The inspection was carried out on 21 and 23 February 2017. The inspection was unannounced.Newington Court provides accommodation, residential and nursing care for up to 58 older people. The main building has three floors and accommodates people who have nursing care on the ground floor and top floor. The middle floor has a separate 'Memory Lane Unit' for people who live with dementia and nursing care needs. There is a separate annex called Falcon Place which provides residential care. The home has a garden and courtyard areas available for all of the people. On the day of our inspection, there were 54 people living at the home. People had a variety of complex needs including people with mental health and physical health needs and people living with dementia. Some people had limited mobility and some people received care in bed.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
At our previous inspection on 23 May 2016, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to person centred care, good governance, failure to ensure enough staff were deployed on shift to meet people's needs, failing to handle and respond to complaints and recruitment procedures. We asked the provider to take action.
We received an action plan on 24 August 2016 from the provider following the inspection, which detailed what action they had taken to address the breaches. They told us that they would meet the breaches by November 2016.
At this inspection we found that the provider had made improvements to the service.
People gave us positive feedback about the home and told us they received safe, effective, caring, responsive care.
People’s care was not always person centred. Care plans did not always detail people’s important information such as their life history, personal history and did not always list the care people required to meet their assessed needs.
The provider did not always follow safe recruitment practice. Essential documentation was in place for employed staff. Gaps in employment history had been explored for five out of six staff to check staff suitability for their role for. We made a recommendation about this.
Decoration of the home did not follow good practice guidelines for supporting people who live with dementia. The bathroom and toilet doors on the first floor were the only ones with dementia friendly decoration. There were no signs to direct people to different areas of the home such as to the dining area, lounge and garden. We made a recommendation about this.
We observed one conversation that was held in a lounge area between two staff members. Whilst confidential information was not discussed in this open environment, personal information about the person’s health was. We made a recommendation about this.
Staff had attended training they needed, training was on going. Staff received supervision and said they were supported in their role.
People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified.
Medicines had been generally well managed, stored securely and records showed that medicines had been administered as they had been prescribed.
The registered manager demonstrated that they had a good understanding of their role and responsibilities in relation to notifying CQC about important events such as injuries, safeguarding concerns and deaths. The registered manager had informed CQC about Deprivation of Liberty Safeguards (DoLS) authorisations that had been approved.
Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies.
There were suitable numbers of staff deployed on shift to meet people’s assessed needs.
The premises were well maintained, clean and tidy. The home smelled fresh.
Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.
Staff had a good understanding of the Mental Capacity Act and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the registered manager.
People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner.
People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.
Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed. Staff treated people with dignity and respect.
People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.
People’s views and experiences were sought through surveys and through meetings. People were listened to. People and their relatives knew how to raise concerns and complaints.
There were quality assurance systems in place. The registered manager and provider carried out regular checks on the home. Action plans were put in place and completed quickly. Staff told us they felt supported by the registered manager.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.