The inspection of Newfield Lodge took place on 28 February 2017 and was unannounced. The previous inspection had taken place in February 2016 and the home had been rated as requiring improvement overall, with a rating of good in the safe, caring and well led domains. During this inspection we checked to see if any improvements had been made.

Newfield Lodge is a purpose built care home for 64 people, divided into four areas, two of which specialise in the care of people with dementia. On the day we inspected there were 56 people living in the home.

There was a registered manager who was available on the day we inspected. 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 safe as staff demonstrated an in-depth understanding of people’s individual needs based on their experience and knowledge gained through care records. Staff knew what constituted a safeguarding concern and were aware of how to report such issues. Any incidents were considered to see if they could have been prevented or if procedures needed to change, which showed the service was able to challenge itself.

The service had robust and rigorous risk assessments in place to minimise the likelihood of harm whether through the use of equipment or people’s behaviour. These were regularly reviewed and updated, and provided clear direction for staff in how to handle such situations.

Staffing levels were appropriate on the day we inspected and ensured people had their needs met in a timely manner. Medicines were administered, recorded and stored safely.

We saw in records and by speaking to staff there was an ongoing supervision and training schedule which supported staff to develop and progress in their own development. Staff were encouraged to challenge and offer new ideas if they could see areas for improvement. Staff also told us they felt confident in their roles which we observed in their interactions with people in the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service was acting in accordance with the requirements of the Mental Capacity Act 2005 by ensuring that people who lacked capacity to make specific decisions had appropriate assessments in place to support staff to make decisions in their best interests. However, some of this was not always recorded correctly. Where people were not able to assess risk to themselves or did not have the freedom to leave, Deprivation of Liberty Safeguards were in place.

People were supported with their nutrition and hydration needs, and the dining experience in the communal area was very good. However, there needed to further monitoring of people who chose to remain in their own rooms as we saw meals and drinks were left. The home did have robust weight monitoring plans in place and people accessed support as needed.

We found people had regular access to external agencies as required and regular meetings and information was shared when needed between such services to maintain people’s optimum care.

Staff were patient, caring and kind and people responded well to attention. There was evidence of a good rapport between staff and people using the service and we saw that people were encouraged to make as many decisions for themselves as possible during the day. The service demonstrated a consistent culture of respecting people’s privacy and promoting their dignity.

People had access to a range of activities both within and outside of the service. We saw care records were clear and detailed, focusing on the individual, emphasising key attributes and provided informati

This inspection took place on 9 November 2015 and was unannounced.

Newfield Lodge is a modern, purpose-built care home, for 64 older people and is divided into four units two of which support people living with dementia. The home is close to Castleford town centre. The home has a nearby bus route, train station and some shops within close walking distance.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At the last inspection on June 2015 we asked the provider to make improvements in four of the five domains; Safe, Effective, Responsive and Well led. At the last inspection there were two breaches of the Health and Social Care Act (HCSA) 2008(Regulated Activities) (RA) Regulations 2014. At this inspection we saw improvements had been made. People who used the service told us they felt safe living at the home. Staff we spoke with had training in safeguarding and were aware of how to raise concerns. This meant people were protected from the risk of harm because staff had been trained to recognise signs of abuse.

Care plans used by the service identified people’s support needs and any associated risk had an assessment and plan in place. This meant people received care that was centred on them as an individual and were protected from the risk of harm.

People who used the service felt there were enough staff to meet their needs. Staff we spoke with felt sometimes the service was short staffed but felt this did not impact upon the care of people within the home.

People received their medicines in a safe and timely manner. People we spoke with told us they received their medicine on time.

We saw aprons and gloves were in good supply and used appropriately by staff. This helped prevent the spread of infection. The home looked clean with no malodours.

Staff confirmed they received supervision and felt it was a useful way to receive feedback about their performance. Training for staff was up to date and staff felt the training helped them carry out their role effectively.

People had signed their consent for the use of their image and to share information with other professionals. Although has signed and agreed to their care record, they had not consented for the provision of personal care.

The service assessed people’s capacity to make decisions in line with the relevant legislation and had made the appropriate applications for Deprivation of Liberty Safeguards.

People were offered a choice of meals and had regular drinks and snacks though the day. The service contacted the appropriate services if they had concerns about people’s weight.

Care plans were reviewed monthly and updated to reflect the changing needs of the individual

People had access to outdoor spaces. People were supported to use the smoking shelter.

We saw staff spoke with people in a respectful manner. Staff told us they enjoyed working at the home. Staff interaction was warm and it was clear staff knew people very well.

The home had an open door policy and people could have visitors at any time of the day, except at meal times which was protected.

Staff spoke highly of the team they worked in and felt they worked well together.

Care records were person centred and focussed on the needs of the individual

The service organised activities which people participated in and enjoyed.

People we spoke with knew who they would talk to if they had any concerns.

People who used the service knew who the registered manager was. Staff we spoke with felt supported by the manager and they could approach them with any concerns.

During our inspection we looked for the answers to five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

We saw the provider carried out checks of the dependency levels of people who used the service. We were told the dependency statistics were reviewed alongside the accidents and falls. The falls analysis showed a large number of people were falling during the night. We were told by the manager they were compiling a report for the provider with a view to increasing staffing levels during the night.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We were told by the manager there would be a phased approach to the submission of DoLS applications.

Is the service effective?

We looked at the care plans of four people who used the service and found them to be comprehensive and easy to follow. There were sections which covered for example the person's life history, future wishes, consent, health and well-being assessment, skin assessment, record of weight, food and nutrition and mental capacity assessment.

Is the service caring?

We saw staff had a kind and caring approach towards people they supported. People appeared comfortable in their home. People chose where they spent their time and we saw staff provided support as needed. We saw staff were aware of different people's communication needs and adjusted their interaction with people accordingly.

We spoke with six people who used the service who told us they were very happy with the care provided at Newfield Lodge. One person said, "Put it this way you wouldn't get any better." Someone else said, "I would prefer not to be here but they look after us really well, the facilities are lovely." A relative we spoke with said, "We have absolutely no problems, we are very happy."

Is the service responsive?

We saw a programme of activities advertised. People were able to take part in, food tasting, cooking, table games, pampering sessions and movie night. Staff we spoke with said, people could take part in whatever activity they wanted and even though there was a daily programmed this could be changed around to suit the people who lived at Newfield Lodge.

We asked for and received copies of recent complaints, we saw where possible the provider had responded to people's complaints and resolved them to their satisfaction.

Is the service well led?

We found audits had been completed regularly by the manager and deputy manager. These included audits of care plans, medication records, the living environment, health and safety, infection control and fire records. All these checks were current and up to date.

We saw copies of incident investigations along with a root cause analysis, this included, 'history/details' of the incident, what the key issues to be investigated were, what evidence was gathered and if staff 'training/skill' contributed to the incident/event'. The investigation concluded with what action was required, by whom, by what date and an evaluation of the outcome and action taken.

We found people's needs were adequately assessed prior to them using the service and people were involved in making decisions about their care. People's plans of care were detailed and any identified risks were appropriately managed. The level of detail within the care plans enabled staff to understand people's needs but it was not always clear which plans of care were stand-alone and which required reference to other related care plans.

We found the provider had sufficient processes in place to protect people from abuse and staff understood the reporting arrangements if they had any concerns to raise. We found the training and support arrangements for staff to be suitable and staff felt supported in their role and appropriately skilled to provide the necessary care and support for people.

We found the provider had effective quality assurance processes in place and assurance was provided from a variety of sources which provided a well-rounded view of the quality of service provided.

We spoke with two people who used the service on the residential unit and one person on the residential/dementia unit. One person on the residential unit said "The home is lovely, lovely staff, wouldn't want to be anywhere else". The person we spoke with on the residential/dementia unit said they "had no complaints and the food was okay".

This was an unannounced inspection carried out on the 27 May 2015. At the last inspection in September 2014 we found the provider met the regulations we looked at.

Newfield Lodge is a modern, purpose-built care home, for 64 older people and people who are living with dementia. It is close to Castleford town centre. The home has a nearby bus route, train station and some shops within close walking distance.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

People who used the service, relatives and staff raised concerns about staffing levels in the home. We saw that staffing levels were not sufficient at all times and there was a risk that people’s needs would not be met and their safety compromised.

Where people did not have the capacity to consent, the provider did not always act in accordance with the legal requirements of the MCA 2005. People’s consent to their care and treatment was not always recorded.

People told us they felt safe and well looked after at the home. They spoke highly of the staff and said they were well trained. Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. Care records were not consistently detailed enough to guide staff on the care needs of people who used the service.

Overall, medication was managed safely and people received their medication when they needed it. People’s views on food and menus in the home were positive. Some people who used the service and their relatives thought there needed to be more activity on offer in the home.

Robust recruitment procedures were in place and appropriate checks had been undertaken before staff began work. Staff said they felt well supported in their role and received the training and supervision they needed. Records we looked at showed a number of staff needed to update their mandatory training. The registered manager had a plan in place to ensure this was done and staff’s practice was up to date.

Systems in place to monitor and assess the quality of service provision were not consistently effective. Quality assurance systems were inconsistently applied which could lead to risks being overlooked. We received positive feedback about the registered manager and management team in the home.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the number of staff employed to meet people’s needs and people’s consenting to their care and treatment.