This was an unannounced inspection carried out on 29 May and 1 June 2018. We saw the registered provider had responded to the breach of the regulations we identified at our last inspection in November 2016. We found risks to people from poor equipment had not been identified as checks were not regular or robust enough. At this inspection we saw improvements had been made in these areas.

Newsome Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Newsome Nursing Home is a registered nursing home in a quiet residential area of Huddersfield. The home provides accommodation for up to 46 people with residential, nursing and dementia care needs. The home consists of two linked houses; Newsome Court and Newsome Lodge. The ground floor of Newsome Court is dedicated to the care of people living with dementia. At the time of our inspection the home had six intermediate care beds. Accommodation in both houses is provided over three floors, which can be accessed using passenger lifts.

At the time of our inspection the manager was registered with CQC. 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.

All but one person told us they felt safe living at this service. We discussed one person’s concerns with the registered manager who took appropriate action. An unplanned fire drill on day two of the inspection was well managed.

The management of medicines was not always robust as body maps for the use of topical creams and patches used for pain relief were not in place. Some members of staff responsible for the administration of medicines had not received up-to-date training in this area and they did not have a recent assessment of their competency.

Recruitment procedures were not entirely robust as a last employer reference had not been taken for one staff member, although all other staff files checked demonstrated satisfactory background checks were completed.

There were sufficient numbers of staff in the home, although the registered provider did not use a dependency tool to assess people’s needs and calculate the number of staff required. People’s nutritional and hydration needs were not being fully met as staff had not routinely recorded where people had snacks part way through the day. We also found snacks were not routinely available for people who needed a soft diet.

Feedback from people and relatives about staff was complimentary. People confirmed their privacy and dignity was respected by staff. Staff were familiar with people’s care needs, although recording in care plans was not found to be person specific in some aspects of people’s care. Electronic care records were missing people’s interests and their personal history. People and staff told us the activities programme required improvement. Newspapers and magazines were provided for people to stay in touch with local and national news.

The principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) were being met, although staff knowledge of DoLS required improvement. Evidence we saw showed people were supported by staff to access healthcare services.

People knew how to complain. Complaints were appropriately managed and responses were sent to people within identified timescales.

The registered provider invited feedback from people and relatives through meetings and surveys regarding the running of the home. Feedback regarding the registered manager was very positive with people, relatives and staff noting how supportive they we

The inspection of Newsome Nursing Home took place on 29 November and 6 December 2016 and was unannounced on both days. The home had previously been inspected in June 2015 and was found to be requiring improvement in all areas with breaches of regulations in dignity and respect, safeguarding service users from harm, nutrition and good governance. We checked during this inspection whether improvements had been made.

Newsome Nursing Home is a registered nursing home in a quiet residential area of Huddersfield. The home provides accommodation for up to 46 people with residential, nursing and dementia care needs. The home consists of linked houses, Newsome Court and Newsome Lodge. Five bedrooms of Newsome Court are provided to support the care of people living with dementia. Accommodation in both houses is provided over three floors which can be accessed using passenger lifts. There are secure gardens which provide a private leisure area for people. There were 33 people in the home on the days we inspected, four of whom were living in Newsome Court.

There was a registered manager in post although they were on leave on the first day of the inspection. We did speak with them on the second day. 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.

We found therse had been considerable changes to the home since our last inspection, most notably in the attitude of staff which helped to promote a welcoming and positive atmosphere within the home.

People told us they felt safe and we were confident staff knew how to acknowledge and respond to any concerns around potential abuse or neglect.

Although risk assessments were in place they were not always detailed enough and did not always get updated following an incident. Combined with a lack of robust equipment audits this meant risks to people were not always minimised to reduce the likelihood of harm. This is a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as not all risks had been identified meaning people were being placed at the potential risk of harm through faulty equipment. The registered manager implemented an immediate plan to address these concerns and we saw evidence of this following the inspection.

Staffing levels were appropriate to the needs of the people in the service and we saw people being responded to promptly and with care. Medicines were stored in line with requirements and the home had effective policies and procedures in place for staff to follow which we observed in their practice.

People told us they enjoyed the food and there was plenty of it. We observed people being offered drinks throughout both days and supported with their nutritional needs as required. External health and social care support was requested when required and we saw evidence of other professionals’ views being integrated into the care plans.

The registered manager understood the requirements of the Mental Capacity Act 2005 well and we saw evidence of appropriate authorisations in place where people’s liberty was deprived.

Staff had a pleasant and friendly manner with people, and it was evident they knew people well. They promoted people’s dignity and privacy at all times. There was ongoing interaction throughout both days in terms of activities and conversation with people, assisted by the activities co-ordinator who amended their plans according to people’s wellbeing and preferences.

Care records were detailed and person-centred, reflecting people’s needs and choices. There was good cross reference between risk assessments and other documentation to enable staff to access all key information quickly. We found care records were updated in a timely manner.

Co

The inspection of Newsome Nursing Home took place on 2 June 2015 and was unannounced. The service was inspected in August 2014 and found to be in breach of the management of medicines and supporting workers. At a follow up inspection in February 2015 we found that although the medicines management had improved, staff were still not being offered regular supervision or appraisals. An action plan was received on 11 March 2015 detailing that regular supervision was to take place and appraisals to have taken place with all staff by 30 June 2015. During the inspection we found that this had been addressed and all actions were completed.

Newsome Nursing Home is a registered nursing home in a quiet residential area of Huddersfield. The home provides accommodation for up to 46 residents with residential, nursing and dementia care needs. The home consists of two linked houses; Newsome Court and Newsome Lodge. The ground floor of Newsome Court is dedicated to the care of people living with dementia. Accommodation in both houses is provided over three floors, which can be accessed using passenger lifts. There are secure gardens which provide a private leisure area for residents.

People told us they felt safe and we found staff were able to identify factors which may be deemed to be safeguarding and were aware of how to act in such situations. However, we did not always observe staff respond appropriately to potential safeguarding situations. We found that risk was assessed thoroughly but not always recorded correctly. Staff received an appropriate induction and had been subject to robust recruitment procedures.

We found that people’s medicines were administered safely and records kept in accordance with the National Institute for Clinical Excellence (NICE) Guidance: Managing Medicines in Care Homes. There were effective links with GPs and other health professionals to ensure that people were receiving timely input of external healthcare professionals.

Staff received regular supervision and appraisals. They also had access to relevant training for their roles. They demonstrated understanding of how to comply with the requirements of the Mental Capacity Act 2005 by seeking consent before undertaking care tasks.

People had support with eating and drinking although we asked the registered provider to consider alternative cups to promote people’s dignity. This extended to protecting people’s privacy where doors were not always closed prior to undertaking personal care tasks. Call bells occasionally took some time to be answered.

We found some staff were not pro-active in supporting people with their care needs and one person’s expressed wish to return to their room was ignored on more than one occasion.

The activities co-ordinator was a positive asset to the home, providing some meaningful engagement with as many people as possible. They ensured people were encouraged to join in where they wished and undertook a range of activities.

We were concerned at the existence of two concurrent recording systems, one paper and one electronic. The registered manager informed us the service was in a transitional period of implementing the new electronic system. However, this transition over a two month period had the potential to lead to errors and omissions in people receiving the correct support and we requested the registered provider deal with this a matter of urgency.

The home had a registered manager who we found was supportive and liked by people and staff alike. 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 some audits in place but because of the risks associated with having two sets of care records, we felt these were not robust enough.

We found breaches in regulations 10,13,14 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

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

During our inspection we looked at how medication administration records and information in care notes for people living in the home supported the safe handling of their medicines. No people were administering their own medicines.

During our last inspection on 1st August 2014 we had found the provider was not meeting this standard because there were not adequate systems and practices in place to manage medicines safely.

During this visit we found the provider had addressed all the regulatory breaches.

We asked a registered nurse about the safe handling of medicines to ensure people received the correct medication. Answers given demonstrated that medicines were given in a competent manner by well trained staff.

During our inspection on 1st August 2014 we found staff were not able to safely deliver care and treatment because the provider was not ensuring staff received appropriate professional development, supervision and appraisals.

During this inspection we found that whilst some progress had been made the provider was still in breach of this regulation.

The provider was not adhering to its own standard of a formal supervision meeting every three months nor was staff appraisal a feature of the service.

We saw mandatory training requirements were adhered to with staff describing the training as being of a high quality.

We spoke with two people receiving care at the home both of whom were complimentary about the staff and their skills.

The inspection visit was carried out by one inspector. During the inspection we spoke with the manager, regional manager, three members of staff, three people who lived at the home, one relative of someone who lived at the home and two friends of someone who lived at the home, who told us they were regular visitors. We looked around the premises, observed staff interactions with people who lived at the home and looked at records. There were 38 people living at the home on the day of our inspection.

When we visited Newsome Nursing Home in February 2014 we found records were not being adequately maintained and there were issues around the management of medication. We asked the provider to make improvements. We went back on this visit to carry out a full inspection and check whether improvements had been made.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were protected from abuse and avoidable harm.

Staff were suitably qualified and had the knowledge and experience needed to carry out their role. Staff we spoke with knew how to recognise and report abuse or allegations of abuse.

People were cared for in an environment that was safe, secure, clean and hygienic.

There were sufficient numbers of suitably qualified staff to meet the care needs of the people who lived at the home.

We found some issues with medications regarding safe storage temperatures.

Is the service effective?

From our observations and from speaking with staff, people who lived at the home and relatives, we found staff knew people well and were aware of people’s care and support needs.

We found staff had received appropriate training to meet people’s needs, although there were some issues with refresher training.

We spoke with people, relatives and their visitors who all told us they were happy with the care provided at the home. They confirmed people’s care, treatment and support needs were being met. One relative said; “[Relative] couldn’t get better anywhere else.”

This showed us people’s care, treatment and support at the home achieved good outcomes.

Is the service caring?

We observed staff interactions with people throughout the day. People who lived at the home were supported by kind and attentive staff. Staff were patient and encouraging when they were supporting people.

One of the relatives we spoke with told us, “[Relative] has dementia so can be difficult to deal with but they are great. They never rush him.” Another person’s relative told us; “They give [relative] time and choice. Like when he’s choosing food, they wait until he’s decided.” This confirmed what we observed during the visit. Care staff encouraged people to be independent as possible. This showed us staff treated people with compassion, kindness, dignity and respect.

Is the service responsive?

Since our inspection in February 2014, measures had been put in place to monitor and manage issues we found around the management of medications. However, we found there were still issues with storing medications safely. The regional manager told us there were plans underway to resolve these issues. They told us they would send us details of the work to be undertaken. We received this via email on the same day as our inspection.

People were supported to maintain relationships with their friends and relatives. Some people who lived at the home told us there were “not a lot of activities at the home but it’s never boring because we all chat.” One friend told us they regularly visited the person who lived at the home but were unable to take him out. The friend told us, “[Person living at the home] is getting the best support they can but it’s difficult for staff at times. They can’t take him out because he has advanced dementia.”

Care and support was provided in accordance with people’s wishes. We saw from the care records and daily records that people’s preferences, interests and diverse needs were taken into consideration. This meant the home was well-organised so that it met people’s care needs.

Is the service well-led?

The leadership and governance of the home assured the delivery of high quality care for the people who lived there. We saw the home had quality assurance processes and systems in place to monitor the care provided to people. For example, we saw evidence of regular auditing of care records.

Staff told us they were clear about their responsibilities and felt well supported by the management team. They told us they could go to the manager or regional manager if they had any issues or wanted to raise anything and were confident that every effort would be made to ensure these issues were resolved. This showed us the home supported learning and innovation and the managers promoted an open and fair culture.

When we inspected Newsome Nursing Home in October 2013, we found they were not compliant with the regulations relating to management of medicines (outcome 9) and records (outcome 21). We told the service they needed to make improvements.

We found the home had made some improvements, but we also found there were still some issues in both areas.

We found staff at the home did not always complete food diaries and some weight management records were calculated incorrectly. Records of multi-agency visits were kept in different areas of care records. We also found there were not always appropriate arrangements in place for the safe management of medication.

We observed staff interactions with people who used the service and found they were professional and caring in their approach. We saw hot drinks were available for people throughout the day and snacks were offered to people, including biscuits.

We spoke with five people who used the service and three care staff members. Everyone we spoke with who used the service told us they liked living at Newsome Nursing Home. They told us the home was always kept clean and tidy and all staff spoke to them with respect. Staff members we spoke with said they felt supported and happy in their roles.

In this report we have been asked by the provider to refer to people using the service as residents.

On the day of our visit there were 38 residents living at Newsome Nursing Home. The manager told us 14 of these were residential and 24 required nursing care. Six residents were living in the dementia unit in Newsome Court. This unit had recently opened and could accommodate up to eight residents.

We observed that the home was clean but untidy; the manager told us there was a general lack of storage space at the home. Some areas were observed to be in need of refurbishment and renovation and residents in the dementia unit told us they were cold. The manager told us parts were on order for the heating system and plans were in place to replace flooring in several communal areas and bedrooms.

During our visit we observed residents interacting with staff in the lounge and dining areas in the two houses. We spoke with the registered manager, regional manager, two nurses, two care assistants, maintenance man, activities coordinator, eight residents and three relatives. We looked at four sets of care records and saw resident's individual needs were assessed and care and support was developed from this information. Residents appeared clean, well-dressed and well cared-for.

As part of our inspection we looked at medicines management and record keeping at the home. We found there were improvements needed in both of these areas. We will be carrying out a follow up visit to check that improvements have been made.

The residents we spoke with all told us they received good care. Comments included, “I’m very happy with my care, the girls are good” and “Me and the staff get on well together.”

One relative we spoke with said, “Everyone has been really helpful in settling us in, anything we have needed they have helped us with”. Another relative told us, “Staff have been very good. They make us so welcome.”

One of the care assistants we spoke with said, “I like it here, because the people living here are given choices in what they want.” They also told us, “I would feel ok approaching the manager if I had a problem.”

When we asked residents about the food they told us:-

“The food’s great, we always have enough to eat.”

“I always enjoy what I eat.”

“Very good food, I’d rather be here than at home on my own.”

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

When we visited the service in February 2013 we found that the home was not compliant with the regulations relating to supporting workers (Regulation 23).

At the inspection visit in February 2013 we found that care staff were not receiving regular management supervision or appraisals, staff meetings were infrequent and communication systems for updating staff about changes were not robust. We went back on this visit to check that changes had been made.

On the day of our visit there were 31 people living at the home and the home employed 54 staff. During our visit we spoke with the registered manager, the deputy manager and a member of staff.

The deputy manager and staff member we spoke with told us they had both had recent supervision sessions. We looked at recent staff supervision records and the supervision and appraisal matrix which recorded dates of planned and completed sessions.

We got a mixed response when we asked staff about the frequency of staff meetings. One member of staff thought staff meetings were held frequently enough. The other member of staff said “I do think we need more frequent staff meetings.”

The manager told us the home was planning to hold a general staff meeting for all staff to attend once a year. They also told us they were planning to hold three meetings each year for each department, such as care assistants and nurses. This would enable the meetings to be pertinent to each group.

In this report we have been asked by the provider to refer to people using the service as residents.

On the day of our visit there were 27 residents living at Newsome Nursing Home. During our visit we observed residents interacting with staff in the lounge area. We spoke with the registered manager, operational manager, regional manager, director, four care assistants, three residents, and two relatives. We saw resident’s individual needs were assessed and care and support was developed from this information.

The four care assistants we spoke with said they felt care at the home was good and they felt well-supported. Comments from care assistants included:-

“We work well as a team”

“I love doing what I do”

“The families are important to us”

“The care is good; I’d trust them here I really would”

One resident told us "They could really do with more staff; they have a lot to do. It would be nice to have time for a chat".

Care assistants received appropriate training for their role and understood the importance of reporting suspected abuse.

The relatives we spoke with told us the staff at the home regularly updated them about their relatives’ health and welfare, they felt the care was good and they were involved in care decisions. One relative told us “The staff there are fantastic and never disrespectful”; and another relative said “I am really happy with the home; I have no complaints at all”. They told us they felt their relatives were safe living there.

People who use the service told us staff were generally good at explaining care and responded well to any requests that were made. They also told us staff are very friendly, approachable and helpful.

One resident said “I am happy at the home and enjoy the care I receive” and another said “everything runs like clockwork”.

We spoke to relatives of people who use the service and they told us they are able to speak to the manager if they have any concerns or issues.

Relatives that we spoke with said they felt activities and social events at the home were not always sufficient. One relative commented that it seemed staffing levels had dropped and that staff were not socialising as much as they could do with the residents.