We carried out a review of the data available to us about Newton House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Newton House, you can give feedback on this service.
Newton House provides accommodation, nursing and personal care for up to 120 adults with needs relating to dementia, physical disabilities, and mental health. The service is divided into four separate units.
At the time of our inspection visit there were 81 people using the service.
People’s experience of using this service and what we found
People were well-cared for at Newton House. Staff responded to people’s needs in a sensitive and caring manner. Staff spoke respectfully with and about people and were quick to respond to their changing needs.
Staff knew how to keep people safe and what to do if they had any concerns about their health or welfare. People’s care and nursing needs were met, with the support of external health care professionals where necessary
The premises were divided into four units, known as communities, to provide a homely atmosphere. Each community had its own staff team who knew the people they supported well. There were enough staff on duty to ensure people’s needs were met including nurses, care workers, activity co-ordinators and ancillary staff.
The manager and staff were friendly and approachable and worked as a team to ensure people had a good quality of life. There were lots of activities for people to take part in and we saw people enjoying one-to-one sessions with the activity co-ordinators.
The manager and provider carried out regular audits to check on the quality of the service. They listened to the views of people, relatives, and staff and made improvements if they were needed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
This was a focused inspection based on concerns we had received about the service. These were in relation to people's care and governance. As a result, we undertook this focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has remained the same. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Newton House on our website at www.cqc.org.uk
Newton House is registered to provide accommodation for up to 126 people requiring nursing or personal care, including people living with dementia. The home is purpose built and is divided into four discrete 'communities' or units. Watergate unit provides accommodation for people with general care needs, Somerby unit provides Nursing Care whilst Castlegate and Brownlow are reserved for people living with dementia. There were 88 people living in the home at the time of our inspection.
People’s experience of using this service and what we found
People living at the service told us they were happy and felt safe. Relatives were very positive about the care and experiences people were getting, and felt well informed, even during the periods of lockdown. One group of people having afternoon tea told us they liked living at Newton House “as all their friends were here”. End of life care was particularly praised for the way in which the home managed to combine care with compassionate, safe visiting.
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 and were seen to be very comprehensive for people with regard to Covid-19 Testing.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 12 September 2017).
Why we inspected
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
We received concerns in relation to staffing and how this impacted on people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well--led sections of this full report.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed from Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Newton House on our website at www.cqc.org.uk.
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We inspected the home on 12 September 2017. The inspection was unannounced. There were 84 people living in the home at the time of our inspection. This was because, following our last inspection in December 2016, the registered provider had introduced an embargo on new admissions.
The home did not have a registered manager. The registered provider had appointed a new manager in July 2017. At the time of our inspection an application to register this person had been submitted to the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers (‘the provider’), 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.
In December 2015 we conducted a first comprehensive inspection of the home. We found the provider was in breach of legal requirements in two areas and rated the home as Requires Improvement in all five key questions and overall. In December 2016 we conducted a focused, follow up inspection to review the provider’s progress in addressing the two breaches of legal requirements. We found that the necessary improvement had not been made and the provider was now in breach of legal requirements in three areas. As a result, we reduced the rating in the Safe key question to Inadequate and initiated further action against the provider.
On this inspection we were pleased to find significant improvement had now been made and that the three breaches of regulations had been addressed. Reflecting our findings, the rating of the home is now Good.
There were sufficient staff to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively.
There was a friendly, relaxed atmosphere and staff supported people in a kind and attentive way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink of good quality that met their individual needs and preferences. The décor and facilities in the home had been refurbished to reflect the needs of people living with dementia.
People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. There had been significant reductions in the number of falls and violent incidents between people living in the home. Staff knew how to recognise and report any concerns to keep people safe from harm.
CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted DoLS authorisations for 45 people living in the home and was waiting for a further 17 applications to be assessed by the local authority. Staff had an understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Decisions that staff had made as being in people’s best interests were correctly documented.
Although she had only been in post for two months, the manager had already won the loyalty and respect of her team. A range of audit systems was in place to monitor the quality and safety of service provision.
We carried out a comprehensive inspection of the service on 8 December 2015. At this inspection we found two breaches of legal requirements. This was because the provider had failed to establish and maintain effective systems of governance and to correctly identify the staffing levels required to meet people’s needs and deploy staffing resources effectively to keep people safe from harm.
After this inspection, the provider wrote to us to tell us what they would do to address these breaches. We undertook this focused, follow-up inspection on 15 December 2016 to check that they had followed their plan and to ascertain that legal requirements were now being met.
This report only covers our findings in relation to these issues. You can read the report from our comprehensive inspection by entering ‘Newton House, Grantham’ into the search engine on our website at www.cqc.org.uk.
We found that the provider had not addressed either of the breaches of legal requirements we identified in December 2015.
The provider was still failing to ensure staffing resources were deployed in a way that ensured people received safe, effective care that met their individual needs and preferences.
The provider was also still failing to implement and maintain effective systems of governance to ensure compliance with legal requirements in the provision of people’s care and support.
Additionally, we found that the provider was continuing to fail to protect people from the risks of falling and of harm from other people living in the home.
We are currently taking action against the provider to ensure that they make the necessary improvements to become compliant with legal requirements. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Newton House is registered to provide accommodation for up to 126 people requiring nursing or personal care, including people living with dementia. The home is purpose built and is divided into four discrete ‘communities’ or units. The Watergate and Somerby units provide accommodation for people with general nursing and care needs whilst Castlegate and Brownlow are reserved for people living with dementia. There were 111 people living in the home at the time of our inspection.
We inspected the home on 8 December 2015. The inspection was unannounced.
The home did not have a registered manager. The registered provider had appointed a new manager in July 2015. At the time of our inspection an application to register this person had been submitted to CQC. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers (‘the provider’), 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.
CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had sought and obtained DoLS authorisation for 29 people living in the home.
During our inspection we identified a number of areas in which improvement was required to ensure people living at Newton House were provided with safe, person-centred care.
The provider had failed to correctly identify the staffing levels required to meet people’s needs and to deploy staffing resources effectively to keep people safe from harm. The provider had also failed to implement and maintain effective systems of governance to ensure compliance with legal requirements in the provision of people’s care and support. You can see what action we told the provider to take in respect of these two issues at the back of the full version of the report.
Although staff understood the issues involved in supporting people who had lost capacity to make some decisions, some staff did not have the necessary skills and knowledge to meet people’s care needs safely and effectively.
People were not provided with sufficient stimulation and some staff did not support people in a caring and person-centred way that promoted their privacy and dignity.
The provider worked closely with local healthcare services to ensure people had prompt access to any specialist support required. However, the management of people’s medicines was inconsistent and was not always in line with good practice or national guidance.
The provider met regularly with people and their relatives to discuss any concerns and suggestions. However, formal complaints were not always handled in accordance with the provider’s policy.
Food and drink were provided to a good standard and the provider had sound recruitment procedures in place.
Our inspection team was made up of three inspectors and an expert by experience. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them. We also looked at people's care records and other documentation.
If you want to see the evidence supporting our summary please read the full report.
Is the service caring?
During our inspection on 10 and 11 March 2014 we found that people's care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare.
The provider was asked to send us an action plan which set out the actions they would take to meet compliance.
We saw evidence that people's care was monitored through care plan audits and observational audits. This ensured that care was delivered as detailed in a person's care plan.
We found that staff had on-going refresher training that ensured they had the skills to carry out their role.
People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when they supported people.
We observed staff interact with people and help people to maintain their independence.
People's preferences, interests and diverse needs had been recorded in their care plan's. People told us that care and support had been provided in accordance with their wishes.
Is the service responsive?
We saw when staff had raised concerns about people's health and social care needs, that the provider had contacted appropriate health and social care professionals. The individual care files identified this and a record of actions taken were recorded.
We saw the provider had contingency plans in place in event of an emergency situation.
The provider had a complaints policy in place and information was displayed around the home, should people who lived there or their relative wish to raise a concern.
People completed a range of activities in and outside the home. We were made aware that the provider was currently recruiting a third member to their activities team which would ensure that all people had access to planned activities in the home.
Is the service safe?
The provider had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise.
The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.
We saw the provider had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing.
We spoke with staff who understood what was meant by abuse and knew how to report their concerns.
Systems were in place to make ensure that the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.
We reviewed the staffing rotas and we saw that they took into account people's care needs, when making decisions about the number, qualifications, skills and experience required. We generally received positive comments about the staffing levels within the home from people and staff.
The provider had taken action to recruit additional members of care staff to reduce the number of agency staff currently working within the home.
Is the service effective?
We found staff attended training courses to meet the individual needs of people in their care such as the care of a person living with dementia.
People's health and care needs were assessed. People, and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.
We looked at people's records which showed that care plans set out people's individual care needs. They were current and the records showed they had been reviewed on a regular basis and amendments made when a person's care needs changed.
During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.
Records showed people had access to a range of healthcare professionals.
Is the service well led?
During our inspection on 10 and 11 March 2014, we found that the provider had failed to notify the Care Quality Commission of incidents that affected the health, safety and wellbeing of the people who used the service. This meant that we could not be confident that important events were reported appropriately, or in a timely manner to us so that appropriate action could be taken if required.
We asked the provider to send us an action plan which demonstrated how they planned to address our concerns.
Since April 2014 we have continued to receive monthly records from the provider which documented all incidents that affected the health, safety and wellbeing of the people who lived at Newton House.
We saw evidence during our inspection on 22 July 2014 that the provider had implemented clear protocols for staff to follow as part of the notification process for the CQC.
The service worked well with other agencies and services to make sure people received their care in a joined up way.
The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service and the environment of the home were improving.
Staff told us they were clear about their roles and responsibilities. They told us that they felt supported and had access to a range of training to ensure they were equipped to carry out their role.
All units had secure access and were staffed individually. We visited for two days and inspected all four units. During our inspection we completed Short Observational Frameworks for Inspection (SOFI) on three of the four units.
Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with three people who used the service and three relatives and asked them for their views. We also spoke with 18 care workers, three activity co-ordinators, the head of hotel services, the training manager, the assistant deputy manager, the deputy manager, and the registered manager.
We also looked at some of the records held in the service including the care files for 16 people. We observed the support people who used the service received from staff and carried out a brief tour of the building. We also used observation to help us understand the experiences of people using the service in two of the units as we were unable to ask them their views
A person who used the service told us, 'It is lovely. The staff are brilliant. They are very caring and that is why I chose to come here.'
A relative told us, 'Care is perfect. Could not be better. All staff are very kind and caring.'
We found that people who used the service did not always experience effective, safe and appropriate care treatment and support that met their needs.
We found that people who used the service were not always supported to have adequate nutrition and hydration to meet their needs.
We found that equipment was not always available to ensure the health, safety and welfare of the people who used the service.
Staff we spoke with confirmed that they had a support structure in place for supervision which included one-to-one sessions and group meetings.
People who used the service, their representatives and staff were asked for their views about the care and treatment they received and these were acted upon.
All units had secure access and were staffed individually. We visited for two days and inspected two out of the four units. One complex nursing care unit and one dementia unit.
We spoke with the registered manager, assistant deputy manager, 6 nurses, 7 care assistants, the maintenance manager, 2 people who used the service, 4 relatives and 2 visiting health care professionals. We also used observation to help us understand the experiences of people using the service in one unit as we were unable to ask them their views
We were supported on one day of inspection by a Specialist Advisor for Tissue Viability. This is a person who offers specialist treatment and advice for all types of wounds which will include advice about dressings, recommendations about equipment and on-going treatment.
A relative of a person who used the service told us, 'Newton House is very good. It is a very nice place and it is spotless.'
Staff we spoke with told us how important they felt it was to gain consent from people who used the service when providing care and treatment. A person who used the service told us, 'Generally the staff knock on the door and ask to enter. A lot of the care staff are mature and experienced.'
Care and treatment was not planned in a way that was intended to ensure the safety and welfare of people who used the service.
A person who used the service told us, 'Yes I feel safe.'
The provider did not have systems in place to quality check all the service provisions and maintain standards.
As part of this follow up inspection we spoke with the registered manager, two nurses, the regional manager, regional director and care specialist for the organisation.
On this inspection we did not speak with people who used the service.
People who used the service understood the care and treatment choices available to them. The people we spoke with all talked positively about the service received. Comments included, 'Staff are always ready to explain things when asked, they are lovely and caring.'
Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. We saw there was a lack of risk assessments and behavioural management strategies in place.
People we spoke with told us they felt safe and relatives said they did not have any concerns about the safety of their relative. Staff members were described as caring, gentle and sensitive.
Records were not kept securely, they could be located promptly when needed but were not stored in a lockable filing cabinet or room.
We were told about the medical treatment one person was receiving and heard staff arranging to sort out getting another person some new clothes.
People told us they did not think there were enough staff on duty, one person said, 'Yesterday's breakfast didn't come until nine o'clock as they were short staffed.'
The staff were described as being 'pretty good' at their job.
We saw action had been taken when comments had been made about the services provided, for example when it was commented that it was noisy to visit people in the lounge a quiet room was created to allow visits in a more peaceful setting.