Newcombe Lodge

Updated 24 September 2021

The inspection

We inspected the service under section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting legal requirements and regulations associated with the Act. We looked at the overall quality of the service according to our duties under section 91 of the Care Act 2014.

Inspection team

One inspector conducted this inspection over the course of two days.

Service and service type

Newcombe Lodge is a residential children’s home where children who have mental health and emotional difficulties live as part of as single package of care and treatment. The provider is Partnerships in Care 1 Limited, part of the Priory Group. The provider is registered with the CQC to carry out the regulated activity ‘Treatment of disease, disorder or injury’ at this location. OFSTED is the regulatory authority in respect of the care and accommodation whereas CQC is the regulatory authority in respect of the health aspects of the location.

The service has a manager registered with the Care Quality Commission. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 14 June 2021 and ended on 18 June 2021. We visited the location on 16 and 17 June 2021.

What we did before the inspection

Prior to the inspection visit we reviewed information we had collected about the provider since the last inspection. This included incidents and events that the provider had told us about according to the terms of their registration. We also took account of reports about the service published by OFSTED.

We had not yet asked the provider to complete a provider information return (PIR) so we were not able to take this into account when making our judgements. A PIR is information we require providers to send us to tell us about key aspects of the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with two of the children who were living in the home about their experience of the care provided – two of the children declined to speak with us and the fifth child was not present during both days of our visit. We spoke with the registered manager, the deputy manager and five other members of staff. These included a clinical psychologist, one of the children’s case managers, two therapeutic care workers and an occupational therapy assistant.

We reviewed a range of records. This included three children’s care and treatment records and multiple medication records. We looked at three staff files in relation to recruitment, training and supervision. We also looked at a variety of records relating to the management of the service, including policies and procedures and records of audits carried out.

After the inspection

We reviewed information that we had asked the provider to send us. This included the statement of purpose for the home and the location’s service improvement plan for Newcombe Lodge.

Updated 24 September 2021

Our last comprehensive inspection of Newcombe Lodge was on the 23 June 2016. At this inspection we rated the service as good overall. We rated effective, caring, responsive and well led as good. However, we rated safe as requires improvement because we saw breaches in regulation surrounding how medicines were managed at the service.

The purpose of this inspection was to follow up on the actions the service had taken following the requirement notice we issued at the last inspection (23 June 2016).

At this inspection we rated safe as good.

At our last inspection on 23 June 2016, we issued a requirement notice against Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment because we had a number of concerns with how the service was managing medicines. The service did not have an ‘as required’ medicines treatment protocols in place. The medicines stock recording system did not accurately record the quantity of medicines held by the service and the medicine cupboard contained some medicines that were not documented on patients’ medicine administration records (MARs). We also saw that staff did not always follow the process for recording medicines for destruction. This meant that people with access to the medicines may have been able to obtain medicines that should have been destroyed.

The medicine policy did not detail the process to follow to risk assess someone for self-administration or the responsibilities for assuring self-administration was being conducted safely.

On the 8 July 2016 the service supplied us with an action plan on how they would meet the requirement notice we had issued. This action plan included implementing new policies for ‘as required’ medicines, self-administration of medicines procedures, and updated procedures for medicines disposal. The action plan also included the service putting training for staff in place for these new policies and displaying the ‘as required’ medicines policy on the wall of the clinic room.

On 29 March 2017 we undertook an unannounced, focussed inspection to look at whether the service had addressed all of the concerns identified in the requirement notice. We looked at the systems in place for managing and administering medicines. We spoke to staff involved in the administration of medicines, and reviewed seven patient’s medicines charts. We found that systems in place had improved since the last inspection and medicines were being managed safely and that the service now addressed all the concerns set out in the requirement notice.

The therapeutic care workers (unregistered healthcare workers) administered medicines to patients. The care workers received training on the safe use of medicines and senior staff assessed their competence before they were signed off to administer medicines to patients. Since the 26 June 2016 inspection, they had undergone further training in the administration of ’as required’ medicines and individual risk assessments.

Arrangements for ordering and receiving patients’ medicines from both the GP and pharmacy were appropriate. Medicines were supplied against prescriptions for named patients from a local pharmacy. The pharmacy supplied medicines, individually labelled for each patient, with printed medicines administration records (MARs). The care workers had completed the MARs once they had administered the medicines and we could clearly see when patients had taken their medicines. Staff double signed handwritten additions or amendments on the MARs and wrote notes when medicines were omitted, which is good practice. Processes were now in place for ensuring waste medicines were recorded and disposed of correctly.

Staff supported patients to take their medicines correctly and there were clear written instructions on how patients liked to take their medicines. Care records also identified any allergies or particular areas of risk for each patient.

We checked a sample of medicines which had been supplied, against the MARs. Staff kept a running balance of stock which meant it was easier to identify if the medicines had actually been given and that there was enough stock for patients.

Some patients were prescribed medicines to be given ‘as required’. We saw that comprehensive protocols were now in place for these medicines. However, in two records we saw that there was no guidance to staff to decide if it was appropriate to give a dose of the medicine. Each patient could also be administered ’homely remedies’ (non-prescription medicines that allow staff to respond to patient’s minor symptoms appropriately) but we did not see a protocol, developed with the GP, to provide guidance to staff on what medicines could be given and when to give the medicines. While there was little written guidance for staff to follow, we observed that staff knew the patients well and were able to make decisions with them about whether a medicine was needed or not.

None of the patients were self-administering medicines when we inspected. The medicines policy had been amended to provide better guidance on the process to follow to risk assess someone for self-administration, and training had been delivered to support the amended policy. However, the medicines policy available in the clinic room was not the most up to date version.

As a result of the improvements made by the service, we lifted the requirement notice that we issued following the last inspection and re rated ‘safe’ as ‘good’.

Updated 2 June 2017