection we asked the provider to complete an action plan to show what they would do and by when to improve all five key question to at least good.

During this inspection we checked to see if the required improvements had been made to meet the required Regulations. We found that improvements had been made.

The service had a manager who was registered with the Care Quality Commission (CQC). They were present throughout the inspection. 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.

Completion of the homes action plan and a period of sustained improvement will help to demonstrate continued development and enhancement of the service so that people receive a good standard of care and support.

Care plans were person centred and contained sufficient information about the current needs, wishes and preferences of people. Risks had been identified, assessed and planned for to help minimise such risk so that staff could quickly respond to people’s changing needs.

All information and checks required when appointing new staff were in place ensuring their suitability for the position so that people were kept safe.

The management and administration of people’s medicines was safe demonstrating people received their medicines as prescribed.

Up to date checks were carried out to ensure the premises and equipment used by people were kept safe. Action was being completed to ensure shortfalls on the fire risk assessment were addressed so that people were protected from harm or injury.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedure to follow so that people were kept safe.

Where people were unable to consent to their care and treatment the principles of the MCA had been followed so that decisions were made in the persons ‘best interest’. The provider had sought the necessary authorisation for those people deprived of their liberty.

On-going training and support was provided to help ensure they had the knowledge and skills essential to their role. Staffing levels were kept under review so that sufficient numbers of staff were available at all times meet people’s individual needs.

People were provided with enough food and drink throughout the day. Where people’s health and well-being was at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

The home was found to be clean and well maintained with good infection prevention and control systems were in place. Recent refurbishment of the communal areas provided a good standard of accommodation for people. Suitable aids and adaptations were provided to promote people’s independence.

People were supported by staff in a friendly and respectful manner. Staff responded promptly when people asked for assistance and were seen to support people in a patient and unhurried manner.

Some opportunities were made available for people to participate in activities helping to promote their independence and choice. The provider was taking action to improve opportunities for people.

The provider had a system in place for the reporting and responding to any complaints brought to their attention. People told us they could raise any issues with staff or the provider if they needed to.

The provider reported any accidents, serious incidents and safeguarding allegations which should be notified to CQC. This information helps us check the service is taking action to ensure people are kept safe.

The CQC rating and report from the last inspection were available in the reception area as well as on the provider web site.

Newlands Nursing and Residential Home is located in the residential area of Heaton Moor, Stockport. The home is registered to accommodate a maximum of 72 people for residential and nursing care, although as double rooms were not in frequent use, HC-One Limited who are the registered provider of the home advertise it as providing care for up to 68 people. Care is provided over four floors, with residential care being provided on the basement level (Oak), nursing care on the ground and first floors (Cedar and Willow), and intermediate care on the top floor (Beech). Beech provided primarily nursing care to up to 19 people, often to allow earlier discharge from hospitals. There is parking on site and in streets nearby. At the time of our inspection there were 57 people living at the home.

We last inspected Newlands Nursing and Residential Home on 02 and 04 August 2016 when we rated the home inadequate overall and placed it into special measures. At that inspection we identified breaches of the regulations in relation to care plans, premises and equipment, safe recruitment processes, safe care, governance, records, staffing levels and staff supervision. We asked the provider to make improvements to the service and they provided us with an action plan of how they would do this. We also issued two warning notices to the provider that instructed the provider to make improvements to the service. At this inspection we found on-going and multiple breaches of the regulations in relation to safe care and treatment, staffing, supervision, governance, premises and equipment, person centred care and safeguarding. You can see what action we told the provider to take at the back of this report.

The home did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Since our last inspection six months previously, two acting managers had left the service. The provider had appointed a new acting manager who was recruited internally and was in the process of applying for their registration with the CQC.

We identified concerns in relation to the safe management of medicines that put people’s health and wellbeing at risk. We found staff were not aware that one person’s medicine needed to be given on an empty stomach, and also found evidence of people having missed a dose of medicines, or having been given another person’s prescribed medicine. Staff did not always have clear instructions that would allow them to administer medicines safely and when required. This included information in relation to any difficulties people might have in relation to swallowing.

The provider had assessed potential risks to people’s health and wellbeing. However, we found staff were not always aware of the guidance in place, which put people at risk of potential harm. The provider had also not taken reasonable steps to ensure the safety of the premises and equipment. For example, we found regular maintenance checks of the water system to control the risks of legionella had lapsed, and one person’s wheelchair was missing a footplate and arm rest. We also found a number of areas being used inappropriately for the storage of furniture and equipment. The provider sent us evidence after the inspection to show they were now completing the required checks in relation to controlling the risk of legionella.

There were sufficient numbers of staff on duty to meet people’s needs. However, we were concerned about the lack of clinical oversight as no member of management staff at the home was a registered nurse. The provider informed us shortly after the inspection that they had appointed a ‘clinical lead’ from one of the other homes they ran. The home had continued to rely on the regular use of agency nursing staff due to difficulties recruiting permanent nursing staff.

The home was undergoing an extensive refurbishment at the time of our inspection that had been ongoing for approximately the last six months. The provider was not able to show us any evidence that they had consulted people living at the home or their representatives in relation to this project, or considered how they could minimise the potential disruption.

People had care plans that in most cases reflected their preferences and had been regularly reviewed. However, staff were not always aware of the content of care plans, which meant they were not working in a person centred way. One person had requested to see a dentist on their admission to the home, but no action had been taken to enable this. Another person required the use of hearing aids but staff had not supported the person to wear them. Whilst we saw some people had been involved in reviewing their care plans, this was not consistent across the home. Relatives also gave variable reports about how well staff communicated with them and involved them in their family member’s care.

There was a lack of planned activities or meaningful stimulation in place for people. During the inspection we found activities staff were also used to cover care staff shifts. Some people reported they could be bored or feel isolated. The provider acknowledged that the provision of activities required improvement and told us they planned to work with activities staff to achieve this.

People gave positive feedback about the food on offer. The chef was knowledgeable about how to support people’s dietary needs and meet people’s preferences. We saw drinks and fresh fruit were freely available around the home.

The home was not operating effective procedures in relation to the Deprivation of Liberty Safeguards (DoLS). This meant there were people who were at risk of having their liberty deprived without proper legal authorisation.

We received mixed reports from relatives and people living at Newlands in relation to whether staff were caring in their approach. This was also reflective of our observations during the inspection where we observed both very positive, caring interactions, and less caring approaches, such as not acknowledging a person’s request to use the toilet.

People had been supported to access services to a range of health professionals including GPs, tissue viability nurses (TVNs), and dieticians. We found that people had received the support they required in relation to dietary support and repositioning to reduce the risk of pressure sores. However, in some instances we found improvements were required to the records kept so that they provided a clear record of care given and the reason for taking particular decisions in relation to people’s care.

Complaints were effectively monitored, investigated and responded to. People we spoke with told us they had been satisfied with the outcome of their complaints.

The provider’s quality assurance systems and systems to monitor and improve the safety and quality of the service had not been operated effectively. For example, there were no meetings to review falls or weight loss as is part of the provider’s normal process. The provider had recognised many of the issues we found during the inspection but had not taken effective action to ensure they were resolved.

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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.

Newlands Nursing and Residential Home is located in the residential area of Heaton Moor, Stockport. The home is registered to accommodate a maximum of 72 people for residential and nursing care, although as double rooms were not in frequent use HC-One Limited who own the home advertise it as providing care for up to 68 people. Care is provided over four floors, with residential care being provided on the basement level, nursing care on the ground and first floors, and intermediate nursing care on the top floor. There is parking on site and in streets nearby. At the time of our inspection there were 65 people living at the home.

We inspected Newlands Nursing and Residential Home on 27 January 2016 when we found the service was not meeting the requirements of the regulations in relation to providing supervision and support and requirements relating to information required to ensure staff were fit and proper to work at the home. Our last inspection of the service took place on 03 July 2014 when we found the service had made improvements and was meeting the requirements of all the regulations inspected at that time.

At this inspection we identified nine breaches of five of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe management of medicines, assessing and mitigating risks, staffing levels, checks relating to employment of fit and proper persons, providing safe care and treatment, records, training, equipment and good governance. You can see what actions we have told the provider to take at the back of this report. We are currently considering our response in relation to enforcement for some of the breaches of regulations and we will update the section at the end of this report once any such action has concluded.

There was no registered manager in post at the time of our inspection. The registered manager had resigned and had left the service the week prior to our inspection, and a new ‘turnaround’ manager had been appointed as the interim acting 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.

We brought this inspection forward from its planned date due to concerns we had received from relatives and a Whistleblower. Whistleblowing is when a worker reports concerns they have around practices or wrongdoing. Concerns relating to various issues at the service had also been raised with us by the local authority following one of their monitoring visits.

We identified concerns with the way the service was assessing and managing risks to people’s care. Whilst risk assessments had been completed, these were not always reviewed as frequently as they should have been. Actions identified in risk assessments, such as monitoring people’s weights on a weekly basis were not always undertaken. We found that records did not consistently evidence that people had received the support they required with repositioning to help reduce the risk of pressure sores.

We reviewed records for one person who required support with a percutaneous endoscopic gastrostomy (PEG). A PEG is a tube that is inserted into the stomach and often used to supply food and medicines to people who are unable to take them orally. We found directions for care staff lacked detail and the provider was unable to show us evidence that all tasks relating to care required in relation to the PEG had been completed. This meant this person may be put at risk of a detrimental impact on their health and wellbeing.

We found issues in relation to the safe management of medicines. For example, we found medicines records were not always updated in a timely manner following advice from a health care professional. This meant there was a risk people would not receive the correct medicines or dosages. Clinic rooms were warm and we saw the temperature had risen above recommended limits. If medicines are not kept at the correct temperature their efficacy can be affected.

During the day we saw there were sufficient numbers of staff to respond to and meet people’s needs. However, night staff raised concerns about staffing levels on night shifts. The provider was not able to demonstrate that staffing levels had been reviewed at a local level in consideration of the dependency of people living at the home. The night prior to our inspection we found support funded for one to one support over-night for one person had not been provided.

Staff received training in a range of subject areas including safeguarding, moving and handling and dementia. However, staff had not received regular supervision from a manager. The provider was also unable to provide evidence that agency staff working at the home had received an induction, or that nursing staff had received training or competency assessments in relation to tasks they were undertaking such as taking blood samples. This meant the provider could not be certain that staff were competent to provide safe and effective care to people.

People told us they found staff had a kind and caring approach. We observed positive interactions between staff and people living at the home and regular staff knew people well. For instance, we observed staff talking with people about shared interests and calling people by their preferred names. People told us staff respected their privacy and dignity and staff we spoke with had a positive approach to supporting people’s independence.

People told us their family members could visit without restrictions and we saw evidence that family members had been involved in helping plan their relative’s care where this was appropriate. Care plans contained information in relation to people’s preferences, likes and dislikes.

We saw people received the support they required to eat and drink. Staff we spoke with were aware of people’s dietary requirements as was recorded in their care plans. However, we found people’s food and fluid intake was not always recorded when there had been a need for this to be done.

Care plans had been regularly reviewed but in some cases had not been re-written for some time, which meant the most relevant information was not always easily accessible. This would increase the risk of care being provided that was not in accordance with a person’s current needs or preferences.

There had been three registered managers in post at Newlands over the previous three years. Staff told us they felt the home needed a stable management team.

There were systems in place to review and monitor the quality and safety of the service. However, these had not been effective at addressing the issues we had identified. We also found actions were not always identified or signed off from audits, and there had been a gap in some of the monitoring following the previous manager’s departure. We found that issues we had identified as concerns in 2014, such as lack of regular staff supervision were also found to be an issue at this inspection. This showed systems had not been effective at maintaining standards at the home.

People told us they were able to make day to day decisions and choices, such as when they got up and when they were supported with bathing. People told us staff listened to them and acted on any concerns they might raise.

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 sufficient improvement is not 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.

Our inspection team was made up of an inspector who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

Most of the people who were living at Newlands Nursing and Residential Home were living with conditions where they could not always give their verbal opinions on the service they received. However, we observed during our visit that people were treated kindly and with respect. We were also able to understand from the people we spoke with that they felt safe while living at the home. They made positive comments such as; 'I feel safe here, they are very good. When I go home I can tell people ' don't be afraid to go there. There is nothing to worry about' 'My mum is safe and well protected, nothing to worry about here'.

From the records we looked at we saw that people who lacked capacity were protected when decisions were necessary regarding their health and personal care needs.

At the time of our inspection we noted that the home was clean however we saw that some boxes delivered to the home had not been moved to appropriate storage areas in a timely way and had been left next to the fire exit on the basement corridor.

We looked at staff training records that confirmed staff had undertaken moving and handling training to protect the people who lived there. Training such as safeguarding adults and health and safety helped to make sure that the staff team had the qualifications and skills to meet people's needs. National Vocational Qualifications (NVQ) in Health and Social Care had been undertaken by the staff team. Fire awareness training had been provided at the home for all of the workers.

We looked at fourteen staff recruitment records and saw that the provider had systems in place to make sure that staff had been properly recruited and trained. However we noted that the development of staff was not fully supported through a regular system of supervision and appraisal. This meant that staff were not fully supported and managed to make sure they were clear about their lines of accountability.

Is the service effective?

From the four care plans that we looked at we were unable to read some hand written care instructions. The deputy manager also confirmed they were unable to make sense of some of the written care instructions that we looked at. Clearly written notes would help to make sure that people received appropriate care to meet their needs. We saw records to confirm that healthcare professionals such as GP's and district nurses also visited the home as requested. Notes were made of the visits on the person's care plan.

Newlands Nursing and Residential Home was purpose built to meet people's individual needs. All bedrooms were single occupancy and had en suite facilities. Bedrooms were situated over four floors and could be accessed via a passenger lift. We saw there was equipment available to meet people's needs such as hoists, assisted baths, wheelchairs, pressure relieving mattress and cushions.

Is the service caring?

We spoke with five people using the service and five relatives of people using the service. We also spoke with a visiting social worker about their opinion of the care provided at the home. People told us that they had no concerns about the care provided. They said that they had no complaints and that the staff were good. All of the people spoken with were very positive about the care they received. Some comments received were; 'from what I can see the staff seem attentive' 'people here are very kind and work really hard, I can't fault the care' 'I think it's a really good place, they look after my dad well' 'we are happy with the care, can't want better' 'they always attend to his care very well'.

All of the people we saw on the day of the inspection looked clean and comfortable and they were smartly dressed.

We saw staff showing respect to people when delivering their individual care and in a way that promoted their privacy and dignity.

Is the service responsive?

We saw that people's needs were assessed before they were admitted to the home to help make sure that their needs could be met. We saw that all of the people who lived at the home had an individual care plan in place.

We saw that necessary individual risk assessments to guide staff in managing individual risks were in place. These records were checked regularly to help make sure that people's changing needs were being met.

People who used the service and most of the visiting relatives told us that they had no concerns about the care provided. They told us, 'staff seem well trained and know what they are doing' 'My mum had a chest infection when she moved in here. Within 24 hours of her being here the staff jumped on it, fantastic. They called the GP immediately. They're proactive here' 'I'm exceptionally happy with the way they dealt with everything.

People spoken with told us that a GP was called as and when necessary and their medication was always given on time.

Is the service well-led?

At Newlands Nursing and Residential Home a registered manager was in charge of the day to day management of the home. The manager was on annual leave at the time of the inspection. The home's deputy manager and the quality assurance manager were available throughout the inspection.

We looked at completed quality and compliance assessment tools which showed that information had been gathered about the safety and quality of the service. Records seen confirmed the actions that had been taken where shortfalls were identified within each assessment.

People we spoke with told us they thought the staff worked hard. However comments made about staffing levels indicated that people thought there were not always enough staff to meet people's needs. People spoken with said, 'there are times they could do with an extra pair of hands', ' I heard they should have a unit manager, it's not happened yet', 'staff are run ragged here', 'they could maybe do with more staff, they're meeting themselves coming backwards'.

People using the service, their relative's and healthcare professionals were also provided with a questionnaire to obtain their views and opinions about the service.

People told us that they could talk to the manager if they had any concerns about the care being provided.

We spoke with six people who used the service and comments included: "I feel the staff do a good job, they are very busy and sometimes I have to wait a while to be taken to the toilet", "I have been here for three years and like it, I have recently moved to this room for the view and I am settled and happy", "I am looked after well, the food is ok and the staff are nice".

We found appropriate systems in place for the safe management of medicines. Staff had access to current medication policies.

There were shortfalls in the recruitment, selection and employment processes within the home.

We found staff were not adequately supported in their roles.

There was an appropriate system in place to manage any complaint about the service.

People who lived there were complimentary about the care that they received and we observed people being looked after properly. One person said the care was "brilliant", another person receiving respite care said it was "100%" and that they did not want to go back to their home. When we looked at risk assessments and plans for people's care we saw that they were fit for purpose.

People told us the food was good, that they had a choice and if there was nothing they liked something special would always be prepared for them. The kitchens were well organised and set up to cater both for people's dietary needs and individual preferences.

The home had appropriate systems in place to protect people from abuse and to report any concerns to the appropriate authorities. Staff were recruited in line with the regulations including appropriate checks required into their background and previous employment.

The home had systems in place to monitor the quality of care it provided and we saw that audits of catering and medicines had recently taken place. The home also took steps to find out about and act on the opinions of residents, relatives and visiting professionals.