Archived: Newland House

Updated 14 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 24 and 30 July and 2 August 2018 and the first day was unannounced.

The inspection team consisted of two adult social care inspectors, a medicines inspector and a specialist professional advisor, in this case a nurse.

We reviewed information we held about the service, including the notifications we had received from the registered provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We also contacted the local authority commissioners for the service and the local Healthwatch to gain their views of the service provided. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

During the inspection we spoke with five people who lived at the service and three relatives. We looked at four care plans and medicine administration records (MARs) along with other aspects of medicine management across the home. We spoke with ten members of staff, including the assistant manager, care staff, maintenance staff and kitchen staff. We looked at four staff files, including recruitment records.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We also spoke with two visiting health and social care professionals and completed observations around the service.

Updated 14 September 2018

This inspection took place on 24 and 30 July and 2 August 2018 and was unannounced.

When we completed our previous inspection in December 2015 the service was rated good. At this inspection we found the service was no longer meeting all the required standards to retain this rating.

This is the first time the service has been rated Requires Improvement.

Newland 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.

Newland House can accommodate up to 30 people in a two-storey adapted building converted from three separate properties. One area of the building was specifically providing care to people living with dementia. There was a passenger lift and a stair lift to provide access between floors. At the time of our inspection there were 16 people using the service.

There was a registered manager in post however at the time of our inspection they had been absent for two months and it was anticipated that they would not return for another two months. 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. In the absence of the registered manager the assistant manager was providing management cover with the support of the provider’s son.

Following the first day of the inspection we had a number of concerns which were shared with the provider. We invited them to submit an interim action plan to outline how they intended to address these concerns and we received this within the required timescale.

There was insufficient management support in place in the absence of the registered manager and staff morale was low. The assistant manager did not have knowledge of all processes and systems necessary to oversee the day to day running of the service. Audits and quality checks were not identifying the concerns we found during the inspection.

Some people did not have risk assessments in place to provide staff with information on how to manage and minimise all identified risks.

We looked at the systems in place for medicines management and found they did not always keep people safe.

Although fire equipment was tested we did not see any evidence of fire drills taking place.

There were insufficient staff on duty. Although basic care needs were met staff were rushed and did not have enough time to speak with people or engage in any activities. Care staff were also expected to do laundry, prepare and serve food from 1pm onwards every day and clean the service one day a week when domestic staff were not working.

People were not adequately supported to maintain a healthy diet. Up to date information on special dietary needs was not always available to staff. The mealtime experience was task orientated and staff did not always encourage people to eat before taking food away. Food and fluid records were not fully completed or reviewed.

People were not always treated with dignity. Staff spoke to people kindly and patiently during care interactions but had little time to do so when care was not being delivered.

There were no activities taking place. People were left sitting in lounge areas with no stimulation or interaction for most of the day. We were told that sometimes staff would sing with people but we did not witness this and it was not an activity tailored to individual needs.

Staff had completed all training the provider had identified as essential but they did not have additional training to meet the specific needs of the people living at the service. We have made a recommendation about this.

There were dementia friendly signs around the building, however the service had not been decorated in a dementia friendly way. There was no interactive equipment or sensory objects available to provide stimulation and reduce anxiety in people living with dementia. We have made a recommendation about this.

Staff understood people's needs and how they liked to be supported but this was not reflected in detail within care plans. Care plans contained generic task focussed information and had not been updated when reviews had identified changes in care needs.

We saw some evidence that complaints were investigated in line with the provider’s complaint’s policy but we did not see records of all complaints people had made.

Checks were carried out around the service to ensure the premises and equipment were safe to use.

Safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff had knowledge of safeguarding and were aware of the action to take if they had concerns.

Appropriate authorisation was requested to ensure people were protected against unlawful deprivation of liberty and staff supported people in the least restrictive way possible. Some people had conditions added to these authorisations but records of how these conditions were being met were not always completed.

We saw evidence in care plans to show the service worked with external healthcare professionals to maintain people’s health and we received some positive feedback from visiting health and social care professionals.

During this inspection 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.