This inspection took place on 27 June 2018 and was announced. The provider was given 48 hours’ notice because the location provides a service for adult men who may be out during the day, we needed to be sure that someone would be in. At our previous inspection in March 2017 we rated this service “Requires Improvement”. We found two breaches of regulations with regards to safe care and treatment, and person-centred care. We also made a recommendation about the home recording verbal complaints. We found that the provider had taken satisfactory actions in response to the last inspection report.

Newnton House 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. Newnton House provides care and support for up to 9 people with mental health needs, many of whom have a forensic history and learning disabilities. The service aims to provide a short-term service for people before they are able to live more independently. At the time of our inspection there were eight men using the service. The service is based in a large house in Hackney, which contains nine bedrooms, three bathrooms, a large lounge and activities room, a kitchen and dining area and a communal garden. There was a staff office within the building and a staff sleeping in room.

There was a registered manager at the service at the time of 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 and associated Regulations about how the service is run.

People told us they felt safe with staff and there were enough staff to meet their needs. Staff were trained in safeguarding and knew how to safeguard people against harm and abuse. People’s risk assessments were completed, regularly reviewed and gave sufficient information to staff on how to provide safe care. Staff kept detailed records of people’s accidents and incidents. Staff wore appropriate protection equipment to prevent the risk of spread of infection. Medicines were stored and administered safely. The home environment was clean.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their own best interests. We saw people were able to choose what they ate and drank. People told us they enjoyed the food. The home was well decorated and adapted to meet their needs of the people.

People told us that they were well treated and the staff were caring. We found that care records were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service. People had access to a wide variety of activities.

The service had not recorded exploring people’s wishes for end of life care. We have made a recommendation about involving people in decisions about their end of life care.

The service had a complaints procedure in place and we found that complaints were investigated and where possible resolved to the satisfaction of the complainant.

Staff told us the service had an open and inclusive atmosphere and the registered manager was approachable and listened to concerns

We carried out this announced comprehensive inspection on 14 and 16 March 2017.

Newnton House provides care and support for up to 9 people with mental health needs, many of whom have a forensic history and learning disabilities. The service aims to provide a short-term service for people before they are able to live more independently. At the time of our inspection there were nine men using the service, and two people received support with personal care. The service is based in a large house in Hackney, which contains nine bedrooms, three bathrooms, a large lounge and activities room, a kitchen and dining area and a communal garden. There was a staff office within the building and a staff sleeping in room, with a manager’s office in a shed at the end of the garden.

The service had a registered manager who had been in place since November 2015. 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 previous inspection in October 2015 we rated this service “Requires Improvement”. We found a breach of regulations with regards to notifying CQC of significant events which had occurred in the service, and made recommendations about the management of medicines and providing activities to people. We found that the provider had taken satisfactory action in response to the last inspection report.

We found that there were measures in place to ensure the safety of the building and risks to people who used the service had been assessed. However, these risk management plans were generic in places and although a number of people had behaviour which may challenge there were not detailed plans in place for recognising the signs that a person may be about to become challenging or how to deescalate the situation. Accidents and incidents were recorded, but in some instances actions required in response to these had not been carried out, and the recording of incidents did not always record the circumstances which had lead up to an incident, which would be useful for developing plans to manage people’s behaviour.

Staffing levels were adequate to meet people’s needs and appropriate checks had been carried out of the suitability of staff. People who used the service told us they felt safe there and were treated well by staff. People benefitted from a small, stable staff team which allowed good caring relationships to develop. Staff promoted people’s dignity and privacy and maintained confidentiality. Staff received training in line with the provider’s policy and regular supervision and appraisals, but the provider’s policy did not fully assess the training needs of the staff team in line with working with people with mental health needs.

We found that care plans documented people’s needs, including their activities and there were tools for monitoring their recovery. However, we found that the service didn’t always document people’s preferences or have plans in place to communicate with people who had difficulty speaking, hearing or reading. This meant we could not be certain that people had always understood the contents of their care plans before they had consented to these. Where people were deprived of their liberty in their best interests, the provider had taken appropriate measures to do this lawfully. When people were free to leave the service, the provider took measures to ensure people were safe, including monitoring when they had left and following missing persons plans when they had not returned. Medicines were safely managed by staff who had the appropriate training and skills to do so, and this was checked by a pharmacist regularly.

The provider worked with mental health teams to monitor people’s health and promote recovery, and there was goo

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We looked at out five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service were treated with dignity and respect. Peole's views and the views of their family and representatives were included as part of their care planning.

Staff took into account risks to individuals to ensure the safety and welfare of people. However care plans and risk assessments needed further development to ensure people’s needs and how to meet them were clearly identified. Medicines were kept safely and handled appropriately.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that the service was compliant in seeking consent from people who used the service.

Is the service effective?

Care workers were knowledgeable about how to meet people’s needs when caring for particular individuals. People were overall stable in their placement and progressing well with their individual plans and goals. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

People’s mental and physical healthcare needs were monitored and met by health and social care professionals.

Is the service caring?

People who used the service were supported by kind and attentive staff. People were overall positive about staff. They said staff were caring, helpful and encouraged them to ensure they remained independent.

People’s diversity, values and human rights were respected. The provider consulted people and their representatives about individual needs and wishes, including their cultural and religious needs. Individual preferences were taken into account as part of their care.

Is the service responsive?

Individual care needs were reviewed and their plans updated to ensure people received a service that met their current needs.

Staff acted appropriately in response to people’s emotional and behavioural needs. Staff used assessment tools to monitor the health and wellbeing of people, consulting other professionals for advice and input where needed. There were no complaints about the service, however people said staff listened and were responsive to dealing with any issues they raised.

Is the service well led?

The provider undertook regular audits to check the quality of service. However there was no system in place to analyse and report on the views of people who used the service, their relatives or people involved in their care.

Staff received training and supervision with their manager and said they were well supported and received appropriate professional development. This meant they were familiar with their roles and responsibilities to carry them out more effectively.

We spoke with one person who used the service. Other people using the service were out or preferred not to speak with us. People received care or support with their consent and the provider acted in accordance with their wishes. Care and support was planned and delivered in a way that ensured people’s safety and welfare. One person who used the service said, “everything is fine. I’m being looked after very well. They are very helpful to me.”

People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. People were protected against the risks of unsafe or unsuitable premises.

We spoke with three out of nine people who told us that they liked the home. They said the staff were supportive and that they received a good service. They said staff respected them, their needs were met and they felt safe. People said that staff frequently asked them if they were ok and if there was any way their service could be improved. People we spoke with told us that they felt they were developing more independent living skills since they moved into the home. One person said, “ It has met my expectations and more. Staff respect and help me.” Another said, “Staff help me with what I need……and I can do more things for myself now.”

People living at the home told us they were well supported and felt safe. People said the staff were kind and they felt involved with their care. People were able to raise any concerns with the manager. Two people we spoke to could not think of anything at all about the home that could be improved but others did identify some improvements, for example having a small fridge in the bedroom, or changing their 'keyworker' at the home.

We were contacted by the relative of one person who had lived in the home with concerns about their care. These concerns triggered this inspection.

Overall people were happy with the home and the staff.

The inspection took place on 29, 30 September and 6 October 2015. The first day of the inspection was unannounced; the provider knew that we would be returning for the subsequent days.

Newnton House is a specialist service offering care and support for up to nine people who have mental health needs and have a forensic mental health history. This means the service is provided to people who have had a mental illness who may have been involved with the police, court or prison.

The provider offers accommodation, supervision and assistance for people preparing to live in a less supported setting. At the time of the inspection there were eight people living at the service.

There was not a registered manager in post, however, the home manager was in the process of registering with the Care Quality Commission to become the 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.

The provider had not always discharged their duty to inform the Care Quality Commission of significant events at the service.

Medicines that were administered on an as required basis were not always managed safely as written protocols for their use to guide staff had not been completed. Regularly administered medicines were managed safely.

Staff were not always supported to obtain the necessary knowledge for their roles as not all mandatory training had been completed. The provider needed to make improvements around monitoring people’s recovery progress.

The provider had used a robust recruitment procedure to employ enough suitable staff to meet people’s care needs and people told us they felt safe. The service protected people from the risk of harm and abuse because staff were aware of their duties to identify abuse and report it to the necessary authorities. Effective risk assessments protected people from harm.

Staff supported people to eat and drink enough and to obtain treatment from health and social care professionals.

Staff developed caring relationships with people using the service. Staff supported people’s independence and recognised the importance of their diversity and privacy.

The provider followed the latest guidance and legal developments about obtaining consent to care. Staff used a range of communication methods to support people to express their views about their care. There was evidence that people were involved in their care planning and the provider followed the latest guidance and legal developments around the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People were supported to feedback about the service and felt they could raise complaints if necessary. There was an open and positive culture at the service and the team expressed they worked well together and could input into the running of the service. There were a range of audits conducted to monitor the service.

We have made two recommendations in relation to monitoring people’s recovery and medicine protocols. We found one breach of the Regulations around the notification of significant events. You can see what action we told the provider to take at the back of the full version of the report.