The inspection of Newlands Hall took place on 16 and 17 January 2019. We previously inspected the service in January 2018; at that time, we found the registered provider was not meeting the regulations relating to the requirements of the Mental Capacity Act 2005, safe care and treatment and good governance. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Newlands Hall 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. Newlands Hall provides accommodation for up to 30 older people, some of whom are living with dementia. The home has communal living areas on the ground floor and bedrooms are located on the ground and first floor. There were 29 people were living at the home on both days of the inspection.

The service had a registered manager in place. 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 told us they felt safe but we found some aspects of the service needed to be improved to ensure people were safe.

The manager was in the process of reviewing and updating peoples care records. However, we found many of the records we looked at were not reflective of people’s current care needs. Care plans for end of life care wishes were not always completed. Where people needed staffs support with moving and handling, records were not always an accurate reflection of current need and did not always provide a sufficient level of detail.

Records of people's food and fluid intake were not always completed and did not evidence they were provided with the appropriate consistency of diet and fluids people had been assessed as needing. However, feedback about the meals at the home was positive.

There were sufficient numbers of staff on duty but safe recruitment procedures needed to be followed. New staff received induction. There was a programme of supervision in place for all staff but not all staff training was up to date.

Medicines were stored safely and administered in a caring manner. Where people were prescribed creams and “as required” medicines, improvements were needed to ensure they were administered in a safe and consistent way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, records did not evidence the service was complaint with the Mental Capacity Act 2005.

People were enabled to access other health care professionals as their needs changed.

People were protected from the risk of infection.

People were treated with kindness. Staff respected people’s right to privacy and maintained their dignity. People spoke positively about the activities provided for them to engage in.

There were systems in place to gather feedback about the service people received. Feedback from people who lived at the home and visitors was without exception, positive. Where a complaint was raised, this was dealt with, although we did not see information on how to complain visible within the home.

The registered provider had a range of audits which the manager and senior care worker completed at regular intervals. However, these had not been effective in identifying where improvements need to be made or action to be taken. Where matters were identified, there was not always evidence the issues had been addressed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’

Ser

The inspection of Newlands Hall took place on 15 and 18 January 2018. We previously inspected the service on 14 and 19 June 2017; at that time we found the registered provider was not meeting the regulations relating to consent, safe care and treatment, staff recruitment, supporting staff and good governance. We rated them as inadequate and placed the home in special measures. Following this inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions; Safe, Effective, Responsive and Well-led to at least good. The purpose of this inspection was to see if significant improvements had been made and to review the quality of the service currently being provided for people.

Newlands Hall 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. Newlands Hall provides accommodation for up to 30 older people, some of whom are living with dementia. The home has communal living areas on the ground floor and bedrooms are located on the ground and first floor. There were 28 people were living at the home on both days of the inspection.

At the time of our inspection a registered manager was 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.

People told us they felt safe living at Newlands Hall. People said there were sufficient staff on duty to meet their needs and we found staff recruitment procedures to be safe.

Improvements had been since the last inspection regarding risk assessments although some records lacked sufficient detail regarding the hoist and slings to be used. People had a Personal Emergency Evacuation Plan in place although where people were not independently mobile, the equipment required to enable staff to evacuate them was not recorded. External contractors were used to service equipment and we saw regular internal checks were completed on the fire alarm system.

Medicines were stored safely and records evidenced people had received their medicines as prescribed. Staff who were responsible for administering people’s medicines had received training and an assessment of their competency.

Staff received induction, on-going training and supervision although we noted some supervision were not always for the purpose of enabling staff to raise concerns, reflect on practice and discuss areas of future development.

People were complimentary about the meals. Lunchtime was relaxed with staff supporting people to make choices and regarding the meals they were served. Improvements had been made to staffs recording of people’s diet and fluid intake but further work was needed to ensure adequate details were consistently recorded.

Staff communicated well as a team and we saw people had access to other healthcare professionals as the need arose.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had received training in the principles of the Mental Capacity Act 2005 and we saw staff encourage people to make choices and decisions regarding their lives. However, the requirements of the Mental Capacity Act had not been met as assessments of capacity pertaining to specific decisions were not always completed. A record of consent was not evident in all the care files we reviewed.

People were treated with kindness, relationships between staff and people who lived at the home were friendly, relaxed but professional. Staff were respectful of people’s individuality, people’s priv

The inspection of Newlands Hall took place on 14 and 19 June 2017. We previously inspected the service on 29 February 2016; we rated the service Requires Improvement, at that time we found the registered provider was not meeting the regulations relating to safe care and treatment and good governance. On this visit we checked to see if improvements had been made.

Newlands Hall provides accommodation for up to 30 older people, some of whom are living with dementia. The home has communal living areas on the ground floor and bedrooms are located on the ground and first floor. There were 27 people were living at the home on both days of the inspection.

The service had a registered manager in place. 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.

During this inspection, we identified there were breaches to regulations related to people’s safe care and treatment, recruitment of staff, staffing, consent to care, records and good governance.

People told us they felt safe however, we found aspects of the service were not safe.

We could not evidence all staff had attended a fire drill. Internal checks on the fire system did not include ensuring the fire alarm would be activated in the event a fire alarm point was pressed. The registered manager did not check fire doors closed effectively and means of escape were accessible.

Where people needed assistance with aspects of their mobility, their records did not contain sufficient information. There was no information within the care plan for a person who had experienced a number of falls, as to how staff were to assist them to get up from the floor. We observed two occasions where staff attempted to use poor moving and handling practices with people.

The system to ensure repairs and maintenance issues were reported and addressed in a timely manner was not effective.

When we checked people’s medicines we found stock balances tallied with the number of recorded administrations and there was a system in place to manage controlled drugs and variable dose medicines. Staff had not consulted with a pharmacist to ensure a person whose tablets were crushed, received them safely.

We could not evidence all relevant staff had received medicines training and there was no system in place to ensure relevant staff had been assessed as competent to administer people’s medicines.

When we reviewed staff recruitment records we found one staff member did not have a reference from their most recent employment and interview records were not always completed in full.

Induction records were incomplete for one member of staff and there was no record of induction in the second staff file. We reviewed the supervision records for four staff and found they had not received regular management supervision to monitor their performance and development needs. Two of the files we reviewed contained no evidence of supervision.

The home was not compliant with the requirements of the Mental Capacity Act 2005. A care plan contained a generic capacity assessment with no evidence of best interest decision making. A person who received their medicines covertly did not have a capacity assessment in place regarding this decision and there was no evidence other relevant people had been involved in the decisions making process to ensure it was in the persons best interests.

There were eight people who lived at the home who were subject to a Deprivation of Liberty Safeguards (DoLS) authorisation.

People spoke positively about the meals at Newlands Hall and the cook was knowledgeable about people preferences and needs. At lunchtime people were provided with a choice of meal and people were supported by staff in a timely manner.

People

The inspection took place on 29 February 2016 and was unannounced. The service provides accommodation and personal care for up to 30 people, some of whom may be living with dementia. There were 20 people living at the home at the time of the inspection.

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.

Newlands Hall was previously registered to another provider. A new provider, Regency Health Care, had taken over the service in 2015.

Building work was ongoing at the time of our inspection, to improve the premises for people. Risk assessments were in place but these were not always clearly illustrated for people.

Staffing levels were appropriate for people’s needs and staff were suitably trained and felt confident in their roles and responsibilities.

The safe management and recording of medicines was not robustly in place.

Staff understood the legislation around Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although documentation relating to this was inconsistent.

People enjoyed the food and the dining experience was sociable and pleasant, although nutritional assessments were not consistently well completed.

Staff demonstrated a friendly, caring approach and there was a happy atmosphere in the home. Staff knew people well and used this knowledge to develop caring relationships.

Care records contained regular updates of information about people’s needs, although sometimes this was contradictory and unclear.

People had opportunities to engage in social activities, although not everybody said they enjoyed these. There were activities staff who had knowledge of people’s social histories and preferences.

There was visible management of the service and an open door policy for staff, people and visitors to approach the registered manager at any time. Staff said morale was high and there was effective teamwork in place to meet people’s needs.

Some quality assurance systems were in place although these were gaps in audits of key aspects of people’s care and support.

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