This inspection took place on 24 and 26 September 2018. The first day was unannounced, however we informed staff we would be returning for a second day to complete the inspection and announced this in advance.

Newlands care home is registered with the Care Quality Commission to provide care for up to 30 older people. The home provides accommodation across two floors and provides both residential and nursing care. The home is located on Tetlow Lane in Salford and is close to local transport routes into Manchester city centre. The home provides care to people who are of Jewish faith, although people of all religions are welcome.

At the time of the inspection there were 23 people living at the home.

Newlands 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.

At our last inspection of Newlands in September 2017, the home was rated as ‘Requires Improvement’, with three breaches of the regulations identified. These were with regards to safeguarding people from abuse, good governance and staffing. A warning notice was also issued because of unsafe staffing levels within the home. Following this inspection, we were sent an action plan by the home which detailed the improvements the intended to make.

This comprehensive inspection checked to see if the concerns from the previous inspection had been addressed. We found improvements had been since our last inspection visit.

There was a registered manager in post. 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 people we spoke with said the food served at the home was of good quality and we saw people being supported to eat by staff at meal times. People were weighed on a regular basis and more frequently if they were identified as being at risk of losing weight. Suitable facilities were available to cater for Kosher diets where people required this as part of their religion.

We saw the home responded appropriately where people had lost weight. However, we recommend actions set during the monthly weight audits done within the home, such as offering people higher calorie foods, are clearly documented within people’s food and fluid intake sheets as being either offered, consumed or refused by people. Also, that people’s nutritional supplements are clearly documented on both MAR and fluid sheets to ensure records of fluid people had consumed were accurate.

We saw people’s fluid charts indicated people received good levels of fluids throughout the day. However we recommend the targets staff should encourage people need to consume are clearly documented within care plans so that staff know how much people need to drink each day. We raised these issues with the registered manager during the inspection feedback, who immediately sent us copies of updated documentation where this information would be recorded.

We found there were enough staff to care for people safely, with staff having access to appropriate training to support them in their role. The registered manager told us the provider was now more willing to provide additional staff if people’s care needs increased, or if occupancy increased.

The service was now working within the principles of the MCA (Mental Capacity Act), with capacity assessments and best interest meetings held where people were unable to consent to their care and treatment.

Improvements had been made to overall quality monitoring systems to ensure the service was being monitored effectively.

People who used the service and their relatives told us they felt the service was safe. T

This unannounced inspection took place on 11 September 2017. At our previous inspection in April 2015 we found that the service was not always responsive and there was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection although we found that the provider was no longer in breach of this regulation we had further concerns that the service was not consistently safe, effective, caring, responsive or well led. We found three further breaches of regulations. You can see what action we have taken at the end of the report.

Newlands Care home provides accommodation, nursing and personal care to up to 30 people. At the time of the inspection there were 30 people using the service. The service is designed to meet the religious and cultural needs of the Jewish community.

There was a registered manager in post who supported us throughout the inspection. 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.

There were insufficient numbers of suitably trained staff to keep people safe and meet their needs in a timely manner. The provider had not responded to the registered manager's request to increase the staffing levels to ensure people's needs were met.

Risks of harm to people were reduced, however some action taken to reduce the risks may not have been the least restrictive.

The principles of The Mental Capacity Act 2005 (MCA) was not consistently followed to ensure that people who lacked the mental capacity to agree to their care and support were supported by the legal representatives to agree in their best interests.

Staff were trained to fulfil their roles, however further supervision was required to ensure that staff practice was safe and appropriate.

People did not always receive care that met their assessed needs or individual preferences and their independence was not always promoted.

The registered manager and staff knew what to do if they suspected abuse and followed the local safeguarding procedures.

People's nutritional needs were met and if their needs changed or they became unwell health care advice and support was gained.

People's medicines were managed, stored and administered safely by staff who had been trained. Staff were employed using safe recruitment procedures to ensure they were of good character and fit to work.

People were supported to engage in hobbies and activities and their religious and cultural needs were met. Staff were kind and compassionate with their interactions with people.

There was a complaints procedure and people were regularly asked their views on the service. Action was taken when people raised concerns.

The registered manager was well liked and respected by people, relatives and staff.

This unannounced inspection took place on 30 April 2015.

Newlands care home is located in the Salford, Greater Manchester and is owned by Angel Care plc. The home is registered with the Care Quality Commission (CQC) to provide care for up to 30 people. The home provides care to those with both residential and nursing care needs. We last visited the home on 13 September 2013 and found the home was meeting the requirements of the regulations, in all the areas we looked at.

There was a registered manager in post. 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 people we spoke with and their relatives told us that they felt safe whilst living at the home. One person said to us; “To fend for myself was difficult and I feel safe because I’m taken care of here. I’m as happy as I could be”.

We looked at the accidents and incidents which had taken place at home which identified that one person had fallen five times between the 1st of January 2015 and 1st of April 2015. Both the care plan and falls risk assessment had not been updated to demonstrate what staff were doing to prevent this from happening again in the future and a referral to the falls service had not been made. This meant that this person could be placed at risk. This was a breach of regulation 12 of the fundamental standards with regards to safe care and treatment. You can see what action we told the provider to take at the back of the full version of this report.

We found medication was handled safely and that people received their medicines at the times they needed it.

During the inspection we spoke with staff about their understanding of safeguarding vulnerable adults. Each member of staff was able to describe the process they would follow if they suspected abuse was taking place. One member of staff said; “I would go straight to the manager but if nothing got done I would speak with the head office”.

We looked at staff personnel files to ensure that staff had been recruited safely, with appropriate checks undertaken. Each file we looked at contained application forms, CRB/DBS checks and evidence that at least two references had been sought from previous employers. Additionally, we saw there was a system in place to monitor when the personal identification numbers (PIN) of nurses working at the home expired.

The home used a matrix to monitor the training requirements of staff. This showed us that staff were trained in core subjects such as safeguarding, moving and handling, infection control and health and safety. Each member of staff we spoke with told us they were happy with the training and support available to them.

We observed the lunch time meal served at the home. We saw staff displayed a good understanding of people’s nutritional needs and offered choice where necessary. Some people required a ‘pureed’ diet and we saw this was provided for them in order for them to consume their food safely. The vast majority of people who lived at the home were of Jewish faith and we saw their religious beliefs were adhered to, particularly at meal times.

We saw that staff received regular supervision as part of their on-going development. This provided an opportunity to discuss their workload, any concerns and any training opportunities they may have. We saw appropriate records were maintained to show these had taken place.

The people we spoke with and their relatives told us they were happy with the care provided by the home. One person said to us; “The staff are fantastic. You wouldn’t get better anywhere. They will do anything for you”.

We saw that people were treated with dignity, respect and were allowed privacy at times they needed it. We saw people looked clean, were well presented and were able to choose how they spent their day which was respected by staff.

We found that complaints were responded to appropriately, with a policy and procedure in place for people to follow when they needed it. Additionally, we saw that a response had been provided to the complainant, letting them know of any action that had been taken.

The staff we spoke with were positive about the leadership of the home. One member of staff said; “The manager is very dedicated to the job. Things get done”.

There were various systems in place to monitor the quality of service provided to people living at the home. These included a monthly managers audit and by gaining feedback from the service through surveys which were sent to relatives and people who lived at the home.

There were 28 people living at Newlands on the day of our inspection. Throughout the day we spoke to four people who used the service. Comments included; “I have lived here for about four years now. I like it here, I’m happy. The staff are very good. They help me to wash, dress and give me my medication. I go to the local synagogue as well”. Another person said to us; “I have been here for about seven years. I couldn’t cope on my own at home but this is the next best place I would say. The carers are good I can’t fault them. They help me with physical tasks like toileting, washing and assisting me to bed”.

We looked at how people’s nutrition and hydration requirements were met and observed part of the lunch time period. This was an organised occasion and people who required assistance to eat and drink were appropriately supported by staff.

We checked the suitability of the premises and found they were fit for purpose. We spoke with four people's relatives during our inspection, two of whom commented that the building needed decoration in places. One relative said to us “It certainly isn’t the most modern place you will see and does need updating in places”.

We also looked at the systems in place to monitor the quality of service provision and recruit staff safely and effectively. This included regular home audits, quarterly surveys and ensuring references and a CRB were produced for all staff.

Not all people were able to tell us about their experiences or give us their views of the service they received. However we were able to speak to some people who could tell us their views. Those people who were able told us that they were consulted about their care, treatment and the support options which were available to them. They said that their views were sought and were acted upon so they felt they were central to the decisions being made about their care. Relatives visiting the home also told us they found the care at the home good and that staff attend to people’s needs in a respectful and dignified way.

We looked at how people were protected from harm at the home. We saw there were robust systems in place to protect people. There were policies and procedures to guide the staff and regular training in place to make sure staff were clear about their role in protecting vulnerable people.

We looked at how well staff were supported whilst they worked at the home. Staff told us they felt very well supported and they felt they worked well as a team. Staff told us they had supervision with the manager and appraisal systems were in place. We also looked at the staff team meetings and saw these were held regularly.

People living at the home and the staff confirmed they knew how to raise concerns. There were good systems in place to make sure people were listened and individuals were confident their concerns would be and dealt with promptly.

During our visit people told us that they liked living in the home. People said staff cared for them well and they were happy with the way staff supported them. They told us medical attention was provided when they needed it. Overall, people told us they felt safe and were happy with the service provided at the home.

Comments made included:

"Mum is always well presented, she's looked after and is well loved. It's small and intimate and a homely atmosphere".

"As family members we feel involved and the staff are good".

"I feel my cultural needs are well respected here and that's very important to me".

"I think its a good homely home with great staff".

Some people living in the home were not able to clearly express their opinions about the care they received due to communication difficulties, however we observed them to be well cared for.