Archived: Newtown House

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘Safe’ to good.

Newtown House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Newtown House is registered to provide care and accommodation for a maximum of 26 people. Accommodation is provided over two floors and all rooms are single occupancy. A passenger lift provides access to the first floor. People have the use of a communal lounge and dining room and there is a level, secure outside garden.

At the time of our inspection there was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks to people had not always been assessed, monitored or reviewed. This included the use of bed rails, using equipment to restrain a person, falls, accidents and incidents. Medicines were not always administered safely. A person had received an incorrect dose and the persons GP and the local safeguarding team had not been informed. That meant any associated safety risks had not been considered by the appropriate professionals. One person had complex symptoms and had medicine prescribed for ‘as and when’. There was no protocol in place to ensure the persons symptoms were managed effectively.

No audits or monitoring of the service had taken place since our last inspection in October 2018. Accurate records of the care and treatment people received had not been maintained. Examples included people’s mobility needs and managing people’s risks. Lessons had not always been learnt when things went wrong. Accident and incidents had been recorded but not reviewed which meant lessons had not always been learned when things went wrong. A complaints process was in place but had not been followed. A complaint had been received but not responded to in a timely manner. Records did not include an acknowledgement to the complainant, details of an investigation or the outcome.

Changes in the management structure of the home had led to reduced nursing hours which impacted on the length of medicine rounds and keeping records up to date. People were supported by staff that had been recruited safely including checks for their suitability to work with vulnerable adults.

Staff had an induction and ongoing training which enabled them to carry out their roles. Since the last inspection staff had not received any supervision and no staff meetings had been held which had left staff feeling unsupported. Staff morale was low and they lacked confidence in the management and organisation.

Pre admission assessments had taken place and captured people’s needs and choices. This information had been used to create an initial care and support plan. Care and support plans were not always reflective of the care people were receiving. People had access to healthcare when needed including dentists, opticians and dieticians. People had their eating and drinking needs understood and met.

The principles of the Mental Capacity Act were not always followed as assessments had not always been completed and there were not always records to demonstrate decisions were made in a person’s best interest and in the least restrictive way.

People did not have comprehensive end of life care plans that included the management of symptoms. Legal reporting responsibilities for reporting an unexpected death had not been followed and was at the time of our inspection being investigated by the police.

People spoke positively about the care they received and felt involved in day to day decisions about their care. People told us staff were respectful of their dignity and privacy.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Newtown House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home had a registered 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.

Risks identified for people had not been monitored and reviewed in order to minimise the risks of avoidable harm. People were at risk as medicine administration was not always carried out in a safe way.

People had a well-balanced diet and drinks were always available. The dining experience was not dementia friendly. Pictorial information was not available to assist people make choices, dining table space was very limited and main meals and deserts served together which created confusion for some people eating independently.

We recommended the service consider NICE guidance on dementia friendly care home environments or similar professional guidance when reviewing peoples eating and drinking needs and experiences.

Auditing processes were in place but had not been effective in highlighting the areas requiring improvement found at inspection. Throughout our inspection the registered manager was responsive to our findings and provided an action plan on our second day detailing how the shortfalls would be addressed.

People were supported by staff that had completed safeguarding training and understood their role in recognising and reporting any suspected abuse. People were protected from discrimination as staff had completed equality and diversity training. People were protected from avoidable infection as infection control practices were followed by the staff team. When things went wrong such as accidents and incidents these were used as opportunities to reflect, learn and continually drive improvement.

Prior to admission people had been involved in assessments which captured their care needs and choices. This information had been used to create person centred care plans that reflected people’s individuality and diversity. People had an opportunity to be involved in end of life care plans that reflected their diversity and choices. Staff had been recruited safely ensuring they were suitable to work with vulnerable adults. They completed an induction and on-going training which provided them with the skills for their roles and had opportunities for professional development. Partnerships with other agencies such as mental health specialists enabled effective care for people. People were supported with access to both emergency and planned healthcare.

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 and their families described the staff as kind, patient and caring. People felt involved in decisions about their care and day to day life’s and had their privacy, dignity and independence respected. A complaints process was in place that people felt able to use and told us they would be listened to and actions taken.

People, their families and the staff team described the service as well led and described the registered manager as visible and somebody who listened and got things done. Staff understood their roles and responsibilities, felt appreciated in their role and spoke positively about teamwork and communication.

Opportunities were available for people, families and the staff team to be engaged in developing the service through meetings, a regular newsletter, quality assurance processes and a suggestion box.

The staff team worked with other organisations and professionals to ensure people received good care. These included ‘Skills for Care’ and the National Institute for Clinical Excellence to keep up to date with best practice guidance. Links had also been made with a local university and Newtown House offered student nurse mentored placements. Information had been shared appropriately with other agencies such as the safeguarding teams and social care commissioners.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Newtown House is a residential nursing home that provides care for up to 23 older people. At the time of our inspection there were 19 people living at the service. The home has a registered manager but they were not at the service during our 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.

People and their families told us they felt safe. Staff had up to date safeguarding training and knew how they would recognise signs of abuse. Staff told us they felt able to report poor practice without fear of any discrimination.

Personal and environmental risks to people had been assessed and where a risk had been identified actions had been put into place to minimise the risk. Risks had been reviewed regularly. Information about people’s changing risks where shared with staff. Staff demonstrated a good understanding of people’s risk whilst understanding the need to respect a person’s freedom and choices.

The building, service and fire equipment had been well maintained. Fire drills had been carried out with staff. Drills had all been carried out in the morning. We discussed this with the deputy manager who agreed to look at including other times of day so that the night staff were able to be included.

There were enough staff with the right skills to provide the care that people needed. Staff had been recruited safely. Staff files contained references from previous employers, criminal records checks and evidence of the persons’ eligibility to work in the UK. Profiles for agency staff were in place prior to them beginning their first shift at the service. The deputy manager agreed to speak to nursing staff to ensure that they have sight of a person’s profile and are satisfied the person is suitable before they commenced a shift. The service had disciplinary processes in place to manage poor or unsafe practice.

Medicines were ordered, stored and administered safely. Staff had a good understanding of actions they would need to take if an error was identified.

Staff received training to give them the skills to carry out their roles. New care staff completed the Care Certificate induction course. The Care Certificate is a national induction for people working in health and social care who have not already had relevant training. Three senior staff had been trained as assessors for the Care Certificate. Agency care workers received an induction on their first shift which familiarised them with the building, health and safety and people they would be supporting. Nurses received clinical updates and opportunities to continue with their professional development.

Individual supervision and appraisals were not consistently happening. However staff were being supported by nurses and managers. In the interim staff meetings had been used to provide group supervision and staff were receiving additional training and development opportunities.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.

The service had been working within the principles of the MCA. Assessments had been carried out to determine whether a person had the ability to consent to key elements of their care. DoLs applications had been sent to the local authority for authorisation where people had been unable to consent to care and treatment. When a person had in place legal arrangements for somebody else to make decisions on their behalf staff were aware of this and had the correct paperwork on file. Staff asked people for their consent before administering medicines or offering support with personal care.

People had their eating and drinking needs met One person had been assessed by a swallowing specialist and they had written a safe swallowing plan. Staff were aware of what the plan said and supported the person safely. People had their weight monitored and actions had been taken when risks had been identified.

People had access to their GP and a range of health professionals including opticians, audiologists, physiotherapists and specialist health professionals.

Staff were caring. We observed positive interactions between staff and people. Staff had a good understanding of people’s interests, likes and dislikes and people’s communication skills. People felt involved in decisions and had been given information about advocacy services that would be able to speak up on their behalf.

People were supported to maintain their independence. .We observed staff treating people with respect and dignity. We saw staff caring for people in a relaxed way, laughing and sharing a joke.

People or their representatives were not always involved in planning their care. We were told that there were four people who chose to spend their time in bed. We spoke to two people and they had not been involved in decisions or given choices about how they wanted to spend their day. We discussed our findings with the deputy manager who told us that they would review both people’s care plans with them.

Assessments had been completed prior to a person moving into the service. Information had been obtained from the person, family and other professionals and formed the basis for people’s care plans. Involvement of people and their families in ongoing reviews did not continue. Reviews had regularly taken place. Staff had a good knowledge of people’s identified care needs.

Activities were available to people every day. Care records included information about people’s interests and hobbies. We spoke with staff who demonstrated a good knowledge of what people enjoyed. People were able to access the local community. Links had been made with a local church and local schools.

People and their families were encouraged to provide feedback. Resident meetings were held and chaired by one of the people living at the service. People were listened too and actions taken if concerns were raised. People and their families had been given information about the carehome.co.uk website and had used it to review the service.

A complaints procedure was in place and included contact information for the local authority, the NHS clinical commissioning group and an advocacy service. People and their families were aware of the complaints procedure and felt able to raise concerns with staff. The complaints book contained a record of written formal complaints. It included details of how the complaint had been investigated and the outcome and response to the complainant. It did not include records of verbal complaints received. This meant the records did not fully capture people’s feedback and the actions taken by the service in response. We discussed this with the deputy manager who told us they would introduce this to the complaints process.

The registered manager had been awarded by the Hampshire Care Association the ‘Manager of the year Award 2015’ and the certificate was displayed in the foyer.

The service had an open, positive and transparent culture. A monthly newsletter was produced and had been put on the noticeboard in the foyer. It included information about redecorations being carried out, entertainment and news about staff leaving or joining the service.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them and were involved in improving the service and keeping people safe.

Auditing processes were in place. They included care plans, health and safety, catering, recruitment, medicine administration and housekeeping. They identified actions required, the person responsible and a completion date. Audits were also completed as part of the operational directors’ weekly visit to the service.

A quality assurance survey was completed annually. In January 2016 the survey had been sent to people, their families, other professionals and staff. The results had not been analysed at the time of our inspection. We were told by the deputy manager that findings would be shared at a resident and staff meeting, in the monthly newsletter and on the noticeboard.

The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

The service had achieved the ‘Gold Standard Framework’ accreditation (GSF). The (GSF) is a national award. It is a model of care that enables good practice to be available to people nearing the end of their lives. It provides a framework for a planned system of care in consultation with the person and their family. The framework promotes forward planning with the GP to ensure medication is available when needed.

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Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This inspection was carried out to assess how medicines were handled and looked after, in response to some concerns that were raised to us. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

We found the service was safe because people were protected against the risks associated with medicines. We found that the provider had appropriate arrangements in place to manage medicines safely.

Below is a summary of what we found. The summary describes what people told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe in the home. For example, one person told us, “You feel secure with them. They are nice staff. They are very tolerant.” Relatives also felt that their family members were safe and described permanent staff as “very good and very professional.”

Staff were able to tell us about how they provided people’s care in a way that ensured their safety. For example, they knew how to move people safely and knew when to seek advice about people’s needs.

The home was taking action to ensure that people who used the service were protected from the risk of abuse. The home was responding to recommendations made by the local authority following a recent safeguarding investigation. The manager had familiarised herself with local safeguarding procedures, staff had attended relevant training and information about reporting concerns was available for all staff to read.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. At the time of our inspection, there was no-one in the home subject to DoLS. The manager told us that they would be reviewing this following a recent Supreme Court judgement. This would help ensure that decisions about the care of people who lacked capacity were made in their best interests and were properly authorised.

Improvements were needed in relation to records about people’s care. Some care plans contained conflicting information about people’s needs. Other records such as food charts and repositioning charts were incomplete. This put people at risk of receiving inappropriate or unsafe care. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

People who lived in the home, and their relatives, had confidence that the home was able to meet their needs. For example, one person told us, “They look after me…they make sure I’m getting what I’m entitled to”, while another person commented, “They’re very good. They do a lot for you.”

There were group and individual activities available for people which helped ensure they had things to do in the home. During our inspection we observed activities taking place in the lounge and on a one-to-one basis in people’s bedrooms. One person told us that they preferred to stay in bed but enjoyed visits from the activities organiser who would come and have a chat with them and do a quiz. Another person told us, “There’s always something going on…games and things…you can make things…we go out sometimes.”

Staff received training and support to carry out their work effectively.

Is the service caring?

People who lived in the home described staff as “nice”, “kind” and “gentle.” A relative told us, “I’ve never had any cause to complain. They’re all very helpful and go out of their way.”

Staff communicated with people in a kind, patient and encouraging way. Staff spoke with people as they supported them which helped them understand what was happening. A senior member of staff described how they had got to know people’s likes and dislikes. They told us that, by understanding people’s life history and things that were important to them, they were able to provide better care. They told us how they supported other staff to do the same and therefore promoted an individualised approach to care.

Is the service responsive?

The home responded to people’s needs and changes in their health. Where staff had concerns about people's welfare, we saw that this had been reported to their doctor and action was taken to ensure they received care that met their individual needs.

People had confidence that staff would take the right action to help them in an emergency or if their health changed. Staff received training to be able to meet people’s needs, including specialist training where people had needs that required specific intervention.

Is the service well-led?

There was a clear management structure in the home although, at the time of our inspection, the home did not have a manager who was registered with the Care Quality Commission. People who used the service, their relatives and staff were aware of the management structure and were clear about who to approach if they had any concerns.

We found that checks were carried out to ensure that staff followed safe procedures and understood their roles and responsibilities.

There were systems in place to monitor accidents and incidents which meant the home was able to identify emerging risks and take appropriate action.

People’s views were taken into account in the way care was provided on a day to day basis. People told us they felt the manager and staff listened to them. We also found that surveys were sent out to people who used the service, their relatives, visitors and staff to obtain their views. However, a more robust approach was needed to ensure that people's feedback in surveys was used promptly to plan, and make, improvements to the home. A compliance action has been set for this and the provider must tell us how they plan to improve.

We spoke with four people and looked at their care plans. We also spoke with one relative. We spoke with five members of staff and reviewed records related to staff training and quality monitoring within the home. We observed the lunchtime meal and support provided to people by staff.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were supported to be able to eat and drink sufficient amounts to meet their needs.

There were enough qualified, skilled and experienced staff to meet people’s needs. People were support by adequate numbers of care staff and they told us that their needs were met appropriately.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. This included audits of the home's environment and infection control.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People were fully involved in how their care and treatment was managed at Newtown House, and consent had been obtained for all aspects of their care and treatment.

People we spoke to told us that high standards were maintained at the home. Everyone had positive things to say about the service they received. They told us that the quality of food and meals was good and that there was a kind and friendly staff team who met their care and treatment needs.

We found that medicines were managed safely and people received the medicines that had been prescribed to them. There were also robust procedures for the disposal of unwanted medicines.

The home had robust staff recruitment policies and procedures. We found that new members of staff had been recruited in line with these policies and procedures, which complied with legal requirements.

The home had a system for managing complaints making sure that these were listened to and responded to appropriately.