The New Inn

The New Inn is a residential care home providing accommodation and personal care to 7 people with learning disabilities, autism, and other support needs including a mental health illness. The service can support up to 10 people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right Support, Right Care, Right Culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

Although the New Inn is registered for 10 people and this was larger than recommended, the service was run in a way that met the guidance. The model of care and environment maximised people's choice, control and independence. There was an open plan lounge/dining room and separate communal area on the first floor so people could spend time apart if they chose to. The garden was also attractive safe and accessible.

Staff supported people's strengths and promoted what they could do for themselves. They

understood the importance of people being as independent as possible, and the fulfilment this gave people. For example, people were encouraged to look after their own rooms and laundry. People were supported to be busy and to have fulfilling lives that included life activities and social events.

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. People's health needs were monitored, and people were supported to ensure they received health care when needed. People received their medicines in line with prescription guidelines.

Right Care:

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff knew people as individuals and responded to their different needs. Staff were aware of people's emotional support needs. They understood what triggered people's anxiety and how to support them during times of distress. Staff were aware of their responsibility to protect people from potential abuse and concerns were reported and investigated in line with good practice and requirements.

Each person had a Key worker who they had formed positive and supportive relationships with. Choices were provided to people in relation to their day to day support and how they wanted to spend their time. Recreational and social events were an important part of people’s lives and given a high priority.

Right Culture:

The registered manager and the extended management team have worked hard at promoting a positive and inclusive environment where people and staff felt valued and listened to. The registered manager was providing effective hands on leadership.

Staff demonstrated their commitment to the values and ethos of the service that put people at the centre of all care and support provided. Staff spoke positively about people's achievements and encouraged their independence whenever possible.

Staff spoke positively about the management team, and the support they received. One staff member said, "I love working here, it’s a good team, and you are well supported.”

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 last rating for this service was requires improvement (22 January 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 17.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The New Inn is a residential care home providing accommodation and personal care to ten people with learning disabilities, autism, and other support needs including a mental health condition. The service is currently full. The New Inn is an adapted detached building on the outskirts of Uckfield.

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

Quality and governance systems had not been fully established to ensure effective quality monitoring was in place. This meant areas needing improvement were not always identified and responded to effectively. We found risk assessments had not been reviewed and updated to reflect current support needs and some medicine records were not complete and available to inform staff on best practice. Accident and incidents were not fully reviewed and monitored to identify trends or to assess if they were dealt with in the most effective way. The impact on staff was not always taken into account.

People were protected from the risks of harm, abuse or discrimination because staff knew how to recognise and respond to any possible abuse. There were enough staff working and available to provide safe support and supervision for people. Recruitment practice was thorough and ensured only suitable staff worked at the service.

There were suitable arrangements in place to respond to any risk to people and to provide people with their prescribed medicines. Infection prevention control measures meant the service was clean and people were protected, as far as possible, from the risk of COVID-19.

The new manager had established a positive culture at the service and was working closely with staff to ensure people were supported appropriately and safely. They understood their responsibilities and were making positive changes in the service to improve systems and outcomes for people. There was a clear management structure with the manager supported by a service manager and the provider who had regular contact with them, staff and people living at the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, Right care, Right culture.

Right support:

The New Inn is registered for 10 people. Although the service was larger than recommended, they ensured the model of care was adapted to meet the guidance. The model of care and the layout of the setting maximised people's choice, control and independence. In addition to an open plan lounge/dining room there was a separate communal area on the first floor so people could spend time apart if they chose to. Some people chose to spend time in the garden where there was a vegetable patch and a chicken run and one person had a pet rabbit. Staff supported people to meet their individual needs and encouraged them to be as independent as possible. Most people were independent with meeting their personal care and attended to their own laundry. Some people went out independently and others were supported in line with their needs.

Right care:

People were treated as individuals and staff knew them well. We saw that people were pleased to see staff when they arrived on shift. The organisation had reorganised their day centre to ensure people had continued to have some access to their preferred activities throughout the lockdown. Additional activities were maintained at the service. One person told us they loved gardening and were looking forward to planting vegetables in the garden later that day. People either had their own ensuite or shared a bathroom with one other.

Right culture:

The ethos, values, attitudes and behaviours of leaders and care staff ensured people led confident,

inclusive and empowered lives. People were encouraged to make choices about how they wanted to spend their time. One person chose to live fairly independently from the others and had definite choices about the times they got up and went to bed and how and who they would communicate with. There was a very lively and friendly atmosphere in the service with lots of jovial banter between people and staff. People told us they liked living at the New Inn and a staff member told us, “I like how it is here, it’s like a little family really.”

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 last rating for this service was Requires Improvement (published 22 January 2020) and they were in breach of a regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of a regulation 17. The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last five consecutive inspections.

Why we inspected

This inspection was prompted by our internal intelligence systems that assesses potential risks at services, taking account of concerns in relation to aspects of care provision and previous ratings any enforcement and safeguarding information. As a result, we undertook a focused inspection to review the key questions of safe and well-led. This enabled us to review any potential risks and review the previous inspection ratings.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

The New Inn is a residential care home providing accommodation and personal care to seven people with learning disabilities, autism, and other complex needs, at the time of the inspection. The service can support up to 10 people. The New Inn is in a detached building on the outskirts of Uckfield. The accommodation comprises a large, communal, open-plan sitting, dining area with access to a rear garden. There are two shared lounges and people have their own bedrooms with en-suite facilities.

Our inspection in April 2017 was prompted in part by a notification of a specific incident. This incident is still subject to a criminal investigation and as a result neither inspections examined the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about how the risk of choking was managed. Both inspections examined those risks and other potential risks to people.

Outcomes for people did not consistently reflect the principles and values of Registering the Right Support as some people experienced a lack of choice and control. Other outcomes reflected the principles of Registering the Right Support such as people’s independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Quality audits had not consistently highlighted or put right issues we found at this inspection. The service has not been rated Requires improvement in Well-led for four consecutive inspections.

Some risks were not consistently assessed. For example, we found some staff were working long hours. Doing consecutive shifts to cover other staff absence, but there had been no risk assessment.

Some staff language and approach was not always person centred or appropriate. Two entries in a ‘telephone log book’ book were not appropriate and one staff’s approach to another person was abrupt.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. One person had a condition that meant their ability to make decisions changed and this was not planned for. We have made a recommendation about this in the main body of the report.

There were enough staff deployed to meet people’s needs safely. The service was clean and free form the risk of infection. Where things had gone wrong, such as incidents, learning was shared, and lessons embedded into practice.

Staff were trained and supported to fulfil their roles. People had enough to eat and drink to maintain good health and their healthcare needs were met by staff who monitored people’s health. The building was accessible and met peoples’ needs.

Staff supported people to be independent and respected people’s privacy. People were involved in their care and staff knew peoples’ communication needs.

People had a range of personalised activities they accessed and told us that they had lots to do. People and relatives knew how to make a complaint if they needed to. There were no people receiving end of life care, but people had care plans for how they would like to be supported during their final days

The registered manager was a visible presence in the service and had a good understanding of the challenges the service faced and how to overcome them. The management team understood their responsibilities in reporting significant events and had worked closely with partner agencies.

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 (June 2018).

At this inspection we found improvements had not been sustained and there was a breach of regulation relating to good governance.

Why we inspected

The inspection was prompted in part due to concerns received from a whistle blower. A decision was made for us to inspect and examine those risks. Although we found no evidence to support the claims made in the whistle blowing allegation we have found other evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring and Well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to a lack of effective audits to identify shortfalls at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to

make the improvements needed. We will continue to monitor information and intelligence we receive

about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services. If we receive any concerning information we may inspect sooner.

The last Inspection took place on 19 and 20 April 2017 and was unannounced. This was prompted in part by a notification of an incident following which a person died. This incident is still subject to a criminal investigation and as a result neither inspections examined the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about how the risk of choking was managed. Both inspections examined those risks and other potential risks to people.

The New Inn is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Care and support is provided for up to ten people with a learning disability, autism and/or other complex needs. At the time of our inspection, there were eight people living at the service. The service is in an older, detached building on the outskirts of Uckfield. The accommodation comprises a large, communal, open-plan sitting, dining area with access to a rear garden. People have their own bedrooms with en-suite facilities. This service is one of three services in East Sussex owned by the provider.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. So that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in post; however, they were not currently in charge of the day to day running of the service. A registered manager is a person who has registered with the Care Quality Commission 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. The registered provider had taken an active role in the service. They had appointed the deputy manager from another of the provider’s service to work as the manager during the registered manager’s absence. There was also a service manager to oversee and support all three of the provider’s services.

At the last inspection on 19 and 20 April 2017 the service was rated overall Requires Improvement. This was because risks were not consistently managed safely as assessments were out of date and lacked some detail. Safety checks, such as food temperature and fire safety checks had not always been completed. Staff were not always trained with the right skills and knowledge to provide people with the care and assistance they needed. Training was out of date for some staff. Staff had not always been able to meet with their line manager for supervision on a one to one basis. When staff were recruited they were not consistently subject to checks to ensure they were safe to work in the care sector or inducted to work in the service. Where people did not have the capacity to understand or consent to a decision, the provider had not always followed the requirements of the Mental Capacity Act (2005). Some mental capacity assessments were completed incorrectly and did not clearly record the outcome. There was a lack of meaningful and structured activities on offer to people and there was a lack of therapeutic input to people’s activities. People had access to a range of healthcare professionals but were at risk of not having their health needs met as care plans were not updated to reflect guidance provided. Some health action plans contained out of date information or had not been updated regularly. There had not always been sufficient leadership in the service. Quality auditing systems had not always been effective. The registered provider had started to make improvements and changes prior to our last inspection. However, we needed to see these changes had been embedded in to practice. The provider sent us an action plan as to how these issues were to be addressed. At this inspection we found further improvements had been made.

People and staff spoke very well of the new management arrangements and of the changes that had been made since the last inspection. One member of staff told us, “It has changed for the better.” Staff told us the manager was always approachable and had an open-door policy if they required some advice or needed to discuss something. One member of staff told us, “The teams a lot happier. (Manager’s name) is so bubbly and it rubs off on the staff.” Another member of staff told us, “She is very open and always has time to talk. She is great with the guys, good with the team. She will actively take it on and do something about it.” Senior staff carried out a range of internal audits, and records confirmed this. People and their relatives and visiting health and social care professionals were regularly consulted about the care provided either through reviews, resident’s meetings or by using quality assurance questionnaires.

Systems were in place to keep people safe. People told us how they felt safe with the care provided. They knew who they could talk with if they had any worries. They felt they could raise concerns and they would be listened to. People were protected from the risk of abuse because staff understood how to identify and report it. Assessments of risks to people had been developed. Staff told us they had been supported to develop their skills and knowledge by receiving training, supervision and appraisal which helped them to carry out their roles and responsibilities effectively.

People's individual care and support needs had been identified before they received a service. Care and support provided was personalised and based on the identified needs of each person. Comprehensive and detailed care plans provided staff with information about how people wished to be cared for in a person-centred way. People met with their keyworkers regularly to discuss the care to be provided. Staff were aware of, and followed the requirements of the Mental Capacity Act (2005) and had a good understanding of consent.

People told us they were happy with the care provided. One person told us, “The staff are here to help if you need it. They are all kind. They know what help I need, it’s not a lot. It’s a very safe place to live because they are always here, they can see to anything that happens and they give me my tablets.” People were supported by kind and caring staff who knew them well and treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. They had been supported to keep in touch with relatives and friends. One person told us, “All the people here understand me and they have been helpful to my sister too.” When asked what the service did well one member of staff told us, “Care. We all have a very good professional relationship with everyone here. We all accommodate their needs really well.”

There were arrangements in place for the safe administration of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and eat a healthy diet.

The New Inn is a care home registered to provide accommodation and personal care for a maximum of ten people with learning disabilities. At the time of our visit there were nine people living in the home. The service had a registered manager in post; however, they were not currently in charge of the day to day running of the service. The registered provider had taken an active role in the service and had appointed the deputy manager from another service to fill in as an acting manager and the deputy manager of The New Inn had been given extra support. A registered manager is a person who has registered with the Care Quality Commission 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.

At our last inspection on 1 and 2 June 2016, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities). This breach was in relation to good governance around cleanliness of the premises. At this inspection we found that improvements relating to cleanliness had been made but that quality auditing systems to identify other improvements had not yet been embedded in to practice, meaning this remained a breach of the regulations.

The provider had systems in place to protect people against abuse and harm. The provider had effective policies and procedures that gave staff guidance on how to report abuse. Staff were trained to identify the different types of abuse and knew who to report to if they had any concerns. Medicines were managed safely and people had access to their medicines when they needed them.

Risks were not consistently managed safely as assessments were out of date and lacked some detail. Safety checks, such as food temperature and fire safety checks had not always been completed. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient numbers of staff to support people safely. Staff were not always trained with the right skills and knowledge to provide people with the care and assistance they needed. Some training was out of date for some staff. Staff had not always been able to meet their line manager on a one to one basis regularly. When staff were recruited they were not consistently subject to checks to ensure they were safe to work in the care sector or inducted to work in the service. We have made a recommendation about this.

Where people did not have the capacity to understand or consent to a decision, the provider had not always followed the requirements of the Mental Capacity Act (2005). Some mental capacity assessments were completed incorrectly and some did not clearly record the outcome. You can see what action we told the provider to take at the back of the full version of the report.

There was a lack of meaningful and structured activities on offer to people and there was a lack of therapeutic input to people’s activities. The registered manager had recruited people who were yet to start and had plans to recruit other staff members. We have made a recommendation about this in our report.

People had access to a range of healthcare professionals but were at risk of not having their health needs met as care plans were not updated. Some health action plans contained out of date information or had not been updated regularly. People had received adequate food and drink to maintain good health.

People were supported to maintain their independence. The staff were kind and caring. Good interactions were seen throughout the day of our inspection. People could have visitors from family and friends whenever they wanted. People spoke positively about the care and support they received from staff members.

People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people’s decisions. People and their relatives told us that their privacy was respected and their dignity was upheld.

There were systems in place to monitor and respond effectively to complaints. Although verbal complaints had been addressed informally, they had not been recorded. We have made a recommendation about this in our report.

Care and support plans were out of date and information these contained was not consistent. Some activities had not happened as planned. This meant that people were not receiving a person centred service. You can see what action we told the provider to take at the back of the full version of the report.

The culture of the service was homely and friendly but some staff members told us there had been some tensions following a recent incident and some staff changes. There had not always been sufficient leadership in the service but the registered provider had made changes and had recently been more involved in the day to day running of the service.

Quality auditing systems had not always been effective and the registered provider had started to make improvements and changes prior to our inspection. We need to see that these changes are embedded in to practice. You can see what action we told the provider to take at the back of the full version of the report.

The New Inn is a care home registered to provide accommodation and personal care for a maximum of ten people with learning disabilities. At the time of our visit there were 9 people living in the home. At the time of our inspection there was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission 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.

Audits did not always identify actions to improve the service. During the inspection 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 the report.

Risks to people’s safety had been assessed and actions taken to protect people from the risk of harm. The provider also had systems in place to reduce the risk of people experiencing abuse. When concerns were raised, the provider had investigated these thoroughly and action had been taken to protect people when necessary.

Medicines were managed safely and people had access to their medicines when they needed them. However, as required medicines were not clearly audited when counting stock from one month to the next. We recommend that the registered manager reviews the procedure for stock checking all medicines

Staff were well trained and there were enough staff with the right skills and knowledge to provide people with the care and assistance they needed. They knew the people they cared for well and treated them with kindness, compassion, dignity and respect. Staff met together regularly and felt supported by the manager. Staff were able to meet their line manager on a one to one basis regularly. New staff were inducted in the service when they started working there but the process was not consistent. We recommend that the registered provider implements a consistent induction programme for all new staff.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff sitting and talking with people as equals. People could have visitors from family and friends whenever they wanted.

People received a person centred service that enabled them to live active and meaningful lives in the way they wanted. People led full and varied lives and were active in their community.

Support plans ensured people received the support they needed in the way they wanted. Peoples health needs were well managed by staff so that they received the treatment and medicines they needed to ensure they gave consent. Staff respond effectively to people’s needs and people were treated with respect. Staff interacted with people very positively and people responded well to staff.

Complaints were responded to appropriately however not all complaints were recorded. We recommend that the registered manager reviews the complaints recording process.

The culture of the service was open and person focused. The registered manager provided clear leadership to the staff team and was an active presence in the home. The manager provided active cover on the rota however this sometimes meant that they did not have sufficient time to fulfil their management role. We recommend that the registered provider reviews the management hours available.

We found that people were supported to make choices and give their consent before any support or treatment. Staff were aware of the legal requirements of the Mental Capacity Act 2005 which meant that people's legal rights were protected.

People received care and support which met their needs and which ensured their safety and well being. Staff had access to detailed, up to date information and guidance about how to support each individual.

We found that the environment was kept clean and that there were suitable systems in place to maintain standards of hygiene and infection control. Staff had access to personal protective equipment if needed.

There were enough qualified, skilled and experienced staff to meet people's needs. There was a stable staff team in place who had a good awareness of the needs of each person that used the service. There were systems in place to cover staff absence in the event of sickness or annual leave.

We found that people who used the service were supported to make comments or complaints and that these were taken seriously. Staff understood how to identify if people who had communication difficulties were unhappy about the care and support they received.

We spoke to four people who used the service. They all told us that they were happy with the improvements that had been made to the environment. One person said "It's nice". We observed that people appeared relaxed and comfortable within the home. All areas were clean and tidy. We found that three people had had their bedrooms redecorated. One person told us they were "Happy with my room and the lounge".

We spoke with the new manager who discussed some of the changes she had implemented since being in post in order to make sure the service was compliant with the Regulations.

We found that there was a new system for managing the maintenance of the home and that this was effective in ensuring that repairs were carried out within reasonable timescales.

We were satisfied that arrangements had been made to ensure that recruitment records for staff were robust and contained all the information required so that people at the home could be confident they were safely supported by skilled and experienced staff.