This inspection was unannounced and took place on 24 May 2017. At the last inspection in April 2016, the overall rating was ‘requires improvement’, but the provider was not in breach of the regulations. At this inspection we found a number of improvements had been made, however some areas of concern still needed to be addressed.

Newlyn Court is registered to provide accommodation with nursing and personal care for up to 80 people including older people, people living with dementia and people with mental health needs. On the day of the inspection there were 64 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Although we found there were sufficient numbers of staff to meet people’s care needs, improvements were required to the way in which staff were deployed, to ensure people received timely support at mealtimes. People living at Newlyn Court told us they felt safe.

The provider had not always carried out assessments of people’s capacity to make specific decisions. Some people who required staff support during mealtimes experienced delays which meant their lunchtime experience was not a positive one. Staff did not always ensure people had the appropriate equipment to support them with the meals.

Staff were aware of their responsibility to report any concerns about people’s safety and knew how to escalate any concerns to the relevant authorities. People were supported to manage their risks by staff who were aware of the need to protect people from avoidable harm. The provider carried out safe recruitment practice to ensure staff who supported people were safe to work with vulnerable adults. People received their medicines as prescribed and there were systems in place to ensure medicines were managed and stored safely.

People were asked for their consent before care was provided. People were supported by staff who received training to ensure they had the skills and knowledge to meet people’s care and support needs. Staff told us training benefited their understanding and knowledge of people’s needs. People were happy with the food and drink they received and were supported to maintain a healthy diet. People received support to access relevant healthcare professionals where required which helped them maintain their health and wellbeing.

People received support from staff who were caring. People were supported to make their own decisions where possible. People were encouraged to maintain their independence and staff supported people in a way that respected their privacy and dignity.

People and relatives were involved in the planning and review of their care and support. Staff were aware of people’s individual care needs and supported them according to their personal preferences. Information about changes to people’s care was shared with staff to ensure people received up to date and relevant support. People and their relatives were aware of who they could contact if they were dissatisfied about the service they received. There was a system in place to manage complaints and where improvements had been identified changes had been made to reduce the likelihood of events reoccurring.

Although some improvements had been made since the last inspection, further action was needed to address the issues identified during this inspection. Action needed to be taken to ensure the quality of mental capacity assessments and the effective deployment of staff during mealtimes. People and their relatives told us they were happy with the support they received. Staff expressed confidence in the management team and provider and told us they could share any issues or concerns. People,

Our inspection took place on 13 April 2016 and was unannounced. We last inspected the service on 15 and 21 April 2015. The service was rated as requires improvement after that inspection but there were no breaches of regulations.

Newlyn Court is registered to provide care and accommodation for up to 80 older persons, some of whom may be living with dementia or have poor mental health. There were 65 people living at the service when we carried out our inspection.

The service 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 felt safe and staff were aware of how to protect them from the risk of harm and escalate any concerns. Risks to individual people were identified and minimised. Visitors were not always confident there was sufficient staff. We saw occasions where staff were busy, meaning people had to wait for assistance. People received their medicine when needed and in a safe way. The provider checked prospective staff to ensure they were safe to work with people.

People were supported by staff who had the appropriate skills and knowledge to meet their needs. People’s health was promoted through timely access to a range of healthcare professionals. People had limited choices of food or drink, as they were not always given access to available options. People did have enough food and drink though, and it was presented in a way that met their specialist dietary requirements. People’s mental capacity was assessed; however assessments and best interest decisions were not specific about the decisions people may need support with.

People did not always receive consistent kind and compassionate care. People received care that was often task orientated and staff did not always listen to, or respond to people at the point care was delivered. Staff understood people’s needs and cared for people in a manner that respected people’s privacy and dignity. People were supported to maintain their independence.

People were involved in the planning of the care and support they received. People were involved in appropriate pastimes which reflected their preferences and gave them enjoyment. The provider took action in respect of people’s complaints but did not pro-actively encourage complaints or record outcomes from complaints to help capture learning or improvements the service may have made.

There was still scope for improvement in respect of some aspects of the service in respect of ensuring people received consistent person centred care. The registered manager expressed a wish to improve so the service was providing high quality care and was able to tell us of plans they had to help them achieve this. Staff told us they were well supported and able to approach managers, who listened to them. There were systems in place to monitor and provide an oversight of risks to people and the service, so these risks could be minimised.

We carried out an inspection on 11 June 2013 and found the provider was non-compliant in one out of six outcomes we looked at. This inspection was carried out to see what action the provider had taken to improve the service.

During this inspection we spoke with the registered manager, the provider, three care staff, one nurse and two visiting relatives. The people who used the service lacked capacity and were unable to tell us about their experiences of using the service, so we observed how staff interacted with people.

We saw that there were sufficient staffing levels with various skills and experience to meet people’s assessed needs. One visiting relative said, “There seems to be enough staff and the staffing levels are consistent during the weekend as well." One care staff told us, “The staffing arrangements are better. Staff are appropriately deployed during mealtimes.”

On the day of our inspection 63 people were in residence. Due to people’s mental health needs and their lack of capacity, we were unable to talk with some people about their experiences of using the service. We observed staff’s interaction with people, we spoke with one person who used the service, the provider, registered manager, four care staff, one nurse, six visiting relatives and two national vocational qualification assessors.

We observed that people’s right to privacy was respected.

We found that care plans provided information about people’s care needs and how to meet them. One visiting relative said, “I am quite content with the care and X is kept nice and clean.” Another relative told us, “They look after X very well.”

The care plans we looked at provided information about people’s dietary needs and the support required to ensure they had sufficient food and drink. One visiting relative said, “If X does not like their lunch the staff will give them something else.”

The layout and design of the property was suitable to meet people’s needs but some areas were sparse and nonstimulating.

We found that there were insufficient staffing levels to assist people at mealtimes and to engage in social activities.

People who used the service and visitors had access to a complaints procedure.

There were 75 people living at the home at the time of our inspection. We spoke with four people, four staff, eight relatives, and the manager.

We saw times when staff engaged positively with people as well as times when they didn't. We observed times when people’s dignity was not always being respected by the way staff supported them with meals, and by the way people were supported with their mobility. This means that people did not always receive support that was respectful and promoted their dignity.

We saw that people’s needs were assessed, and care plans were in place. Staff spoken to were able to tell us about people’s needs. This ensures they receive support is a way they prefer.

Relatives we spoke with were happy with the care provided. One relative told us “I think my relative is well looked after”. Another relative told us “The care is good and the staff work hard”.

We found that staff were clear about the action to take should they become aware of an allegation of abuse in the home. This ensures people are safeguarded from harm.

We found that the medication systems in place ensured people received their medication as required.

Staff spoken with told us they felt supported by the manager, and have regular training opportunities.

We found that there were some systems in place to monitor the quality of the services, and make improvements where required.

The majority of people who use the service do not have the capacity to tell us about the care they receive. However, one person was able to say, “The staff look after me well.” "I’m happy living here.”

We observed care staff being attentive to people’s needs. People appeared comfortable and were able to wander around the home with staff being nearby, should they require any assistance. We saw that people were appropriately dressed and tidy.

Discussions with visiting relatives confirmed their satisfaction with the way the home is run.

Our inspection took place on 15 and 21 April 2015 and was unannounced. We last inspected the service on 20 November 2013 and we did not identify any areas where the provider was not meeting the law at this time.

Newlyn Court provides care and nursing care for up to 80 older people who live with dementia or a mental illness.

The service had a registered manager at the time of our 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. People told us that the service was well managed and the registered manager was approachable. People and visitors to the service described positive outcomes for people living at there. We found there were still some areas for improvement that commissioners had identified that the provider was yet to address. Timescales for these were however in place and the registered manager gave us a commitment that they were working towards addressing these, for example improving people’s care plans so that they were easier for people to understand.

We have made a recommendation about how the environment could be improved so it supports the needs of people living with dementia.

We found that staff did not consistently know how to respond to people that presented challenges to them in a way that calmed them and prevented them challenging other people. We also saw people were sometimes not supported by staff to stand or transfer between chairs in accordance with their individual risk assessments. We saw people did not always look safe when transferred in this way. On other occasions we saw staff supported people safely to transfer between chairs.

While people told us they thought staff were skilled and well trained there were some areas where training could be better embedded in day to day practice, for example in respect of how they responded to people that challenged them.

People said they were enough staff to meet their needs and keep them safe but we saw some occasions where people were kept waiting for assistance.

People received their medicines in a way that ensured they were given to them as prescribed and in a safe way.

People told us that they were safe. The registered manager and staff demonstrated awareness of what could constitute abuse and knew how to report issues so that any allegations of abuse would be investigated.

The provider ensured that people’s rights were upheld, and any restrictions considered their best interests as to how their safety was managed.

The provider had systems in place to monitor people’s on going health and people told us they experienced positive outcomes regarding their health. Where equipment was needed to support people’s healthcare needs people told us this was made available.

People told us they enjoyed their meals. The provider had systems in place to monitor the risk to people from poor nutrition and involved external healthcare services where appropriate.

People received kind and compassionate care and staff respected their dignity. Staff were aware of people’s preferences, likes and dislikes.

People or/and their representatives were involved in planning their care prior to and after they came to live at the service.

The provider had methods in place for gaining people’s views about the care they receive and any issues or concerns they may have.

People’s ability to pursue their interests or take part in social activities was mixed, but staff where able promoted people’s stimulation.