The inspection was carried out on 25 October 2018 and 6 November 2018. The first day of the inspection was unannounced.

Newhaven is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection

Newhaven is registered to provide support for up to 16 people. At the time of our inspection 12 people were living there. At the time of the inspection the home was registered with CQC to provide services for older people. In fact, it provides services for people with a learning disability, many of whom are older people, as recorded within previous inspection reports. We discussed this with the registered manager during the first day of the inspection following which they submitted the relevant paperwork so that this could be rectified.

The home has a registered manager. 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. The registered manager is also the provider and has worked at the home since it opened over 20 years ago.

At our last inspection of the home in June 2017 published in August 2017 the service was rated ‘requires improvement overall. At that inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 12, safe care and treatment. This was because risks to the health and safety of service users had not been consistently assessed.

After that inspection the provider wrote to us to say what they would do to meet their legal requirements. At this inspection we identified that improvements had been made with regard to Regulation 12 and the provider was no longer in breach of this regulation. This was because risks to the health and safety of service users had been assessed and plans put into place to reduce known risks.

In June 2017 CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability. At this inspection we assessed the service in line with this guidance.

During this inspection we found breaches in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider’s systems were not always effective at monitoring and improving the service people received. In particular no system was in place for checking that the home was providing support to people in line with current best practice guidance for supporting people who have a learning disability.

We also found a breach of Regulation 18 of Care Quality Commission (Registration) Regulations 2009. This was because the provider had failed to notify us of incidents that had occurred in the home in accordance with our statutory requirements. This meant that we did not have all of the information needed to effectively monitor the service.

Newhaven did not always meet the values and principles of Registering the Right Support and associated guidance. Current good practice guidance encompasses the values of choice, independence, inclusion and living as ordinary a life as any citizen. The size and layout of Newhaven means it does not always operate of feel like an ordinary home.

Some of the practices within the home were institutional and not personalised for individuals. Examples of this included, some staff wearing uniforms, a large sign outside of the home and the use of plastic crockery for everyone.

Systems were in place for safeguarding people from the risk of abuse and reporting any concerns that arose and staff knew what

Newhaven is residential care home for up to 16 people who have a learning disability; at the time of our inspection 14 people were living at the home. The home is in two joined domestic style properties in a residential area of Wirral. The first floor was accessible by stairs and a stair lift. Most accommodation is in single rooms, two of the rooms are shared rooms. The home has been owned by the same family for over 20 years.

At the last inspection in March 2015, the service was rated Good. At this inspection we found the rating for the service changed to requires improvement as there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Safe care and treatment. This was because the fire risk assessment was not individualised and specific to Newhaven care home. Also there were no personal emergency evacuation plans in place to give guidance to staff in case of emergency. We also found that risk assessments in people’s care files had not always highlighted risks present in providing people’s care which could be mitigated in care planning. You can see what action we told the provider to take at the back of the full version of the report.

The home required and had a registered manager. 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.

People living at the home told us that they were happy, well cared for and they felt safe living at Newhaven. One person told us, “I’ve been here for 14 years. I love it here”. People’s relatives we spoke with told us that they had confidence in the staff and management of the home. One person’s relative told us they thought “Staff go beyond what you would expect”. Another family member told us the managers were, “Very approachable, like an add on family, we sit down and talk like family”.

We saw that there were sufficient experienced and qualified staff on duty to meet people’s care and support needs. Staff had received regular training and refreshers of training, for example in safeguarding vulnerable adults and administering medication. Staff knew people well and had positive relationships with them. This contributed to a friendly and relaxed atmosphere at the home. People were supported in many different activities both in the home and in their community.

People told us they liked the food, there was choice and people’s special requests were catered for. The kitchen had been awarded the highest rating of five star by the local authority environmental health team. The home environment was clean, fresh smelling and well maintained. There had been improvements made to the home since our last inspection.

People had individualised support plans in place which highlighted their wishes and preferences with regard to their support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s relatives told us that they felt the registered manager and deputy manager were friendly and approachable. In many areas the service was well led and we saw that the managers made regular checks and audits of areas within the home. However these checks had not addressed our concerns with planning for emergencies and assessing risk in people’s care.

Staff working at the home were able to understand people’s needs and choices and there was evident warmth and respect between the staff and the people who lived at the home. People’s needs and preferences were recorded in their care plans and reviewed regularly. A minibus was available for trips out. People we spoke with said that they always had plenty to eat including fresh fruit and vegetables. People we spoke with said that they felt safe living at Newhaven and one person said “I would soon tell them if I wasn’t happy, we’re not scared to speak up”.

People’s medicines were well managed to ensure that they always received what was prescribed by their doctor.

All of the staff had recently completed an eight week course leading to a Certificate in Understanding Working in Mental Health. They had also attended other relevant training.

People living at Newhaven were older people who had a learning disability and had spent much of their lives in a care setting. All except one had lived at Newhaven for a long time. We saw two questionnaires that had been filled in recently by family members. One relative commented that the person they visited “always seems happy and well looked after”, and the other wrote that their relative was “very happy and loves the staff, no complaints whatsoever”.

People who lived at the home were free to choose how they spent their time and had unrestricted access to all parts of the house. Most people had limited verbal communication, however it was evident from smiles and hugs and from the general atmosphere in the home that people felt happy and comfortable. The home had a minibus and most people went out to use leisure facilities in the community including the local theatre. All of the staff team had recently completed the Northern Council for Further Education level 2 certificate in Equality and Diversity.

A district nurse who was visiting the home told us “The care is absolutely outstanding here.” A feedback form that had been filled in recently by a community staff nurse stated “I have always been met with helpful and respectful staff. All clients are nicely presented and appear happy. We have always felt instructions have been met and any concerns carers had were discussed openly with us.”

The inspection took place on 8th and 13th October 2014 and was unannounced on the first day. The service was a domestic style property in a quiet residential area, which was a care home for up to 16 people who had a learning disability. The home had been owned and managed by the same family for more than 20 years and the manager was registered with the Care Quality Commission. 

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 and associated Regulations about how the service is run.

Most people had lived at Newhaven for many years and considered it to be their home. There was a small team of ten staff, all of whom had completed a national vocational qualification in care at level 2, 3 or 4. During our visit we saw that there were enough staff to support people and meet their needs, and everyone we spoke with considered there were enough staff.

The staff we spoke with were able to tell us the action they would take to ensure that people were protected from abuse. All staff had received training about safeguarding and were booked to update their training with the local authority in the near future.

We found that the home was clean and well-maintained. Records we looked at showed that the required safety checks for gas, electric, and fire safety were carried out and a monthly fire practise was held.

We found that medicines were managed safely and records confirmed that people received the medication prescribed by their doctor.

People we spoke with confirmed that they had choices in all aspects of daily living.  Menus were flexible and alternatives were always provided for anyone who didn’t want to have the meal that was planned. People we spoke with said they always had plenty to eat.

People were all registered with a local GP practice and had an annual health check carried out by the primary care team. District nurses supported people who had health needs and provided support with end of life care so that people could stay in their own surroundings when they became terminally ill. The care plans we looked at gave details of people’s medical history and medication, and information about the person’s life and their preferences. 

People were encouraged to complete satisfaction surveys and we saw that people who lived at the home, relatives, and visiting professionals had all done this. The manager told us that he was keen to learn from any comments that people made.