This inspection took place on 12 February 2018 and was unannounced. At the last inspection completed on 28 November 2016 we found the service was rated Good. At this inspection we found the service remained Good.

Newbury Manor 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.

Newbury Manor accommodates 56 people in one adapted building. At the time of our inspection there were 49 people living at the home.

There was a registered manager in post at the time of the inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were kept safe by staff that could recognise abuse and understood how to safeguard them. Risks to people were assessed and plans were followed to prevent risks to people’s safety. There were sufficient suitably recruited staff in place to support people. People received their prescribed medicines safely. People were protected from the risk of infection. Incidents were reviewed to ensure learning when things went wrong.

People were assessed and care plans were put in place to meet their needs. Staff received training and could demonstrate they had the skills to support people effectively. People had enough to eat and drink and could make choices about their meals. People were supported in a adapted environment with access to equipment to support them effectively. People had access to health professionals and were supported to maintain their health. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice.

People were supported by caring staff and staff understood people’s needs and knew them well. People could make choices about their care and support and were supported by staff to do this. People were treated with dignity and respect and their privacy was maintained.

People’s preferences were considered by staff when they provided support. People had access to activities and were supported to maintain their religious beliefs. People understood how to complain and the registered manager ensured all complaints were responded to. People were supported with dignity at the end of their lives.

The registered manager was accessible and people and their relatives were able to share their views about the service. There were quality audits in place which enabled the registered manager to check people had received the care and support they needed.

The inspection took place on 28 November 2016 and was unannounced. At our last inspection of the service in January 2016, the provider was rated as Requires Improvement due to concerns around the management of medications. At a follow up inspection in August 2016, the provider had made the required improvements and was meeting regulation.

Newbury Manor is registered to provide accommodation and nursing care to adults who may have learning disabilities or physical disabilities. At the time of the inspection there were 39 people living at the home.

There was a registered manager in post who was present throughout the inspection. 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.

People were supported by sufficient numbers of staff who had been recruited safely. Staff knew how to report any concerns of abuse and managed risks to keep people safe. Medications were managed in a safe way.

Staff received training and supervision to enable them to meet people’s needs effectively. People had their rights upheld in line with Mental Capacity Act 2005 and were supported to have choices at mealtimes and access healthcare services where required.

People were supported by staff that were kind and treated them with dignity. People were encouraged to maintain their independence and where required, advocacy services were accessed for people.

People were involved in the planning and review of their care. Staff knew people’s preferences with regards to their care and acted in line with this. Activities were available that met people’s individual interests and information was available about how people could make complaints.

People spoke positively about the leadership at the home and were given opportunity to feedback on their experience of the service. Systems were in place to monitor the quality of the service and make improvements where issues were identified. The registered manager had not consistently notified us of incidents that occurred at the service as is required as part of their registration.

Our inspection was unannounced and took place on 31 August 2016.

The home is registered to provide accommodation, nursing and personal care to a maximum of 45 people. People who lived there had a range of conditions, the majority of which, related to old age.

The manager was registered with us. 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.

We carried out an unannounced comprehensive inspection of this service on 11 January 2016. A breach of legal requirements (relating to the management of medicines) was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

At this inspection a pharmacy inspector found that improvements had been made to ensure the safe management of medicines.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Newbury Manor on our website at www.cqc.org.uk.

Our inspection was unannounced and took place on 11 January 2016.

The home is registered to provide accommodation and personal care to a maximum of 45 people. On the day of our inspection 40 people lived at the home. People who lived there had a range of conditions, the majority of which, related to old age.

At our last inspection in November 2014 we assessed that improvements were needed regarding medicine safety. This inspection we found that improvements were still required as the medicine systems in place did not ensure the proper and safe management of medicines.

The quality monitoring systems failed to ensure that shortfalls relating to medicine management had been addressed. The Provider Information Return (PIR) was returned within the timescale we gave but it had not been as fully completed so did not give us all of the information we needed.

The manager was registered with us. 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.

People who lived at the home felt safe. Systems were in place to protect people from the risk of harm and abuse.

People were happy with the meals offered. People were supported to have meals that they liked. Drinks were offered throughout the day to prevent people being placed at risk of dehydration.

Staff felt that they were provided with the training that they required to enable them to provide safe and appropriate care to people. Staff also felt that they were adequately supported in their job roles.

Staff sought people’s consent before providing support. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People and their relatives felt that the staff were kind. Staff were friendly, polite and helpful to people.

People received assessments and/or treatment when it was needed from a range of health care professionals which helped to prevent deterioration to their health and well-being.

People participated in and enjoyed the varied activities offered.

A complaints system was available for people to use. People and their relatives confirmed that they would use the process if they had the need.

People, their relatives and staff felt that the quality of service was good.

You can see what action we told the provider to take at the back of the full version of the report.

Our inspection took place on 24 November 2014 and was unannounced so no-one knew we would be inspecting that day.

The home is registered to provide accommodation and nursing care to a maximum of 47 people. On the day of our inspection 37 people lived there.

A manager was registered with us as is required by law. 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.

During our previous inspections that we carried over the last 18 months we found that the provider was not meeting all of the regulations that they should. This placed people at risk of ill health and/or of them not receiving appropriate care that met their needs. Our previous inspection on 23 June 2014 found that regulations related to medicine management, care and welfare issues and the quality monitoring of the service were not met. Following that inspection we had a formal meeting with the provider who gave us full assurance that improvements would be made. During this, our most recent inspection, we found that although some improvements had been made, improvement regarding medicine management was not sufficient. We identified a breach in the law concerning medicine management. You can see the action we told the provider to take at the back of the full version of the report.

We found that there was a lack of recording to give assurance that learning from accidents and incidents had been taken into consideration. We found that action was not always taken to avoid repeated falls and decrease the risk of injury to the people who lived there.

People told us that they felt safe living there. We saw that there were systems in place to protect people from the risk of abuse.

People told us that they were happy with the meals on offer. We saw that people were supported to have a nourishing diet and drinks were offered throughout the day so that they were less at risk of dehydration.

The registered manager gave us assurance that staffing levels would be reviewed to fully ensure that people would be safe and that their needs were met in the way that they wanted them to be.

People and their relatives described the staff as being kind and caring and our observations showed that they were.

We saw that interactions between staff and the people who lived at the home were positive in that staff were kind, polite and helpful to people.

We found that that people received care in line with their best interests. Deprivation of Liberty Safeguarding (DoLS) is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. Staff gave us a basic account of what DoLS meant and had acted correctly in applying to the local authority about one person regarding their DoLS issue.

Staff told us that they were provided with the training that they required. This would ensure that they had the skills and knowledge to provide safe and appropriate care to people. Staff also told us that were adequately supported in their job roles.

People told us that staff met their recreational needs by supporting and enabling individual and group activities.

We found that a complaints system was available for people to use. This meant that people and their relatives could state their concerns and dissatisfaction and issues would be looked into.

We found that although further improvements were needed the leadership in the home had been strengthened. People told us that they felt that the service was run in their best interests.

Our inspection was unannounced. Our inspection team consisted of an inspector, a pharmacy inspector and an expert by experience. On the day of our inspection 37 people lived at Newbury Manor this included two people who required palliative care. Palliative care is provided to people who are at an end stage of their life.

Over the last few months we had received some anonymous concerns. Sandwell Local Authority and Clinical Commissioning Group (CCG) who monitor and fund the majority of adult social care services visited and looked into the concerns. The concerns included care planning, record keeping and the management of medication. The local authority and CCG identified during their visits to the home that although some of the aforementioned issues remained there were some positive aspects of care as well. They found that people who lived there were satisfied with the service provided and that staff were motivated and had caring attitudes .

During our inspection we spoke with 15 people who lived there, two relatives, eight staff and the registered manager. The majority of people and staff we spoke with told us that the overall service provided was good. One person said, “It’s marvellous living here the staff look after me”. Another person told us, “It’s nice in here”. However, one person said, “It could be better”. Another person said, “I do not rate the place very highly”.

The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

The registered manager knew of Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. We determined that two DoLS applications had been recently approved by the local authority. This showed that the registered manager had followed processes required to ensure that people were not unlawfully being deprived of their liberty.

We found that where staff had identified concerns regarding risks associated with people’s health and welfare they had been referred to appropriate agencies.

Our pharmacist inspected the medication management systems and processes and found that they were not safe. This placed people at risk of harm and ill health either through them not being given the medication they were prescribed or them not being given their medication correctly.

Is the service effective?

People we spoke with gave us mixed views about the standard of care and support they received. One person said, “They look after me well”. Another person said, "I am well cared for here". However, other people told us that the service provided did not always meet their needs. One person said, “They do not know how to look after me”.

We found that staffing numbers were in need of a review to demonstrate that they could effectively meet people's needs and preferences. A number of people and staff we spoke with highlighted that they felt at times additional staff were needed. People told us that at times, they had to wait for support and assistance.

Staff received on-going support from senior staff to ensure they carried out their role effectively. All staff we spoke with told us that they felt supported. One staff member said, “The manager and nurses are good. We can always ask for advice, I feel supported”.

Arrangements were in place to request heath, social and medical support to help keep people well.

Is the service caring?

Overall, we found that care and support was provided with kindness and compassion. People told us that they could make some choices about how they wanted to be supported. People we spoke with had mixed views about the staff. The majority of the people we spoke with were complimentary about the staff and described them as being, “Kind” and “Caring”. One person told us, “I feel that I am treated with kindness and dignity”. However, one person told us that some staff were not careful enough when handling them and another person told us that one staff member had a poor attitude.

We spent some time observing interactions between staff and the people who used the service. We saw that most staff showed patience when supporting people. One person told us, “The staff are patient and go at my pace”.

The staff did not always know the full care and support needs of people enough to ensure individual personal care was provided in a way that people preferred.

Is the service responsive?

We found that people were asked if they wanted to raise any issues. This showed that the provider was willing to listen to the views of the people who lived there to improve the overall service provision.

When people became unwell the staff noticed this and secured appropriate medical input.

We found that the provider had taken note of the findings of local authority and CCG visits and had taken action to improve. However, insufficient action had been taken to ensure that medication management systems and care planning systems were safe and responsive. This lack of improvement placed people at risk of not having their needs met and not having their medication as it had been prescribed by their doctor.

We found that staff were not responsive to one person’s basic request, though this request could have been easily addressed, it was not. This caused the person upset and clear dissatisfaction.

Is the service well led?

A registered manager was in post which meant that consistency and familiarity was provided.

The staff were confident they could raise any concern about poor practice at the home and it would be addressed to ensure people were protected from harm.

Staffing was not always organised to ensure people’s needs were met and support was not always available for activities. A number of people told us that they had to wait for staff assistance.

We saw that processes were in place to provide one to one supervision to staff so that they had a development and support structure to assist them in their roles.

Overall we found that training was available and most of the required training had been received. However, some training needed to be arranged in the subjects of food hygiene and dementia care. Without this assurance could not be given that the care provided would be appropriate or safe.

We identified that some staff did not follow instructions and one staff member's attitude was poor. This had a negative effect on the running of, and the atmosphere of, the home.

This repeat inspection was unannounced. No one knew we would be inspecting that day. Thirty four people lived at Newbury Manor on the day of our inspection. We spoke with seven people who lived there, six staff, the manager, two relatives, an external healthcare professional and a GP. All of the people we spoke with were complimentary about the care provided to them. A person who lived there told us, “It is a very good place”. Another person said, “I like it here”. A relative said, “I am happy with the care that they receive”. People were also complimentary about the staff. They used words which included, “Kind,” and, “Good” to describe the staff.

During our previous inspections of February and June 2013 we found that that staffing levels were not adequate to meet people’s needs and to keep them safe. During our inspection of June 2013 we found that aspects of the care provided to people did not demonstrate that their needs had been met. We carried out this inspection to find out if improvements had been made and we found that they had.

We looked at care records for four people who were living there. We saw that care plans gave detail about people’s individual needs and what staff should do to meet those needs. Overall, records that we looked at and all staff we spoke with gave a better account of the care that was being provided. This meant that processes better promoted the care, welfare, and safety of the people who lived there.

All staff we spoke with confirmed that staffing levels had been increased. Our observations showed that there was a higher number of staff to care and support the people who lived there. This meant that staffing levels better ensured that people’s needs would be met and that they would be safe.

There were 38 people living at the home on the day of our inspection. No one knew we would be inspecting that day.

During our inspection we spoke with 11 people living at the home. The majority of people we spoke with were complimentary about the home. One person said, “I like it here”. Another person said, “They do look after me”. However, a number of people told us that improvements would be made if more staff were available.

We observed some good interactions between staff and people living there. We saw that staff were polite to people and showed them respect.

We saw that people's needs had been assessed by a range of health professionals including dieticians and specialist nurses. However, we found that care planning and care actions did not always ensure that people’s needs were met or that they were safe.

We found that equipment was in working order and was available to meet people’s needs.

As we found during our previous inspection staffing levels were not always adequate which meant that staff did not have the time to fully meet people’s needs in the way that they preferred.

We saw that the registered provider had some processes in place to monitor the service being provided.

There were 41 people living at the home on the day of our inspection. No one knew we would be inspecting that day.

During our inspection we spoke with 12 people living at the home and three relatives. The majority of people we spoke with were complimentary about the home. One person said, “I have to tell the truth it is good here”. Another person said, “They look after us”. A relative said, “I think it is a very good place”.

We observed good interactions between staff and people living there. People's needs had been assessed by a range of health professionals including dieticians and specialist nurses. This meant that people's health care needs had been monitored and met.

We found that some equipment was not in working order and some equipment was not being monitored effectively enough. However, the registered provider had taken action to address these issues to make sure that equipment was available as it needed to be.

Staffing levels were not always adequate at peak times which meant that staff did not have the time to fully meet people’s needs in the way that they preferred.

We saw that the provider had made available a complaints process for people living at the home and their families to use if they were not happy. We saw that complaints received had been dealt with in an appropriate way.

Most of the people we spoke with during our visit of 3 January 2012, confirmed their satisfaction with the accommodation, the staff and the food at Newbury Manor.

We carried out this review to check on the care and welfare of people using this service. We visited the home as part of this review, and looked at information we had received about this provider since our last visit in August 2011. We checked the systems for planning care, and managing risks to people and identified improvements that had been made. The risk of inconsistent care was reduced as staff had better information about people’s care needs. This meant that people got the care they need when they needed it.

We spoke with a range of people whilst at the home. These included people who live at the home, nursing and care staff and managers. Staff told us that there had been improvements in the staffing levels since the last visit. People who lived at the home gave us examples of how the staff supported them when they needed it. People appeared happy and when they were not, we saw staff supported them in a sensitive way.

for the essential standards of quality and safety

The manager explained the way that they monitor the quality of the home. We saw that checks are being made, and were effective enough to identify areas of potential risk or concern.

We spoke with nine people who live at the home, some described staff as “golden” and “kind and helpful”. Some people we met were unable to tell us about their experiences of living at the home, so we spent time observing and finding out how staff supported and cared for them. We found most staff interacted well, were chatty and responsive and regularly checked if people were ok. In contrast we saw that some people experienced long periods without staff interaction.

We also spoke with four staff, two nurses the acting manager and the provider. This helped us find out the views of staff and their knowledge of the best ways to support people.

Prior to and following our visit we spoke with other visiting professionals who told us they were concerned about how the service manages staff shortages, and risks of skin damage and weight loss for people.

We undertook a desk top review of this service. This involved us looking at all the information we hold on this provider and requesting more information when we needed further information.

At our review of this service on 21 December 2010, we found improvements were needed to ensure that medicines which were running out could be ordered in time so that people did not go without their medicines. We issued a compliance action at that time because our judgement was that there were minor concerns with the management of medicines.

In February 2011 we received information from the Primary Care Trust (PCT) which told us that the shortfalls in relation to the management of medication had been addressed.

We visited again in August 2011 and people and their relatives told us:

“It’s a nice home, they look after me well.” “It’s a nice home the staff are friendly, I have no complaints, quite happy.” “I visit every other day, the staff are very welcoming and keep me up to date with my relative’s wellbeing. They (staff) are very good they look after my relative very well.”

Since the review in August 2011, we have not been made aware of any concerns about medicine practices.

On 3 January 2012 we visited Newbury Manor. We found that nurse and care staff levels had been improved so that people received care from sufficient numbers of staff who had the necessary skills and training to meet their needs. We saw that the care manager had reviewed and improved the effectiveness of audits, and these had been effective in identifying areas of potential risk to people. We saw that the manager had taken action to respond to issues of quality and safety for people.

We asked for information from the provider for this latest review. The care manager provided us with information which confirmed they had reviewed the arrangements for the management of medicines.

They told us they completed a weekly audit of all medication. Nurses had successfully completed a medication competency test, a record of which is kept in each persons file. They advised that they had an up to date copy of current guidance on the administration of medicines, which is available to guide nurses.

We were advised that a list of homely remedies is in place, and that a procedure for the ordering of medication is in place including ‘out of hours’. They told us that medication records had up to date photographs of each person for easy identification. There are written plans in place for people who self- medicate so that staff could support them to handle their own medication. We were informed that daily checks were in place for the management of controlled drugs.

Given the information we have received and assessed, we were assured that appropriate steps had been taken to reduce the risk of medicines running out. This should reduce the risk of people going without their medicines.