Newline Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This key question has been rated requires improvement. We reviewed 8 quality statements for this key question. We found the provider did not always take necessary actions or have safe processes in place to keep people safe. Although people and their relatives reported they felt the service kept them safe, they were not kept informed during care planning and consent was not always gained when needed. People did not always receive their medicines as prescribed. We identified breaches of the legal regulations. Recruitment procedures for staff were robust and staff we spoke to said they had received the relevant training.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although relatives felt assured by the actions taken by the provider, we found multiple shortfalls in the provider's procedures following accidents, incidents and falls. We were not assured the provider was taking all appropriate action to mitigate future risks, this meant some people had multiple falls which could have been avoided if risk assessments and care plans had been updated. The provider did not always seek further support from other professionals to reduce risks.

We spoke with 15 staff members during the assessment, inclusive of the business director, manager, deputy manager and care staff. Staff feedback conveyed a positive supportive environment and staff showed their knowledge of the people they cared for and their needs.

At the start of our assessment we found the provider did not have an effective monthly accident and incident analysis process in place. Although feedback was provided, during our last visit we found no improvements had been made. This meant we could not be assured lessons had been learnt. We did not find evidence people were harmed but this was a breach of regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

Relatives were not adequately involved in the admission process. Although the provider involved relatives in the admission process to a degree, the provider did not always discuss people’s needs prior to admission. One relative told us how they were disappointed with the pre arrival arrangements for their family member. They stated, " My [relative] and I were told this is where the local authority were placing [relative]. There was no discussion or assessment prior to arrival."

Management did not complete the required documentation in a timely way for new admissions. Although staff and leaders feedback was positive and showed staff were aware of the assessment process, care records were not robustly completed. Staff were not provided with guidance and care documents on people's needs.

Feedback from partners and stakeholders was positive and no concerns or comments were raised.

The provider did not have processes in place to support safe admissions and transfers of care. Most people did not have robust pre assessment documents completed to capture their needs, wishes, preferences or current assessments to guide staff. This did not support people to receive care which met their needs safely. Without this information staff were unable to formulate person-centred care plans from this information.

People told us they felt safe in the service. Comments included, "I am safe here. They [staff] look after you well" and, "I have everything I need. The carers come when I press my buzzer for support."

Staff told us they had received the necessary training and knew what to do if they were concerned about abuse and felt confident to report any concerns.

We observed practices by staff which safeguarded people from the risk of harm, and observed staff making decisions clearly in the best interest of people they knew well.

The process to minimise the use of restrictive practices was not always effective. Although there had been some improvements with the introduction of deprivation of liberty safeguarding (DoLS) care plans during our assessment, we found the completion of paperwork required to legally restrict someone was inconsistent. The provider was not working in line with the principles of the Mental Capacity Act and had not improved their systems to capture the persons consent to restrictions. We did not find evidence people were harmed but this was a breach of regulation 11 (Need for consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

People told us they felt staff managed their risks well. One person told us, "I do feel safe and cared for here. When staff are around me, I don't feel I am at risk of falling." Relatives told us they were informed if their family member had fallen, and they felt reassured with the communication from the staff. However, we found risks to people were not always or consistently managed effectively which placed people at risk of harm or injury.

Staff were aware of most risks to people through the handover process. Leaders informed us of the risk assessment process. However, we found multiple examples where risk assessments had not been completed or had not been updated when required. This meant staff did not have the most up to date information regarding people's current risks.

We observed safe moving and handling techniques. We observed risks to people's care managed well and staff followed safe practices. Support was provided in a kind and caring nature, and where people were anxious staff managed this sensitively avoiding escalation and managing potential risk well.

People were at risk of harm because the risks to them were not understood, monitored or reviewed. Where incidents took place, timely action was not always taken. Staff did not have the knowledge needed and care records did not contain accurate information. Quality assurance measures had not identified these omissions. We could not be assured people were always kept safe and risk of harm was minimised. This was a continued breach of regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

We received mixed feedback from people regarding the environment. Although some people told us they were happy with their bedrooms and the environment we did receive feedback from multiple people and relatives stating they felt room allocations were done indiscriminately and without any consideration for people's mental well being needs. Comments included, "Carpets are dirty" and, "The walls and curtains look very tired and dull.

Staff had a good understanding of their responsibilities to keep the environment safe and secure. Staff explained the process of escalating concerns. The leadership team were also aware of their responsibilities to ensure a safe environment was maintained and also provided details as to who's responsibility it was to ensure the maintenance was up to date. However, we found the temperature of multiple water outlets was not within the recommended remits and there was no evidence of appropriate action taken to rectify this.

Further improvements were needed to support a safe environment. Water temperatures did not fall consistently within safe temperature limits. The environment was accessible with signage and clear exits maintained.

The environment was not always safely managed. There was an increased risk of harm to people because quality monitoring systems had not identified issues with safe water temperatures. Risk assessments in place to support temperatures which were too hot did not mitigate the risk of scalding. We could not be assured people were always kept safe and risk of harm was minimised. This was a breach of regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

Feedback from people showed they felt there was adequate staffing levels in the home, and they confirmed staff responded quickly when they pressed the call bell for support.

Staff received the necessary training to provide safe care and treatment to people, and staff were in receipt of regular supervisions and appraisals. Staff told us they were able to fully participate in supervisions and found them useful.

There was sufficient staff available to meet people’s needs, and a good staff presence in communal areas. The previous manager had implemented tailored staffing arrangements to accommodate individuals presenting with Sundown syndrome.

The service had systems to recruit staff safely, however this had not always been followed prior to employment. We reviewed 3 staff recruitment files and found in 2 of them appropriate checks were completed prior to employment. In the other staff file documentation was not fully completed, and the providers recruitment systems had not been fully followed or implemented prior to the staff member completing shadow shifts.

People's experiences were positive. People and relatives said staff wore personal protective equipment (PPE) and felt there was safe infection prevention control (IPC) measures in place. People told us bathrooms were stocked for handwashing and people's clothes were cleaned and well looked after.

Staff meetings were held regularly which showed the inclusion of housekeeping staff. Competency checks to review their practices had been completed.

Staff followed safe infection prevention and control practices. People lived in a clean environment with bedrooms and bathrooms appropriately stocked for safe hand hygiene.

Cleaning schedules were robust and completed showing a combination of deep cleans and regular scheduled cleaning tasks being competed. Staff had also received the required infection prevention and control training.

People and relatives told us they received the medication they required, when they needed it. Relatives told us they felt assured their family members received the required medication as prescribed. However, we found people had missed doses of medicine.

The service did not always have safe systems for appropriate and safe handling of medicines. Medicines were not always stored securely. The leadership told us that risk assessments were not in place to prevent inappropriate access to creams stored in people’s rooms. Medicines audits were completed each month; however, these were not always effective in identifying errors.

Medicines were not managed safely. During the assessment we found topical medicine such as creams were not accurately documented on medicines administration records (MAR). There was a risk that people were not receiving topical medicine as prescribed. Information to support staff to safely give ‘when required’ topical medicines was not always in place. People were not always given medicine due to being asleep or refusal; reasons were unclear in the documentation. This meant there was a risk people might not receive medicines when they needed them. Temperatures were not routinely monitored in areas where medicines were stored. We could not be assured that medicines were always kept at the recommended temperature. We could not be assured people were always kept safe and risk of harm was minimised. This was a breach of regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.