This inspection took place on 02 and 04 August 2016 and was unannounced. Newlands Nursing and Residential Home is located in the residential area of Heaton Moor, Stockport. The home is registered to accommodate a maximum of 72 people for residential and nursing care, although as double rooms were not in frequent use HC-One Limited who own the home advertise it as providing care for up to 68 people. Care is provided over four floors, with residential care being provided on the basement level, nursing care on the ground and first floors, and intermediate nursing care on the top floor. There is parking on site and in streets nearby. At the time of our inspection there were 65 people living at the home.
We inspected Newlands Nursing and Residential Home on 27 January 2016 when we found the service was not meeting the requirements of the regulations in relation to providing supervision and support and requirements relating to information required to ensure staff were fit and proper to work at the home. Our last inspection of the service took place on 03 July 2014 when we found the service had made improvements and was meeting the requirements of all the regulations inspected at that time.
At this inspection we identified nine breaches of five of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe management of medicines, assessing and mitigating risks, staffing levels, checks relating to employment of fit and proper persons, providing safe care and treatment, records, training, equipment and good governance. You can see what actions we have told the provider to take at the back of this report. We are currently considering our response in relation to enforcement for some of the breaches of regulations and we will update the section at the end of this report once any such action has concluded.
There was no registered manager in post at the time of our inspection. The registered manager had resigned and had left the service the week prior to our inspection, and a new ‘turnaround’ manager had been appointed as the interim acting 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.
We brought this inspection forward from its planned date due to concerns we had received from relatives and a Whistleblower. Whistleblowing is when a worker reports concerns they have around practices or wrongdoing. Concerns relating to various issues at the service had also been raised with us by the local authority following one of their monitoring visits.
We identified concerns with the way the service was assessing and managing risks to people’s care. Whilst risk assessments had been completed, these were not always reviewed as frequently as they should have been. Actions identified in risk assessments, such as monitoring people’s weights on a weekly basis were not always undertaken. We found that records did not consistently evidence that people had received the support they required with repositioning to help reduce the risk of pressure sores.
We reviewed records for one person who required support with a percutaneous endoscopic gastrostomy (PEG). A PEG is a tube that is inserted into the stomach and often used to supply food and medicines to people who are unable to take them orally. We found directions for care staff lacked detail and the provider was unable to show us evidence that all tasks relating to care required in relation to the PEG had been completed. This meant this person may be put at risk of a detrimental impact on their health and wellbeing.
We found issues in relation to the safe management of medicines. For example, we found medicines records were not always updated in a timely manner following advice from a health care professional. This meant there was a risk people would not receive the correct medicines or dosages. Clinic rooms were warm and we saw the temperature had risen above recommended limits. If medicines are not kept at the correct temperature their efficacy can be affected.
During the day we saw there were sufficient numbers of staff to respond to and meet people’s needs. However, night staff raised concerns about staffing levels on night shifts. The provider was not able to demonstrate that staffing levels had been reviewed at a local level in consideration of the dependency of people living at the home. The night prior to our inspection we found support funded for one to one support over-night for one person had not been provided.
Staff received training in a range of subject areas including safeguarding, moving and handling and dementia. However, staff had not received regular supervision from a manager. The provider was also unable to provide evidence that agency staff working at the home had received an induction, or that nursing staff had received training or competency assessments in relation to tasks they were undertaking such as taking blood samples. This meant the provider could not be certain that staff were competent to provide safe and effective care to people.
People told us they found staff had a kind and caring approach. We observed positive interactions between staff and people living at the home and regular staff knew people well. For instance, we observed staff talking with people about shared interests and calling people by their preferred names. People told us staff respected their privacy and dignity and staff we spoke with had a positive approach to supporting people’s independence.
People told us their family members could visit without restrictions and we saw evidence that family members had been involved in helping plan their relative’s care where this was appropriate. Care plans contained information in relation to people’s preferences, likes and dislikes.
We saw people received the support they required to eat and drink. Staff we spoke with were aware of people’s dietary requirements as was recorded in their care plans. However, we found people’s food and fluid intake was not always recorded when there had been a need for this to be done.
Care plans had been regularly reviewed but in some cases had not been re-written for some time, which meant the most relevant information was not always easily accessible. This would increase the risk of care being provided that was not in accordance with a person’s current needs or preferences.
There had been three registered managers in post at Newlands over the previous three years. Staff told us they felt the home needed a stable management team.
There were systems in place to review and monitor the quality and safety of the service. However, these had not been effective at addressing the issues we had identified. We also found actions were not always identified or signed off from audits, and there had been a gap in some of the monitoring following the previous manager’s departure. We found that issues we had identified as concerns in 2014, such as lack of regular staff supervision were also found to be an issue at this inspection. This showed systems had not been effective at maintaining standards at the home.
People told us they were able to make day to day decisions and choices, such as when they got up and when they were supported with bathing. People told us staff listened to them and acted on any concerns they might raise.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If sufficient improvement is not made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.