The Care Quality Commission
  • Care Home
  • Care home

Newcombe Lodge

Overall: Good read more about inspection ratings

City Gate, Gallowgate, Newcastle Upon Tyne, NE1 4PA (01453) 882020

Provided and run by:
Partnerships in Care 1 Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

16 June 2021

During a routine inspection

About the service

Newcombe Lodge is a residential children’s home for up to eight children who have mental ill-health or emotional wellbeing needs. The home is a described by the provider as a transitional recovery service. The home specialises in accommodating and treating children with emotionally unstable personality disorder (EUPD) and who have a history of self-harm.

Each child has their own room but shares some facilities with the other children living there. There were five children living there at the time of our visit.

Children live, and receive care and treatment, at Newcombe Lodge on a long-term basis. Children are either looked after by their local authority, and / or they have moved to the home under transitional arrangements from an inpatient facility.

The published date on this report is the date that the report was republished due to changes that needed to be made. There are no changes to the narrative of the report which still reflects CQCs findings at the time of inspection.

People’s experience of using this service and what we found

Children were safe and protected from avoidable harm. The provider had systems in place to identify and respond to abuse or the risk of abuse. Children told us they felt safe and they were involved in the creation and review of their risk management plans. The registered manager had improved safe recruitment processes following specific safeguarding incidents. Medicines were appropriately stored and managed. There were effective arrangements for the prevention and control of infection and the provider had clear processes for managing the risk of COVID 19 transmission. Learning from incidents took place. We have made a recommendation about the way interventions are described in children’s support plans. We have made a recommendation about the way controlled drugs are recorded.

Children had a treatment pathway that was planned through the provider’s multi-disciplinary team and which made use of a range of therapeutic approaches according to national guidance. Staff, including newly recruited staff, had access to a range of role specific training and access to supervision. Staff had opportunities to develop their skill through an external qualification. Children told us they were involved in care planning and were able to express their wishes and feelings. We have made a recommendation about the way goals are recorded in children’s treatment plans.

Children said they felt they were well-treated and that staff understood their needs. We observed staff speaking respectfully and kindly to children. Children were enabled to make decisions about their care and treatment and were involved in all aspects of planning. Children’s independence was supported and they were treated with dignity and respect. We have made a recommendation about the routine wearing of masks by staff.

Children were supported to have maximum choice and control of their lives using the provider’s MDT approach. Initial assessments were thorough and took account of information from other professionals and the child. Plans reflected children’s assessed needs. Children were supported to maintain contact with their families and could have pets at the home.

The registered manager promoted an inclusive culture and was well-liked by staff and the children we spoke to. A new statement of purpose was detailed and set out the strategic vision and the operating systems at the home. An open culture promoted the application of the duty of candour. Children’s views were sought about how the service could be developed. The service worked appropriately with local partners.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The provider was in breach of regulations (report published in January 2020). At that time the provider did not;

- assess and mitigate the risks to young people to take account of their changing needs and,

- establish and operate systems to effectively assess, monitor and improve the quality and safety of the services provided.

Following that inspection, we required the provider to make improvements. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We conducted an unannounced, comprehensive inspection on 16 and 17 June 2021. This inspection was to follow up the breaches of regulation from our earlier inspection.

We also inspected following a concern that had been brought to our attention about the provider’s ability to safeguard children from abuse. We found no evidence during this inspection that people were at risk of harm in relation to this concern. Please see the ‘safe’ and ‘well-led’ sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Newcombe Lodge on our website at www.cqc.org.uk.

We will continue to monitor information we receive about the service until we return to visit according to our re-inspection programme. If we receive any concerning information we may inspect sooner.

6 August 2019

During a routine inspection

Newcombe Lodge is a children’s home that provides specialist treatment and care for people with mental ill health and self-harming behaviours to seven children and young people aged 13 to 21. The children's home is also registered with and inspected by OFSTED and at the time of the inspection the home provided accommodation for up to two children and young people under the age of 18 who are in care. The service can support up to eight children and young people in the home.

The published date on this report is the date that the report was republished due to changes that needed to be made. There are no changes to the narrative of the report which still reflects CQCs findings at the time of inspection.

Children and young people’s experience of using this service and what we found.

Risk assessments had not been reviewed and guidelines to mitigate risks were not updated in response to young people’s changing health needs. Care records lacked key information and had not been reviewed to ensure they contained current information about young people’s health, education and social care needs.

Systems to assess, monitor and improve the service were in place but did not identify all the issues we found. Although some issues were picked up in the provider’s audits these were not acted on over a significant amount of time. The provider's vision about the service was unclear and the service that was provided to young people did not align with the providers statement of purpose.

Young people were not always offered privacy in the home to ensure they received care and support in a dignified way.

Staff had received training to develop their skills and competencies, however, further face to face training was required to reflect the self harming behaviours of children and young people who lived in the home.

Young people understood how to make a complaint, however formal complaints were not recorded. Feedback questionnaires were not sent to young people, staff and professionals to provide feedback about how the service was run and the care they had received.

Staff understood how to recognise and report signs of abuse in line with the provider’s safeguarding procedures and people and young people told us they felt safe.

Changes in young people’s healthcare needs were identified and they had access to healthcare services. Young people were supported with their medicines as required and this was recorded in their care plans.

Young people told us that staff were supportive and their views were listened to. Young people told us they were supported by caring staff and because of this they enjoyed living at Newcombe Lodge.

Staff spoke confidently about the management team and told us they were continually supported. Where incidents had occurred, actions were put in place to improve the delivery of the service and the actions taken to ensure lessons learnt.

Young people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this service because this was a planned inspection based on the previous inspection findings.

We have found evidence that the provider needs to make improvements and children and young people were at risk of harm. Please see safe, effective, caring, responsive and well led domains sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Newcombe Lodge on our website at www.cqc.org.uk.

We have identified two breaches in relation to safe care and treatment and good governance. We have also made two recommendation in relation to the providers self -harm policy and complaints.

Follow up

We will request an action plan and meet with the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and Ofsted to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

29 March 2017

During a routine inspection

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’.

23 June 2016

During a routine inspection

We rated Newcombe Lodge as good because:

  • The home had good indoor facilities and had a good garden. The home involved young people in decorating the home and they were encouraged to decorate their room and to personalise it. Young people were admitted from around the country. They were given the chance to visit the home and stay overnight to see if they liked the placement.
  • Staffing levels had improved over the six months before this inspection. Staff said they felt supported by managers through this time and that moral was now better and the home was calmer. Governance systems had helped to address the gaps in staffing and in mandatory training.
  • The care plans we reviewed covered the individual needs for the young people in the home. Staff could arrange external therapy if it would be helpful for the young person. Staff helped young people to build life skills to prepare them for discharge.
  • Young people had access to a number of experienced staff with different professional backgrounds. They met weekly. We saw that staff were kind and respectful when speaking with young people. They clearly knew the needs of the young people living at the home. Young people were involved in staff meetings and said they felt listened too. In house chefs made meals to meet the needs of the young people.
  • The provider responded quickly to the issues highlighted by this inspection and put measures in place to address them

However,

  • Systems were not always either in place, or robust enough when it came to managing medicines safely, notifying the Care Quality Commission about safeguarding concerns, and ensuring audits were completed in staff absence. We raised these concerns with the provider and they acted quickly to address them. The provider introduced policies to address the shortfalls and trained their staff on the new procedures.

9 August 2013

During a routine inspection

People we spoke with told us they felt safe and understood the rules and boundaries of the home. Staff we talked with demonstrated a clear understanding of the young women's needs and the therapeutic ethos of the home. The home had a clear therapeutic aim and staff were supported to understand this and to apply the rules and boundaries consistently. Whilst young people were asked for their consent we noted that the home did not always take into account the difference in consent between people who were legally adults rather than children.

The home worked with other providers to deliver care and we saw that the young people's social workers were regularly informed of their progress.

Staff had a clear understanding of safeguarding and the importance of reporting concerns. Restraint was recorded and the restraint log contained evidence of appropriate use of restraint.

Staff received regular supervision and training and the provider had a system in place to monitor the quality of the service.