Archived: Newstead Nursing Home

Is the service safe? An investigation found that in August 2014, the home omitted to care for a person properly, and did not seek treatment for their health problems. Staff support and supervision had improved since our last inspection in July 2014 to help them care for people safely.

Is the service effective? Some people were at risk of poor nutrition, dehydration or choking during meals. One person had a wound which staff were not looking after appropriately. Most people did not have an up to date care plan.

Is the service caring? We spent time observing people living in the home, including using a structured observational tool (SOFI). We found that staff worked positively with people, treating them with kindness. People told us that staff were caring. Comments included, "the girls look after me, they work hard."

Is the service responsive? We found that the number of staff had increased. We found night staff continued to say there were not enough staff. People living in the home and two relatives told us that they had seen improvements in the service recently. One told us "it runs a bit more smoothly now."

Is the service well-led? The temporary manager was making positive changes. Improvements included more staff training and supervision. The provider had improved the quality of service by carrying out audits and arranging for regional managers to work in the home.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with fifteen people using the service, thirteen of the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Some staff had not yet been provided with safeguarding training to inform them how to recognise and act if they had any concern that a person at Newstead had been abused. Staff did not receive appropriate regular support and supervision to ensure that they worked with people safely and in line with best practice. The service has a quality assurance system but we found that some concerns in the home had not been identified or addressed. This put people at risk of unsafe or inappropriate care.

Is the service effective?

The service was not always effective. We found some problems with record keeping in the home. People's fluid and turning charts were not always completed accurately and some records of care given at night were completed in advance so it was not always possible to see if people had received the care and treatment they needed. People were not involved in their care plans and were not aware of what was in their care plan. They also did not choose when to have their showers so there was a lack of involvement in their own care.

Is the service caring?

Over two days we spent five periods of time observing interaction between staff and people living in the home. Staff spoke to people kindly. People told us that staff were caring. Comments included, "They are lovely. They look after us" and 'I have found staff very nice and helpful.' We observed staff showing patience and empathy when supporting people.

Is the service responsive?

We found that the number of staff on duty was based on the number of people living in the home instead of the needs of the people living in the home. We found that staff, some people living in the home and three relatives, had concerns that there were not always enough staff on duty to respond to people's needs. We observed that in the early morning staff were not able to respond to each person who wanted them as there were not enough staff to do so. Night staff had to assist an agreed number of people to get washed and changed before they went off duty which made it difficult for them to respond to the needs of other people wanting support at the same time.

Is the service well-led?

The manager of the home had not been provided with enough training or supervision and the provider had not carried out any appraisal to assess whether the manager was managing the home well. The provider had carried out some monitoring visits but had not identified some improvements needed, not ensured that other improvements had taken place and had not shown evidence of seeking the views of people living in the home to assess the quality of service being provided.

We spoke with six people, two nurses and the acting manager of the home. There was no registered manager for this service at the time of our inspection. However we were told that the acting manager intends to apply to be the registered manager.

We found that most people were experiencing care and treatment which met their needs. We looked at a sample of care records and saw that they were up to date and reflected the individual needs of people who used the service. We saw that some people had the opportunity to take part in activities during the day. We saw people's physical health was monitored and there was appropriate access to primary and secondary health care as necessary.

Systems to gather feedback from people who used the service and their families or representatives had improved. We saw that there were regular residents and relatives meetings and a survey had been conducted of relatives regarding what they expected and wanted from the service. We saw complaints had been followed up adequately.

Following the inspection visit, we received information which indicated that there were times when the staffing levels at the home had not been sufficient to meet the needs of people who used the service.

We saw that consent for different aspects of people's care was recorded. Some people had end of life preferences recorded. Staff were able to explain to us in detail the needs of different residents well which indicated they knew the people that they provided care to.

The provider had carried out an analysis of the numbers of staff needed and there were sufficient staff to meet the requirements of the service.

Staff had not received supervision since April when there had been a change in management however staff we spoke with told us they felt supported.

We found that one person had been given medicine for three days which had not been signed for or recorded by staff.

The provider conducted audits regularly including infection control, care plans to ensure that the quality of the service provision was maintained. Some concerns raised in a report regarding blood glucose levels had not been acted upon.

We spent some time observing care and support being provided and we inspected the records relating specifically to the care of six people living at the home and other general care records. We also inspected the records of five members of staff. We spoke with people using the service, relatives and staff members. We discussed the service with the home manager, the regional manager, who line-managed the home manager, and a director of the provider company, Gold Care Homes.

We found that the standard of care had improved sufficiently to justify the rescinding of the warning notice. Staffing levels were generally sufficient, but new and imminent vacancies at senior level in the home mean the service has remained non-compliant on staffing and we have again set a compliance action.

This inspection was carried out over two days. We visited the home during the evening of the 30th October 2012 and returned the following day. We spoke with people using the service and visiting relatives. We also spoke with the manager and four staff members and observed care being provided. We looked at records relating to the care of people in the home.

We found that some improvements had been made and the compliance actions relating cleanliness and infection control and support given to workers had been met. We did however have concerns regarding the level of staffing at the home and the consequent effect that had on the quality of care provided. We also found that whilst there had been some improvements in care, such as supporting people to wear clean clothing and suitable footwear. There were also areas where care was not satisfactory, including enabling each individual to get the care they need, the provision of suitable activities and ensuring staff attitude and approach is of a consistently high standard.