Newgrove House Care Home is registered to provide residential care for up to 40 older people, some of whom may be living with dementia. Accommodation is provided over two floors with lift and stair access. The home is situated on the outskirts of the town of Grimsby. On the day of the inspection there were 22 people using the service.The service had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, 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. Following the inspection we were informed by the operations director that the registered manager had taken the decision to step down and had left the service. The day to day management of the service would be undertaken by the operations director until a new manager was recruited.
We undertook this unannounced comprehensive inspection on the 19 and 20 July 2017. The last comprehensive inspection took place on 26 and 27 May 2016 and although no breaches in regulations were identified we rated the service ‘Requires Improvement’ for four out of the five key questions and rated the service ‘Requires Improvement’ overall.
Due to concerns found during the inspection regarding assessing and delivering person-centred care, managing risk, need for consent, notifying CQC of incidents, having an effective monitoring system and ensuring sufficient numbers of staff were deployed at all times, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Following the inspection, we received an interim action plan. We also requested and have received weekly updates to assure us actions have been taken to address the concerns. We found multiple concerns and are considering our regulatory response. 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. You can see what action we told the provider to take at the back of the full version of the report.
We found there was inconsistency regarding the application of the Mental Capacity Act 2005. The provider and manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests.
People were left exposed to avoidable risks because steps had not always been taken to assess and mitigate risks to people’s health and safety.
We found there were times when there were insufficient staff deployed to meet people's needs.
People had care plans in place, however, we found these were not always person-centred and missed important information regarding how staff were to care for them. The care plans were not always updated when people’s needs changed. This meant that important care could be missed.
The quality monitoring system had not been effective in highlighting areas that required improvement such as the care records, risk management and consent to care. We found action had not been consistently taken in order to address these. There were discrepancies regarding the records of some people who used the service which made it difficult to check if the correct care and treatment had been delivered. We found where accidents had been logged, these highlighted specific issues but lacked analysis to ensure lessons were learned to prevent reoccurrence. The CQC had not always received notifications of incidents which affected the welfare of people who used the service.
We received mixed feedback regarding the leadership of the service, which had affected staff morale and the turnover of staff in recent months. Visiting health care professionals felt the communication at the home was not always effective; there were some delays with referrals and the implementation of their guidance was inconsistent at times. The operations manager was undertaking a review of each person’s heath and care needs.
People liked the meals provided to them and there was sufficient quantity and choice available. Staff supported people to eat their meals in a sensitive way when required. We saw there were plenty of drinks and snacks available in between meals.
There was a range of activities for people to participate in and staff supported people’s access to the local community.
We found people who used the service were protected from the risk of harm and abuse because staff had received safeguarding training and they knew what to do should they have any concerns.
Staff were recruited safely and employment checks were carried out before new people started work in the service. People received their medicines as prescribed and they were obtained, stored and recorded appropriately.
The majority of staff had received regular supervision from their line manager. Staff had access to a range of training. There were some shortfalls and delays with staff completing some courses or refresher training. We have made a recommendation about reviewing the staff training programme in relation to the quality of the induction training and timely access to courses.
People told us they were supported by caring and attentive staff who knew their needs and understood their preferences. Relatives we spoke with were complimentary about staff’s approach and felt their family member’s needs were met in a caring way. People told us and we observed they were treated with dignity and respect by staff.
There was a complaints procedure on display in the service and it was included in information given to people. Staff knew how to manage complaints and people spoken with felt able to raise concerns.