Archived: Newland House

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.

Newland House provides care and accommodation for up to 30 people requiring nursing or personal care. On the day of our inspection there were 22 people using the service.

The home had a registered manager in place. 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.

Newland House was last inspected by CQC on 16 May 2013 and was compliant.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Thorough investigations had been carried out in response to safeguarding incidents or allegations and accidents and incidents.

People were protected against the risks associated with the unsafe use and management of medicines.

Staff training was up to date and staff received regular supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

The home was clean and suitable for the people who used the service however could be more suitably designed for people with a dementia type condition.

People were protected from the risk of poor nutrition.

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 registered provider was working within the principles of the MCA.

People who used the service, and family members, were complimentary about the standard of care at Newland House.

Staff treated people with dignity and respect and helped to maintain people’s independence.

The home had a programme of activities in place for people who used the service.

Care records showed that people’s needs were assessed before they moved into Newland House and care plans were written in a person centred way.

The registered provider had an effective complaints policy and procedure in place. People who used the service knew how to make a complaint.

The service had links with the community and other organisations.

The registered provider gathered information about the quality of their service from a variety of sources and was in the process of implementing a new quality assurance system.

We observed staff interacting well with people and saw there was a friendly and relaxed atmosphere between people living and working at the home. One person told us, 'I sometimes play games' and 'I get regular visitors.' We found that this contributed to maintaining people's welfare and promoting their wellbeing.

We found that people who used the service had a choice of food and drink and this was readily available. One person told us, 'The food is lovely; you get plenty of food and drink.' We found that there was a choice of suitable and nutritious food and hydration to meet the needs of people who used the service.

We found that people were supported by suitably qualified, skilled and experienced staff, however we found that pre-employment references had not always been obtained from the previous employer.

We found there was an effective complaints system in place at the home.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.