Archived: Newsome Nursing Home

Newsome Nursing Home is a residential care home providing personal and nursing care for up to 46 people, including people living with dementia. At the time of inspection there were 19 people living at the service.

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

Risks in the service to individual people and in general were not always known, robustly assessed, mitigated or managed. There was no one with any oversight of clinical risk when we arrived on the first day of the inspection. Care records had improved but they still did not always contain enough detail to enable staff to support people safely.

Initially, there were insufficient staff; people living with dementia in an adjacent part of the building were without sufficient staff to support them. Staff were not always supported with supervision and role specific training, to ensure they had the knowledge and skills to support people safely. The service had experienced a recent large turnover in the staff team. Staff morale was low and staff were actively leaving the service on the first day of the inspection.

We had urgent discussions with the provider and the local authority and found by day three of the inspection, there were enough care staff and ancillary staff on duty and they were working well together. Staff were better supported and deployed more effectively; there were two staff working in the adjacent part of the building and care was being provided much more safely.

On the first day of the inspection, there was a lack of clear leadership in the service. There was a new manager in post, not yet registered, and the regional manager had recently left without notice. There was no clear clinical leadership or oversight of risks in the service.

We raised concerns with the provider, who took swift action to mitigate the risks identified. The new manager had been in post only a short time at the point of inspection but was getting to know the people and staff very quickly.

People were not routinely using the living areas, and the management team was continuing to consider how this could be improved. There was evidence of work being done to make the environment more homely. The provider had ensured improvements to infection prevention and control procedures. The premises were clean, with regular cleaning taking place.

By day three of the inspection, feedback from staff was overwhelmingly positive and staff morale had significantly improved. They reported feeling well supported and valued, mostly they said because of the new management team being involved and helpful. Staff who had left were back in post with some new enthusiasm. There were identified responsibilities agreed, clear direction and a cohesive management team.

At the last inspection, staff did not always use respectful terminology when speaking with or about people. People were spoken to in respectful ways and the staff used appropriate language.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, some improvements had been made to address the breaches of regulation, but there had been a recent deterioration due to changes to management in the service. The provider responded swiftly to the initial inspection feedback and took steps to address the concerns before the inspection was complete.

Rating at last inspection and update

This service has been in Special Measures since September 2021. During this inspection the provider demonstrated that sufficient improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

The overall rating for the service has changed from Inadequate to Requires improvement. This is based on the findings at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Newsome Nursing Home is a residential care home providing personal and nursing care for up to 46 people, including people living with dementia. At the time of inspection there were 28 people living at the service.

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

Health and safety risks at the service were not always assessed, monitored and managed effectively. Parts of the environment were in need of refurbishment and placed people at increased risk of harm.

Care records did not always contain enough detail to enable staff to support people safely. The provider did not fully take into account people’s dependency needs and there were not always enough staff to meet people’s needs in a timely way.

Systems in place to monitor the service had not been effective in identifying and addressing areas requiring improvement. Lessons learned from accidents and incidents were not identified and were not used to make improvements to the service.

Staff did not always use respectful terminology when talking to people. We made a recommendation that the provider takes action to address and monitor staff interactions with people to ensure that this is consistently respectful.

The service had not acted upon feedback obtained from people and relatives to inform improvements in quality and safety.

Infection prevention and control (IPC) processes and procedures were in place however some aspects relating to IPC required improvement.

People were safeguarded from the risk of abuse. The service worked in partnership with other agencies to support people and people felt that staff knew them well.

Staff received appropriate training and support in order to fulfil their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 24 January 2020). This service has been rated requires improvement for the last four consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvements to the service had not been made and there are multiple breaches of regulation.

Why we inspected

The inspection was prompted in part due to concerns received about the environment, health and safety and culture at the service. 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 previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Newsome Nursing Home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and 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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Newsome Nursing Home provides care and support for up to 46 people, including people living with dementia and people requiring intermediate care. There were 34 people living at the service when we visited on the first day and 32 people on the second day.

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

Most people shared positive feedback about living at the service but others told us some areas could improve, such as the provision of activities.

Most risks to people’s care were appropriately identified and assessed. However, we found management’s oversight had not always been robust in this area. For example, to ensure equipment available to move people was always safe, the necessary fire safety checks had always been completed and care was always being recorded in line with people’s requirements.

There were mixed views about the staffing levels at the home but we did not find evidence of this having a detrimental impact on people’s care.

We could not be sure people and relatives had always been involved in making decisions about the care people received. We have made a recommendation for the registered manager to involve people in planning their care.

At the last inspection, we found concerns about the safe administration of people’s medicines and the delivery of person-centred care. At this inspection we found improvements in both areas.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to access relevant healthcare services when they needed them, and they were supported to eat and drink well.

Most people told us they were cared for by staff who were caring and respectful. People's independence was promoted.

People were kept safe from avoidable harm and abuse by staff who knew how to identify and escalate concerns.

There were systems in place to monitor and improve the quality of the service however these had not always been effective in identifying the issues found at this inspection.

The registered manager was open to the inspection process and responsive to the issues found and areas identified as requiring improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 December 2018) and we found two breaches in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider had addressed the two breaches in regulation previously identified but a new one was found at this inspection.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Newsome Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Newsome Nursing Home is a registered nursing home in a quiet residential area of Huddersfield. The home provides accommodation for up to 46 people with residential, nursing and dementia care needs. The home consists of two linked houses; Newsome Court and Newsome Lodge. The ground floor of Newsome Court is dedicated to the care of people living with dementia. At the time of our inspection the home had six intermediate care beds. Accommodation in both houses is provided over three floors, which can be accessed using passenger lifts.

At the time of our inspection the manager was registered with CQC. 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.

All but one person told us they felt safe living at this service. We discussed one person’s concerns with the registered manager who took appropriate action. An unplanned fire drill on day two of the inspection was well managed.

The management of medicines was not always robust as body maps for the use of topical creams and patches used for pain relief were not in place. Some members of staff responsible for the administration of medicines had not received up-to-date training in this area and they did not have a recent assessment of their competency.

Recruitment procedures were not entirely robust as a last employer reference had not been taken for one staff member, although all other staff files checked demonstrated satisfactory background checks were completed.

There were sufficient numbers of staff in the home, although the registered provider did not use a dependency tool to assess people’s needs and calculate the number of staff required. People’s nutritional and hydration needs were not being fully met as staff had not routinely recorded where people had snacks part way through the day. We also found snacks were not routinely available for people who needed a soft diet.

Feedback from people and relatives about staff was complimentary. People confirmed their privacy and dignity was respected by staff. Staff were familiar with people’s care needs, although recording in care plans was not found to be person specific in some aspects of people’s care. Electronic care records were missing people’s interests and their personal history. People and staff told us the activities programme required improvement. Newspapers and magazines were provided for people to stay in touch with local and national news.

The principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) were being met, although staff knowledge of DoLS required improvement. Evidence we saw showed people were supported by staff to access healthcare services.

People knew how to complain. Complaints were appropriately managed and responses were sent to people within identified timescales.

The registered provider invited feedback from people and relatives through meetings and surveys regarding the running of the home. Feedback regarding the registered manager was very positive with people, relatives and staff noting how supportive they were.

Supervision and appraisals were seen to be detailed and covered staff development. The training matrix showed staff were up-to-date with their training programme.

Audits were seen to be accompanied by action plans which had been completed. However, we found some concerns seen at this inspection had not been identified through the programme of audits.

The registered manager and regional manager were found to be responsive to the issues we identified during our inspection and took immediate action to remedy these concerns. You can see more details regarding this in the main body of the report.

We have made a recommendation about the registered provider introducing a dependency tool and regularly reviewing this, regularly holding relatives and staff meetings as well as the provider adding end of life care to its mandatory training.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

Newsome Nursing Home is a registered nursing home in a quiet residential area of Huddersfield. The home provides accommodation for up to 46 people with residential, nursing and dementia care needs. The home consists of linked houses, Newsome Court and Newsome Lodge. Five bedrooms of Newsome Court are provided to support the care of people living with dementia. Accommodation in both houses is provided over three floors which can be accessed using passenger lifts. There are secure gardens which provide a private leisure area for people. There were 33 people in the home on the days we inspected, four of whom were living in Newsome Court.

There was a registered manager in post although they were on leave on the first day of the inspection. We did speak with them on the second day. 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 found therse had been considerable changes to the home since our last inspection, most notably in the attitude of staff which helped to promote a welcoming and positive atmosphere within the home.

People told us they felt safe and we were confident staff knew how to acknowledge and respond to any concerns around potential abuse or neglect.

Although risk assessments were in place they were not always detailed enough and did not always get updated following an incident. Combined with a lack of robust equipment audits this meant risks to people were not always minimised to reduce the likelihood of harm. This is a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as not all risks had been identified meaning people were being placed at the potential risk of harm through faulty equipment. The registered manager implemented an immediate plan to address these concerns and we saw evidence of this following the inspection.

Staffing levels were appropriate to the needs of the people in the service and we saw people being responded to promptly and with care. Medicines were stored in line with requirements and the home had effective policies and procedures in place for staff to follow which we observed in their practice.

People told us they enjoyed the food and there was plenty of it. We observed people being offered drinks throughout both days and supported with their nutritional needs as required. External health and social care support was requested when required and we saw evidence of other professionals’ views being integrated into the care plans.

The registered manager understood the requirements of the Mental Capacity Act 2005 well and we saw evidence of appropriate authorisations in place where people’s liberty was deprived.

Staff had a pleasant and friendly manner with people, and it was evident they knew people well. They promoted people’s dignity and privacy at all times. There was ongoing interaction throughout both days in terms of activities and conversation with people, assisted by the activities co-ordinator who amended their plans according to people’s wellbeing and preferences.

Care records were detailed and person-centred, reflecting people’s needs and choices. There was good cross reference between risk assessments and other documentation to enable staff to access all key information quickly. We found care records were updated in a timely manner.

Complaints were handled in depth and thorough investigations conducted where necessary.

The registered manager was fully aware of all key events in the home and was able to relay all recent changes. We found the audit system was not robust enough to identify some of the concerns we noted in relation to equipment but had confidence this would be taken forward and urgent improvements made. This was evidenced following the inspection where photographic and documentary evidence detailed the changes made.

You can see what action we told the provider to take at the back of the full version of the report.

During our last inspection on 1st August 2014 we had found the provider was not meeting this standard because there were not adequate systems and practices in place to manage medicines safely.

During this visit we found the provider had addressed all the regulatory breaches.

We asked a registered nurse about the safe handling of medicines to ensure people received the correct medication. Answers given demonstrated that medicines were given in a competent manner by well trained staff.

During our inspection on 1st August 2014 we found staff were not able to safely deliver care and treatment because the provider was not ensuring staff received appropriate professional development, supervision and appraisals.

During this inspection we found that whilst some progress had been made the provider was still in breach of this regulation.

The provider was not adhering to its own standard of a formal supervision meeting every three months nor was staff appraisal a feature of the service.

We saw mandatory training requirements were adhered to with staff describing the training as being of a high quality.

We spoke with two people receiving care at the home both of whom were complimentary about the staff and their skills.

When we visited Newsome Nursing Home in February 2014 we found records were not being adequately maintained and there were issues around the management of medication. We asked the provider to make improvements. We went back on this visit to carry out a full inspection and check whether improvements had been made.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

People were protected from abuse and avoidable harm.

Staff were suitably qualified and had the knowledge and experience needed to carry out their role. Staff we spoke with knew how to recognise and report abuse or allegations of abuse.

People were cared for in an environment that was safe, secure, clean and hygienic.

There were sufficient numbers of suitably qualified staff to meet the care needs of the people who lived at the home.

We found some issues with medications regarding safe storage temperatures.

Is the service effective?

From our observations and from speaking with staff, people who lived at the home and relatives, we found staff knew people well and were aware of people's care and support needs.

We found staff had received appropriate training to meet people's needs, although there were some issues with refresher training.

We spoke with people, relatives and their visitors who all told us they were happy with the care provided at the home. They confirmed people's care, treatment and support needs were being met. One relative said; '[Relative] couldn't get better anywhere else.'

This showed us people's care, treatment and support at the home achieved good outcomes.

Is the service caring?

We observed staff interactions with people throughout the day. People who lived at the home were supported by kind and attentive staff. Staff were patient and encouraging when they were supporting people.

One of the relatives we spoke with told us, '[Relative] has dementia so can be difficult to deal with but they are great. They never rush him.' Another person's relative told us; 'They give [relative] time and choice. Like when he's choosing food, they wait until he's decided.' This confirmed what we observed during the visit. Care staff encouraged people to be independent as possible. This showed us staff treated people with compassion, kindness, dignity and respect.

Is the service responsive?

Since our inspection in February 2014, measures had been put in place to monitor and manage issues we found around the management of medications. However, we found there were still issues with storing medications safely. The regional manager told us there were plans underway to resolve these issues. They told us they would send us details of the work to be undertaken. We received this via email on the same day as our inspection.

People were supported to maintain relationships with their friends and relatives. Some people who lived at the home told us there were 'not a lot of activities at the home but it's never boring because we all chat.' One friend told us they regularly visited the person who lived at the home but were unable to take him out. The friend told us, '[Person living at the home] is getting the best support they can but it's difficult for staff at times. They can't take him out because he has advanced dementia.'

Care and support was provided in accordance with people's wishes. We saw from the care records and daily records that people's preferences, interests and diverse needs were taken into consideration. This meant the home was well-organised so that it met people's care needs.

Is the service well-led?

The leadership and governance of the home assured the delivery of high quality care for the people who lived there. We saw the home had quality assurance processes and systems in place to monitor the care provided to people. For example, we saw evidence of regular auditing of care records.

Staff told us they were clear about their responsibilities and felt well supported by the management team. They told us they could go to the manager or regional manager if they had any issues or wanted to raise anything and were confident that every effort would be made to ensure these issues were resolved. This showed us the home supported learning and innovation and the managers promoted an open and fair culture.

We found the home had made some improvements, but we also found there were still some issues in both areas.

We found staff at the home did not always complete food diaries and some weight management records were calculated incorrectly. Records of multi-agency visits were kept in different areas of care records. We also found there were not always appropriate arrangements in place for the safe management of medication.

We observed staff interactions with people who used the service and found they were professional and caring in their approach. We saw hot drinks were available for people throughout the day and snacks were offered to people, including biscuits.

We spoke with five people who used the service and three care staff members. Everyone we spoke with who used the service told us they liked living at Newsome Nursing Home. They told us the home was always kept clean and tidy and all staff spoke to them with respect. Staff members we spoke with said they felt supported and happy in their roles.

On the day of our visit there were 38 residents living at Newsome Nursing Home. The manager told us 14 of these were residential and 24 required nursing care. Six residents were living in the dementia unit in Newsome Court. This unit had recently opened and could accommodate up to eight residents.

We observed that the home was clean but untidy; the manager told us there was a general lack of storage space at the home. Some areas were observed to be in need of refurbishment and renovation and residents in the dementia unit told us they were cold. The manager told us parts were on order for the heating system and plans were in place to replace flooring in several communal areas and bedrooms.

During our visit we observed residents interacting with staff in the lounge and dining areas in the two houses. We spoke with the registered manager, regional manager, two nurses, two care assistants, maintenance man, activities coordinator, eight residents and three relatives. We looked at four sets of care records and saw resident's individual needs were assessed and care and support was developed from this information. Residents appeared clean, well-dressed and well cared-for.

As part of our inspection we looked at medicines management and record keeping at the home. We found there were improvements needed in both of these areas. We will be carrying out a follow up visit to check that improvements have been made.

The residents we spoke with all told us they received good care. Comments included, 'I'm very happy with my care, the girls are good' and 'Me and the staff get on well together.'

One relative we spoke with said, 'Everyone has been really helpful in settling us in, anything we have needed they have helped us with'. Another relative told us, 'Staff have been very good. They make us so welcome.'

One of the care assistants we spoke with said, 'I like it here, because the people living here are given choices in what they want.' They also told us, 'I would feel ok approaching the manager if I had a problem.'

When we asked residents about the food they told us:-

'The food's great, we always have enough to eat.'

'I always enjoy what I eat.'

'Very good food, I'd rather be here than at home on my own.'

When we visited the service in February 2013 we found that the home was not compliant with the regulations relating to supporting workers (Regulation 23).

At the inspection visit in February 2013 we found that care staff were not receiving regular management supervision or appraisals, staff meetings were infrequent and communication systems for updating staff about changes were not robust. We went back on this visit to check that changes had been made.

On the day of our visit there were 31 people living at the home and the home employed 54 staff. During our visit we spoke with the registered manager, the deputy manager and a member of staff.

The deputy manager and staff member we spoke with told us they had both had recent supervision sessions. We looked at recent staff supervision records and the supervision and appraisal matrix which recorded dates of planned and completed sessions.

We got a mixed response when we asked staff about the frequency of staff meetings. One member of staff thought staff meetings were held frequently enough. The other member of staff said 'I do think we need more frequent staff meetings.'

The manager told us the home was planning to hold a general staff meeting for all staff to attend once a year. They also told us they were planning to hold three meetings each year for each department, such as care assistants and nurses. This would enable the meetings to be pertinent to each group.

On the day of our visit there were 27 residents living at Newsome Nursing Home. During our visit we observed residents interacting with staff in the lounge area. We spoke with the registered manager, operational manager, regional manager, director, four care assistants, three residents, and two relatives. We saw resident's individual needs were assessed and care and support was developed from this information.

The four care assistants we spoke with said they felt care at the home was good and they felt well-supported. Comments from care assistants included:-

'We work well as a team'

'I love doing what I do'

'The families are important to us'

'The care is good; I'd trust them here I really would'

One resident told us "They could really do with more staff; they have a lot to do. It would be nice to have time for a chat".

Care assistants received appropriate training for their role and understood the importance of reporting suspected abuse.

The relatives we spoke with told us the staff at the home regularly updated them about their relatives' health and welfare, they felt the care was good and they were involved in care decisions. One relative told us 'The staff there are fantastic and never disrespectful'; and another relative said 'I am really happy with the home; I have no complaints at all'. They told us they felt their relatives were safe living there.