The inspection took place on 27 September 2018 and was unannounced. Newlands House - Care Home is a 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. The home provides care in an accessible building including electronic door openings because everyone who lives there uses a wheelchair to mobilise. It is a care home for 35 people with physical disabilities and at the time of our inspection 32 people were living there. However, only 28 people were present as 4 were either on holiday or visiting family.

They were last inspected on 14 September 2017 and were found to require improvement. At this inspection they still required improvement.

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 2008 and associated Regulations about how the service is run.

Risk was not always assessed and actions were not always considered to reduce it. The review of when things went wrong was not always thorough enough to reduce the risk of repetition. Some incidents which could have been reviewed independently as a safeguarding concern, had not been considered as such and had therefore not been reported to the relevant safeguarding authority.

People did not always receive personalised care which was based on their preferences. They also did not always have enough opportunity for meaningful engagement. Information had not been adapted to meet people’s individual needs. Some information in care plans did not give enough guidance and daily records were not always fully completed. The audits and reviews conducted did not always fully consider this and ensure that people were at the centre of their care. Although there were enough staff to meet people’s needs and this was kept under review, the audits did not consider the quality of interaction some people experienced.

Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. They had developed caring, respectful relationships with people and ensured that their dignity and privacy were upheld. 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 environment was planned to meet their needs and encourage independence.

People were assisted to maintain good health and had regular access to healthcare professionals. Medicines were managed safely and people received them when they needed them. Mealtimes included a choice of meal and people received patient support to assist them when needed. There were systems in the home to keep it clean and free from infection.

Visitors were welcomed at any time. People and their relatives knew the registered manager and felt confident that any concerns they raised would be resolved promptly. There were regular meetings with people which people told us they enjoyed and that they felt listened to. There were good relationships with other organisations and professionals; including working closely with commissioners to meet actions on improvement plans.

Staff felt well supported by the registered manager and there were regular meetings with them to ensure they were consulted and informed of changes.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We inspected Newlands House on 14 September 2017 and it was unannounced. Newlands House provides accommodation and nursing care for up to 33 people with physical disabilities. There were 29 people living at the service when we visited. They were last inspected on 13 and 21 July 2016 and were found to require improvement. We found regulatory breaches in medicines management and upholding people’s dignity. We also asked the provider to make improvements to ensure they deployed sufficient staff to meet people’s needs and in their management systems. The provider completed an action plan in September 2016 which demonstrated how these improvements would be made. At this inspection we found that some actions had been completed and others still required improvement

The service had a registered manager. 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.

Medicines were not always manged to ensure that people received them as needed. When people were prescribed medicines which could be taken ‘as required’ there was not always clear guidance in place for staff to understand when to administer it. The management systems in place to monitor recording and the amount of medicines kept for people were not always effective because no immediate action was taken. People did receive their medicines on an individual basis and when they required additional procedures these were completed in private to protect their dignity.

Improvements had been made in the audits and systems in place to ensure that the quality of the service was monitored. However, they were not all effective in identifying and responding to shortfalls. People were supported to have choice and control of their lives but their capacity to make certain decisions was not always considered or reviewed if their condition deteriorated.

Systems had been put in place for the deployment of staff and they checked that people were safe and well on a regular basis. Staff supported people in a kind and respectful manner. When they were assisting people with meals they ensured that they spoke with people and gave them their full attention.

Staff received training and support to enable them to fulfil their role effectively. They understood their responsibilities to detect and report abuse. People told us that there were enough staff to meet their needs and that they felt safe.

Risk was assessed, actions were put in place to reduce it and their effectiveness was reviewed. People were supported to maintain good health and had regular access to healthcare professionals. Their weight and diets were carefully monitored to ensure that they had enough to eat and drink.

People were encouraged to pursue interests and hobbies and regular activities were planned. Visitors were welcomed at any time and some families were involved in the home as volunteers. People knew the manager and felt confident that any concerns they raised would be resolved promptly.

We inspected Newlands House on 13 and 21 July 2016 and it was unannounced. Newlands House provides accommodation and nursing care for up to 33 people with physical disabilities. There were 32 people living at the service when we visited. They were last inspected on 19 September 2013 and were compliant.

The service had a registered manager. 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.

Medicines were not always managed to reduce the risks associated with them. The systems in place to audit the quality of the service were not always effective because they did not identify the errors that were found. The service did not always promote peoples dignity and privacy and there were not always enough staff deployed to meet people’s needs.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. They knew people well and provided care that met their preferences. They understood the importance of consent. When people did not have the capacity to consent to their care, assessments were completed and decisions made in their best interests.

People were supported to maintain good health and had regular access to healthcare professionals. They had enough to eat and drink and specialised meals were provided when needed. Their care plans were regularly reviewed to correspond with changing support needs and they were personalised and accessible.

People were encouraged to pursue interests and hobbies and activities were planned on a daily basis. Visitors were welcomed at any time and volunteers supported activities and fundraising activities.

People told us that they knew the manager and felt confident that any concerns they raised would be resolved promptly. They were supported to understand their choices in the care they received, including using communication systems to help them with this. The provider had systems in place to assess risk, actions were put in place to reduce these and their effectiveness was monitored and regularly reviewed.

We saw that staff were being properly supervised in line with the provider's policy. Staff had the opportunity to discuss work related issues with their supervisors on a regular basis.

Care, treatment and support was delivered so that people were safe, their welfare protected and their needs met. People who used the service told us that they were well looked after and that their needs were met. One person said “The staff are very good. They are always around, very friendly and do what I need from them”.

All of the medication records we looked at, comparing them with the medication for people, were accurate. This shows that people using the service receive their medicines at the times they need them and in a safe way.

We found that people who used the service were safe and their health and welfare needs were met by sufficient numbers of staff. People who used the service provided positive comments about the staffing levels in the home. One person told us “I enjoy living here. I liked the bungalow but now I’m here I know there are always staff around who can help me if I need it”.

Although significant improvements have been made, staff are still not being properly supervised by the provider in line with their policy.

The provider has completely changed the care plans that they use. They have introduced a plan called “My Support Plan” which contains very specific person centred information. The new care plans contain relevant information about people using the service and information contained within them is very easy to find.

We spoke to nine people, three relatives and eight members of staff.

Some people were unable to share their experiences with us, while others could. Those that could spoke highly of the care and service they received, and felt that their care needs were met. People consider that their privacy and dignity is respected. Relatives said ‘‘they were very happy with the way staff cared for their family member’’

People told us they enjoyed their meals and the activities provided. People said they get the help they need as there are enough staff on duty. People felt listened to and had a say in how the home is run.

People told us that most of the staff engaged with them to discuss, explain and agree their care. One person told us “I am involved in developing my plan and I know what it contains”.

We saw that the provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Two people requiring specific one to one support were not receiving it and this had an adverse effect on people living in the bungalow. People did not experience care, treatment and support that met their needs and protected their rights.

We found that staffing levels were not sufficient and as a result people who were funded for one to one care were not always receiving it.

Staff working at Newlands House were not being supervised in line with the provider's supervision policy. This means that the provider was not properly supporting staff to provide care and treatment to people who used the service.

Care plans did not contain accurate information about people who use the service. They were described by staff as complicated and information was difficult to find.