This inspection took place on 9 and 13 October 2017 and was unannounced.

Newford Nursing Home provides accommodation with nursing and personal care to a maximum of 41 people with physical disabilities, dementia-related illness and/or mental health needs. There were 38 people living at the home at the time of our inspection visit.

A registered manager was in post and present during our 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.

At our last comprehensive inspection of the service on 26 April 2016, we found breaches of Regulations 12 and 17 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014 and a breach Regulation 18 of the Care Quality Commission (Registration) Regulation 2009. These breaches related to the provider’s failure to consistently and effectively assess, monitor and manage the risks to people, and a lack of clear leadership at the service. The provider had also failed to notify us of important events involving people who lived at the home, in line with their registration with us. We gave the service an overall rating of requires improvement. We undertook a focused inspection at Newford Nursing Home on 10 October 2016 to check whether the provider was now meeting their legal requirements and found continued regulatory beaches. The provider sent us an action plan setting out the improvements they intended to make.

At this inspection, we found the provider had made improvements to the service, and that they were now meeting the Regulations. The risks associated with people’s individual care and support needs had been assessed, recorded and reviewed, and plans implements to manage these. The registered manager had the time and support needed to provide staff with effective leadership and management.

People were supported by staff who had received training in, and understood, how to protect them from avoidable harm and abuse. The staffing levels maintained at the service ensured people’s individual needs could be met safely. Systems and procedures were in place designed to ensure people received their medicines safely and as prescribed. However, people’s medicines were not always securely stored at all times.

Staff received ongoing training and support to enable them to successfully fulfil their duties and responsibilities. People’s consent to care was sought and their right to make their own decisions respected. People had enough to eat and drink, and any associated risks were assessed and managed. Staff supported people to access professional medical advice and treatment if they were unwell.

Staff treated people with kindness and compassion, and took the time to get to know them well. People’s involvement in care planning was encouraged, and their views about the service welcomed. People’s rights to dignity and respect were understood and promoted.

People received care and support that took into account their individual needs and requirements. They had support to spend time doing things they found stimulating and enjoyable. People and their relatives were clear how to raise a complaint with the provider, and had confidence they would be listened to.

People, their relatives and community professionals described an open and inclusive culture within the service. Staff felt well supported and were clear what was expected of them at work. The provider carried out a range of quality assurance activities to assess, monitor and address the quality of the service people received at Newford Nursing Home.

We carried out an unannounced comprehensive inspection of this service on 26 April 2016 and breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12, safe care and treatment and Regulation 17, good governance. 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. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Newford Nursing Home on our website at www.cqc.org.uk.

Newford Nursing Home is registered to provide accommodation with personal care and nursing for up to 41 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 38 people.

There was a registered manager at 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.

At this inspection we found continued regulatory breaches. You can see what action we told the provider to take at the back of the full version of the report.

Some improvements had been made in the way medicines were managed, but further improvements were needed to ensure that administration and monitoring of people's prescribed dietary supplements was monitored to protect people from potential risks associated with medicines.

People's risks had been assessed, but we found improvements were still needed to ensure these were consistently planned and followed to protect people from the risk of harm.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care.

Improvements were needed to the management structure to enable the registered manager to have dedicated time to act on improvements and monitor the quality of the service effectively.

There were enough suitably qualified staff available to keep people safe and the provider had effective recruitment procedures in place.

People and staff told us the registered manager was approachable and staff felt supported in their role.

We completed an unannounced inspection at Newford Nursing Home on 26 April 2016. At the last inspection on 31 December 2013 the provider was meeting the required standards.

Newford Nursing Home is registered to provide accommodation with personal care and nursing for up to 41 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 38 people.

There was a registered manager at 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.

We found medicines were not managed in a safe way and improvements were needed to ensure people were protected from the risk of harm.

The registered manager was not fully aware of their responsibilities to notify us (CQC) of any Deprivation of Liberty Safeguards (DoLS) that had been authorised for people who used the service.

People told us they felt safe with the care provided by staff. However, the registered manager had not always reported alleged abuse appropriately.

People’s risks had been assessed, but we found improvements were needed to ensure these were monitored and managed to protect people from the risk of harm.

Improvements were needed to ensure that people were supported consistently in line with their eating and drinking assessments. Mealtime choices were not always promoted in a way that helped people who had difficulty communicating their needs.

Improvements were needed to ensure that staff provided care in a way that protected people’s privacy and dignity.

Improvements were needed to ensure that people were able to access hobbies and interests that were important to them.

People were not always supported in a way that met their communication needs which meant people did not always receive support in line with their preferences.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was unable to be identified and rectified by the registered manager and provider.

There were enough suitably qualified staff available to keep people safe and the provider had effective recruitment procedures in place.

People were supported by staff who had received training, which gave staff the knowledge and skills to provide appropriate care that met people’s needs.

People consented to their care and the provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA and Deprivation of Liberty Safeguards (DoLS) when they provided support.

People were supported to access other health professionals to maintain their health and wellbeing.

People were supported by staff that were caring and compassionate. Choices on how people wanted their care and support provided were promoted, listened to and acted on.

People and their relatives were involved in the planning and review of their care.

The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

People were given the opportunity to feedback on the quality of their care and actions were in place to make improvements.

People and staff told us the registered manager was approachable and staff felt supported in their role.

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

We inspected Newford Nursing home as part of our planned schedule of inspections. The inspection was unannounced which meant the manager or staff did not know we were visiting.

People we spoke with told us, "I've been very happy. At first I just wanted to go home, but my family knew I wouldn't have been able to cope. I have a good life" and, "I have made friends here. I can do what I like and my family are just around the corner".

We found people who used the service were offered a choice of food, supported to have a good nutritional intake and where necessary people's diet and fluid intake was monitored. We also saw care records reflected people's needs, were reviewed and where risks had been identified, action plans were in place. We spoke with relatives and staff; we also observed how people were supported and cared for because some people were not able to tell us about their experiences.

We found that systems were in place to maintain good standards of hygiene and infection control, and that staff were provided in sufficient numbers to support people. We checked and found that staff had received the training to meet people's needs safely.

We undertook this inspection of Newford Nursing home to follow up areas of non-compliance identified at our last inspection.

One person we spoke with said: "I have everything I want and if I need anything I ask them (The staff)". A relative told us: "I visit three or four times a week and spend quite a bit of time here. I find the care to be great and my relative is happy. We chose this home following a recommendation and haven't been disappointed".

At the last inspection we were concerned that decisions about people's care and treatment were being made but the service could not always evidence how people that used the service were consulted or were involved in decisions.

During this inspection we looked at a sample of people's care records, risk assessments and other relevant information. We looked to see if people had been involved with important decisions about their care and preferred lifestyle. We saw that people were able to make choices about their care and the things they did.

At the last inspection we noted the provider had not ensured that staff were trained to meet the needs of people who were diagnosed with dementia. During this inspection we were provided with evidence that this training had taken place. This meant that staff had the knowledge and skills to support people who were affected by dementia and to support them appropriately.

Since our last inspection we have received concerns that people using the service were not being treated with respect. We were told that people were not receiving their medication as prescribed because staff were not following proper administration procedures. We were told that people using the service were not being taken to the toilet regularly and were therefore incontinent because of this, meaning people's dignity was not considered. We were told that some people who did not have the capacity to choose for themselves were taken to bed at unreasonably early hours.

We referred all of the concerns to the local authority for their investigation. The local authority quality monitoring team had undertaken a number of visits to the service to look into the concerns. They had concluded their investigation at the time of our inspection.

During this inspection we did not observe any concerns relating to the things we were told prior to our inspection. People that used the service said they were satisfied with the service.

At the last inspection we judged that the provider had not provided staff in sufficient numbers to meet people's needs. During this inspection we observed that staffing levels had been increased. However we also noted that staff had not received training to meet the needs of people who had dementia; this had a direct impact on the lifestyles of those people.

We saw that people's views and involvement in day to day decisions had not been sought.

Newford Nursing Home was registered to deliver nursing and personal care to people. We visited the service on 10 August 2012, our visit was unannounced which meant the service did not know we were going to inspect.

During our visit we spoke with four people who lived at Newford Nursing Home, four staff members, and three relatives. Through a process called 'pathway tracking' we looked at care plans, spoke with people about the care they received and asked staff about how they provided support. This helped us establish that people were getting appropriate care that met their needs and supported their rights.

The service had systems in place to ensure that staff understood their responsibilities in safeguarding (protecting vulnerable adults) and reported concerns appropriately.

We spoke to staff and looked at the numbers of staff provided, we were concerned that there were insufficient staff during the afternoon and evening to provide people with the support they needed.

During the inspection we looked at the process the service had in place to monitor the quality of the service provided. We found systems were in place for auditing and monitoring the service.

People we spoke with said, "I like it here they are relaxed about things, and if I want to go out on my own I can do."

People using the service told us they are listened to, and that staff involve them and their relative/representative in the care planning process and in regard to regular reviews of care.

Comments received included, “I am satisfied with the staff, they look after my relative well”, “my relative has been in this home for many years, and I trust the staff to care for her, she is made comfortable and they check her regularly to change her position”. “I had been at Newford Nursing Home quite a few times for respite, and got on alright, my relative has been living here for some years now”. “I get on well with all of the staff here”. “The food could do with being a bit more adventurous, but it’s alright, it’s difficult catering for everyone’s tastes”. “We could do with a few more activities”.

One person told us she had been visiting the home for more than five years, and had always found staff to be “polite, co-operative and caring”. She told us that they sometimes needed to wait for staff to come, but appreciated that there were others waiting.

Staff told us that they had undergone appropriate security checks during their recruitment process. They have a probationary period, to ensure that they are competent to undertake their role and responsibilities. This included shadowing a more experienced or senior member of staff, and the completion of an induction programme, that is signed off by a senior staff member. This ensures the safety and welfare of the people using the service.

Staff told us they were aware of the importance of keeping people safe. Senior staff confirmed they had received appropriate training in regard to the safeguarding of vulnerable adults, the Mental Capacity Act 2005 and Deprivation of Liberty guidance.