This inspection took place on 25 and 26 April 2017 and was unannounced. The home provides accommodation for up to 31 people, most of whom had mental health care needs. There were 31 people living at the home when we visited.

There was 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.

The home was split into two inter-connecting units. Previously, support staff in the main part of the home supported younger adults with mental health care needs and care staff in the lower part of the home supported older adults, some of whom were living with dementia. The provider had recently taken the decision to focus entirely on accommodating younger adults with mental health needs. As vacancies arose, these were gradually being filled by people with mental health needs. At the time of our inspection, only three older people living with dementia were still being accommodated.

At our last inspection, in October 2015, we identified breaches of two regulations. Risks to people were not always managed appropriately; medicines were not always managed safely; and legislation designed to protect people’s rights was not always followed.

At this inspection we found action had been taken and there were no longer any breaches of regulation; however, some further improvement was still needed to help ensure people’s safety. The service had created new systems to gather additional information from external agencies about potential risks to people before they moved to the home. However, the information was not always accurate and staff had not made further enquiries to clarify inconsistencies. This meant the risk assessments were not always effective.

Other aspects of risk management were effective. Staff understood the factors that put people at risk of harm and people were involved in discussions about risk. A new fire alarm system had been installed to make it easier for staff to identify the source of a fire and this had reduced evacuation times during fire drills.

Medicines were managed safely and systems were in place to help ensure people received their medicines as prescribed. Staff knew how to protect people from the risk of abuse. There were enough staff to meet people’s needs and safe recruitment processes were followed.

People’s needs were met by staff who were trained and appropriately supported in their role. They were particularly skilled at supporting people with complex mental health needs and followed legislation designed to protect people’s rights.

People praised the standard of care and the level of support their received. They enjoyed the meals and said their dietary needs were met. When people needed support to eat, they received this in a dignified and supportive way. People were supported to access healthcare services when needed and to attend hospital appointments.

People were cared for with kindness and compassion. Staff created a calm atmosphere and interacted with people in a positive, supportive way. They spoke about people warmly and demonstrated a detailed knowledge of them as individuals.

Staff encouraged people to remain as independent as possible. They respected their privacy and dignity. They involved then in decisions about the care and support they received.

People were encouraged to make choices about every aspect of their daily lives. They received personalised care and support that met their needs. Staff understood the signs that could indicate a person’s mental health was deteriorating and responded promptly by providing additional support.

Care plans provided staff with detailed information about how they should support people in an individualised way and were reviewed regularly. For peopl

The purpose of this inspection was to check whether Newport Residential Care had complied with compliance actions we had made in May 2014 in relation to staff recruitment and notification of incidents to the commission. The inspection was carried out by an adult social care inspector. We considered all the evidence we gathered under the two outcomes we inspected. We used the information to answer these questions:

Is the service safe?

Is the service well-led?

Is the service safe?

We found the service was safer because action had been taken to improve the recruitment procedures and ensure pre-employment checks were completed. We saw written references and other pre-employment checks had been obtained prior to new staff commencing employment.

Is the service well led?

We found the service was well-led as the manager had taken action to ensure procedures were in place to ensure we were notified appropriately about incidents which occurred.

We spoke with nine of the 25 people who were living at the home. They said they were “happy” with their care and the staff “knew how to care for them”. People also said staff were “available when I need them” and that staff would sort out any problems for them. Everybody said they were happy with the meals that were provided and told us choices were available. We spoke with a visiting health professional who said they were contacted appropriately and staff acted on their requests and guidance. They had no concerns as to how people’s health or care needs were met.

We also spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. Staff knew what care and support people needed and they respected their wishes. We viewed four care plans and related records. The care we observed corresponded with care plans.

We found sufficient staff were available to meet people’s needs and people received a varied diet with a choice provided at each meal. The environment was suitable for people, well maintained and clean. There were a number of systems in place for the quality of the service to be monitored. People’s views were sought as part of the quality assurance procedures.

We spoke with 15 people who lived at the home. We met other people and spent some time in the home’s communal areas observing people and the way they were cared for. People told us that they could make decisions and that the staff were nice. The younger people told us that they could decide where to go when they went out. They told us ‘you have to sign the book to say you are out and if you are going to be back after 10pm you need to make sure you have a front door key’. People said that they had no concerns about how their care needs were met. They also told us that if they were unwell then staff would contact a doctor for them and that staff would take them for medical appointments. We were told that staff were available when people needed them and knew what care they required. One person said ‘the staff are wonderful, I give them 100%’. Another agreed with this adding ‘the staff are always there and work really hard’. People told us they had care plans and could see these if they wanted to do so.

We spoke with a health professional involved in the care of people. They stated that they had no concerns about how people’s health and care needs were met and were complimentary about the way the service met people’s needs.

Everyone we spoke with confirmed that people’s privacy and dignity was maintained at all times. People told us staff always knocked on their bedroom doors and waited for a response before entering. People told us the staff were wonderful and that they felt safe and happy at the home.

People said that if they had any concerns or complaints they would raise these with the manager.

This inspection took place on 29 and 30 October 2015 and was unannounced. The home provides accommodation for up to 31 people, including people living with dementia and mental health care needs. There were 30 people living at the home when we visited.

At the time of our inspection the manager had applied to be registered with CQC and their application was being processed. 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 home was split into two inter-connecting units. Support staff in the main part of the home supported younger adults with mental health care needs; care staff in the newer part of the home supported older adults, some of whom were living with dementia or had mental health care needs.

Risks to people living in the unit caring for younger adults were not always assessed and managed effectively as staff did not always have sufficient information about them. Individual risk assessments had not been completed for all people who smoked.

Arrangements to manage medicines safely were not robust. This meant it was not easy for staff to account for all medicines and medicine administration records were not always accurate. In some cases, there was a lack of information about when staff should administer ‘as required’ medicines.

Decisions taken on behalf of people in the unit caring for older people were not always documented in accordance with legislation designed to protect people’s rights. However, staff were following the legislation that protected the liberty of people living at the home.

People living in the unit for younger adults were required to comply with a set of house rules, which included agreeing to daily room checks. These were not conducted on the basis of risk, so could compromise people’s right to privacy. However, people were treated with dignity and respect at all times.

People were involved in assessing, planning and agreeing the care and support they received. Whilst some care plans were personalised and detailed people’s individual needs, the care plans for people with mental health care needs sometimes lacked information about people’s goals or objectives.

The manager conducted a range of audits on a monthly basis to assess, monitor and improve the quality of service provided. Where improvements were identified, prompt action was taken. However, the systems were not robust as they had not identified that some care plans and risk assessments lacked information; or that medicines were not always managed safely. Management arrangements were not resilient, although plans were in place to develop and appoint more senior staff.

People, staff and professionals felt the home was organised, well-led and praised the manager, who they described as “approachable” and “supportive”. Staff understood their roles and worked well as a team. They were motivated, enjoyed working at the home and had good working relationships with external professionals.

Staff were responsive to changes in people’s needs and supported them in a way that prevented unnecessary admissions to hospital. Reviews of care were conducted regularly and care records showed that people’s needs were met. The provider sought, and acted on, feedback from people, for example in changing the activities they supported people to take part in.

People received effective care and support from staff who were suitably trained. Staff were encouraged to gain formal qualifications in health and social care and received appropriate support and supervision in their roles.

Staff used appropriate methods to help communicate with people who had difficulty expressing themselves verbally. They promoted a relaxed atmosphere and we observed positive interactions between people and staff.

Risks such as pressure injuries, malnutrition, falls and confusion, were recorded, monitored and managed effectively. People praised the quality of the meals and were supported to eat and drink well. The chef sought feedback from people and changed the menu to suit their needs and preferences. People were supported to attend health care appointments and saw doctors, psychiatrists, nurses and other health professionals when needed.

Staff were knowledgeable about the signs of abuse and how to report their concerns. There were sufficient staff to meet people’s needs safely and checks were carried out on staff suitability before they started working in the home.

Appropriate arrangements were in place to deal with foreseeable emergencies, such as a fire. People had individual evacuation plans in place and took part in regular fire drills. Accidents were analysed and effective action taken to minimise the risk of recurrence.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.