Newhaven

Newhaven is a residential care home providing personal care to four people at the time of the inspection. The service can support up to four people.

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

Right Support

People were not supported to have maximum choice and control of their lives. People were not always supported to pursue their interests and activities they enjoyed. Whilst staff supported people in the least restrictive way possible, there was a lack of documentation in relation to making decisions in people’s best interests.

Right Care

We received mixed feedback from people’s relatives about how well staff knew their family members. People’s care records detailed how they communicated their needs and feelings. Risk assessments detailed the support people required in order to keep themselves and others safe.

Right Culture

There was a lack of effective governance in place in order to drive improvement within the service. The culture of the service was not fully inclusive. There were no processes in place to engage people, their relatives and healthcare professional in providing feedback about 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

The last rating for this service was good (published 12 November 2018).

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.

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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to good governance 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 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.

We found the following examples of good practice.

People were supported to maintain contact with their relatives. This included speaking with their relatives via telephone or video-calling. People were also able to see their relatives in the garden at a safe distance.

There were procedures in place for visitors to the home to minimise the risk of spreading infection. Visitor’s temperatures were taken upon arrival, and they were asked a series of questions to ensure they were not symptomatic or had come into contact with anyone who had COVID-19. Personal Protective Equipment (PPE) and hand sanitiser were available for staff to use upon arrival.

At the start of the pandemic, some people were anxious about staff wearing masks. One member of staff told us how they drew smiley faces on their masks to help people feel less anxious about staff wearing masks.

The service was clean throughout and free from clutter which made it easier for staff to clean. Additional cleaning of high touch points such as door handles and light switches was carried out at regular intervals.

Staff were observed to be wearing masks and additional PPE such as aprons and gloves where social distancing could not be maintained.

Newhaven is a ‘care home’ providing residential care to people with learning disabilities, autism and mental health conditions. 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy

The service is registered to provide care to a maximum of three people. There were three people living at the service at the time of the inspection.

The service had a manager who had been in post for eight weeks prior to the inspection, and was in the process of completing their CQC registration. 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.

At our last inspection completed on 16 August 2017 the service was rated as requires improvement overall with no breaches of regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The rating of requires improvement was because risks to people in relation to the premises and recruitment were not always fully identified and responded to appropriately. Governance and quality monitoring systems in the home needed further improvement to ensure they were effective at identifying and addressing issues with the service provided, and there was no registered manager in post.

At this inspection we found staff treated people with care and compassion, and took pride in their caring roles. Staff understood how to identify and report safeguarding concerns and demonstrated a good understanding of each person’s individual care and support needs and associated risks. People had choice of food and fluids, with value placed on nutrition and food quality.

People accessed activities in the local community and spent time with relatives and friends. People were encouraged to live life to the full and maintain involvement in hobbies and interests. Relatives knew how to make a complaint, and were encouraged to give feedback to the new manager to improve the overall standard of the service and care experience for the people living at Newhaven.

The service had governance processes in place for monitoring standards and quality of care provided, this included completion of regular audits in areas such as medicines management and infection prevention control.

There were flexible staffing levels to meet the daily needs of people living at the service. Staff supported people in line with their personalised care records to manage individual risks and care needs. The new management team had completed a review of people’s training, supervision and appraisal needs, and an action plan had been implemented to address any shortfalls.

We did identify the need for some improvements in the condition of aspects of the care environment, particularly people’s bathrooms. The management team needed to update their environmental risk assessment to ensure this accurately reflected the risk levels of the people living at the service at the time of the inspection.

A registered manager was not 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.

Risks to people in relation to the premises and recruitment were not always fully identified and responded to appropriately. Governance and quality monitoring systems in the home needed further improvement to ensure they were effective at identifying and addressing issues with the service provided.

Staff demonstrated an awareness of adult safeguarding and knew how to report concerns.

Medicines were managed and stored safely. There was guidance in place so staff knew how to administer medicines. Regular audits were taken on medicines to check and ensure they were managed safely.

People were supported to access health care services and maintain their health; this included supporting people to eat healthily. Staff worked collaboratively with health care professionals to ensure people’s needs were met.

Staff were supported to provide effective care through training, team work, and supportive management.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff and the management team understood the MCA and DoLS and its impact on the support they provided.. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff who cared for them and treated them respectfully. Staff consulted and listened to people about their care. Important relationships were recognised and facilitated for people. People’s independence was encouraged.

The support provided was individual and tailored to people’s needs and interests. Staff ensured they knew people’s individual preferences and needs and support was provided in a way that met these.

The service responded appropriately to any concerns raised. Relatives felt comfortable and able to raise any concerns they had.

The management team were open, supportive, and approachable with people, relatives, and staff.

The home did not have a registered manager in post. There was an acting manager who had submitted an application to become the registered manager. 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 and associated Regulations about how the service is run.

We found that whilst risks to people’s health and wellbeing had been identified, the risk assessments were not reviewed or updated. Environmental risks that had been identified as posing a risk to people had not been managed.

There was a safe recruitment process in place which ensured that only suitable staff were recruited to work in the home. Appropriate references had been sought and all staff had been police checked.

Medicines were stored and administered safely in the home and people received their medicines as prescribed.

The service was not operating in line with the principles of the Mental Capacity Act 2005. People had not received a mental capacity assessment so it was unclear what choices people could make for themselves.

Risks around people’s nutritional needs had been identified but were not managed effectively. However, prompt referrals were made to the relevant healthcare professionals where there were concerns about people’s health or wellbeing.

Staff were caring and had the necessary training to carry out their role. People were supported to make choices about their daily life and staff communicated with people according to their needs. People were supported to maintain relationships with their relatives and visitors were welcome in the home. People were able to access a range of activities and were supported to pursue their interests.

There was a complaints procedure in place and people were supported if they needed to make a complaint.

Staff felt supported by the management and the manager was approachable and open to discussion. There was open and frequent communication between the manager and the staff.

Systems were in place to monitor the quality of the service and would highlight the areas that needed improvement. Action was not always taken to address the concerns raised in the audit.

We spoke with one person using this service who told us that, 'Staff have been very good, they have stepped back and allowed me to maintain my independence.' They further commented, 'Everything has been good and I have no suggestions for improvement; the standard has been very good."

Appropriate arrangements were in place in relation to obtaining and managing people's medication.

Appropriate checks were undertaken before staff began work and there was an appropriate recruitment process in place.

People were given support by the provider to make a comment or complaint.

We spoke to both of the people living at this home and they both indicated to us that they were happy being at Newhaven. We asked one person if they were able to undertake activities which they enjoyed and they responded 'Yes'. Our observations and conversations with staff demonstrated to us that they had a good understanding of the people they were caring for.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Staff were supported through a regular system of training and supervision.

There were systems in place to monitor the quality of service that people received.