Archived: Newton House

Updated 28 November 2019

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

The inspection was prompted in part by whistleblowing and the lack of ongoing assurance that the required improvements were being implemented following the last inspection.

Inspection team:

The inspection of Newton House was completed by one inspector. A team of inspectors inspected the other locations which are situated on the same site.

Service and service type:

Newton 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 service did not have a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. There was an interim home manager in post at the time of the Inspection.

Notice of inspection:

The inspection was unannounced.

What we did:

We obtained feedback from one person using their preferred method of communication. We spoke with the interim manager, the nurse and two care staff.

We looked at one person’s care record and other records relating to the management of the service.

Updated 28 November 2019

About the service:

Newton House is a care home providing personal and nursing care to 11 people with progressive neurological conditions. It is one of six adult social care locations and a hospital registered separately with CQC that are on the same site.

Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. While each of the services are registered separately some of the systems are managed centrally for example maintenance, systems to manage and review accidents and incidents and the systems for ordering and managing medicines. Physiotherapy and occupational staff cover the whole site. Facilities such as the hydrotherapy pool are shared across the whole site.

One adult social care location (Pembroke Lodge) is currently closed as there were ongoing and continual issues with the provision of heating and hot water.

The hospital is also currently closed due to a flood caused by a major water leak. People from the hospital were transferred at short notice to some of the adult social care locations on site. Works to repair the fabric of the hospital building are currently underway. People from the hospital were not being accommodated at Newton House.

People’s experience of using this service:

The service did not have a registered manager in post. The service was being managed by an interim manager.

People were placed at risk from poor management. We found systemic overarching poor management systems and that improvements were not prioritised. There had been sudden and persistent changes of senior managers. There was a lack of regulatory response from the provider. There were poor recruitment procedures, and a lack of investment with equipment and maintenance of the property. The morale of the staff was low and they were reluctant to give feedback because of fear of reprisals. This had an impact on the care people received.

Whilst we saw that some improvements had been made these were not sufficient to improve the ratings. Improvements had been made since the focus inspection dated November 2019 with the provision of equipment. However improvements with the supply of equipment had not always resulted in better outcomes for people. The environment still required improvement and there were still concerns about maintenance of the premises

People were not always protected from risks associated with their conditions. Medicines continued to be managed in a way that was not always safe.

Some staff were positive about management changes and felt supported by the home manager of Newton House.

There were still concerns about staff trust in the provider and the overarching management systems for the site as a whole. There continued to be a clear disconnect between management on the Glenside site and the provider resulting in poor responses to the areas of concerns identified by CQC; partner agencies and as a result of the previous inspections.

Rating at last inspection:

Requires improvement. Full comprehensive inspection published 2 October 2018.

Why we inspected:

This inspection was brought forward due to information of risk or concern. Following the comprehensive and focus inspections CQC have received on going whistleblowing concerns. After the last inspection CQC requested assurances from the provider about the action they would take to improve the service. To date these assurances have not been forthcoming.

Enforcement:

Following the last inspection we imposed a condition on the providers registration to submit monthly improvement action plans to CQC. However, the action plans from February 2019 had not been received.

Follow up:

The overall rating for this service has changed to Inadequate. We are placing the service in 'special measures'. This means that it has been placed into special measures by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

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