This comprehensive inspection took place on the 14 and 15th November 2018 and was unannounced. At our previous inspection 18th and 20th September 2017 the overall rating was ‘requires improvement.’ We had found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to, the need for consent, improvements needed for safe care and treatment and improvements needed for governance systems within the service. Following the inspection in September 2017 the provider implemented an action plan to show what they would do and by when to improve the service. At this inspection we found that the actions had been met and the provider was no longer in breach of these regulations.

Newton Court Care Home is a purpose built care home located close to Middlewich town centre and is part of the Bupa Care Homes group. All bedrooms are single with en-suite toilet and washbasins. The home is registered to provide care for up to 60 people, at the time of the inspection there were 52 people in receipt of a service. 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.

The service has 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.

Some areas needed continued oversight and improvements with the management of records and paperwork.There were various systems and audits in place to monitor and support the quality and safety of the service.

Staff supported people to take their medicines safely and as prescribed. Supplies of medications were recently out of stock which is inappropriate. Staff took appropriate actions with changes to their suppliers so they reduced further risks to people being without necessary medications due to issues with suppliers. The provider had taken appropriate on-going actions to show continued improvements to supplies of medications and staff training and competencies in managing people’s medications.

People were protected from potential harm and abuse by trained staff who were knowledgeable of local safeguarding procedures. Risks to people’s safety were identified and where necessary, appropriate action taken to keep people safe. There were systems in place to help make sure staff employed at the home were suitable to work with vulnerable people.

There was mixed feedback regarding staffing levels. Senior staff were confident that staffing levels were increased when they identified a need to do this to meet the needs of people at the service. Trained nurses were recently provided with extra hours to help them in managing their paperwork and management of medications.

The service was clean, tidy and well maintained. We recommend the service reviews all areas of the building and refers to published guidance in developing services and their environments to meet people’s needs with dementia.

People who used the service and most relatives had a positive attitude about the service being delivered and about the standard of care and support provided by the staff team. People were treated with respect, consideration and kindness. Most relatives, staff and people being supported acknowledged improvements since the registered manager had commenced working at the service.

Stakeholders and members of multidisciplinary teams shared positive feedback about the care provided to people living at the service.

People were referred to appropriate health and social care professionals when necessary to ensure they received treatment and support for their specific needs.

People were supported by a team of staff that had received training and support to maint

This inspection took place on 18 and 20 September 2017 and was unannounced. Prior to this on 30 August 2017, a medicines inspector and a shadowing medicines support officer undertook an inspection and looked at supply, storage, administration and audit records for medicines used in the home. The previous comprehensive inspection took place on the 19 July 2016 and the service was compliant with the regulations at that time.

Newton Court Care Home is a purpose built care home located close to Middlewich town centre and is part of the Bupa Care Homes group. All bedrooms are single with en-suite toilet and washbasins. The home is registered to provide care for up to 60 people, at the time of the inspection there were 56 people in receipt of a service.

There was a registered manager in place, who had been registered with The Care Quality Commission since October 2010. 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 identified three breaches of the relevant legislation, in respect of safe care and treatment, the need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Overall, the people and relatives we spoke with were positive about the care and support they received at Newton Court.

We found shortfalls in the safe management of medicines. There were a number of issues relating to the storage, administration and recording of medicines. The registered manager immediately implemented an action plan to address the issues raised.

We reviewed how risks to individuals were managed and found that potential risks had not always been fully assessed, acted upon and recorded within people’s care records. We found two examples where staff had not taken appropriate action to mitigate against identified risks.

We saw that accidents and incidents, along with any pressure ulcers and weight loss or gain were monitored. However, we found that the system to monitor and analyse accidents had incidents was not robust because some incidents had not been reported to the registered manager.

We found in some cases that staff had not acted in accordance with the Mental Capacity Act (2005). One person’s liberty had been restricted without the person’s consent and another person’s wishes were not respected because a member of staff believed they were acting in the person’s best interests but had not followed procedures correctly.

Staff understood their responsibility to protect people from abuse and harm. The provider had policies in place for safeguarding vulnerable adults and whistleblowing. Staff we spoke with had an understanding of the signs of abuse and told us that they knew how to report any safeguarding concerns.

We found there were enough staff available to meet the needs of people living at the home. We saw that there were processes in place to ensure the registered manager regularly assessed and monitored staffing levels and ensure sufficient staff were available to provide the appropriate levels of support. The registered manager told us there were some staff vacancies and the home was actively recruiting staff, and that if necessary agency staff were used to maintain staffing levels.

The environment was very clean, well decorated and maintained to a good standard. The home was also free from odours. We observed domestic staff cleaning areas around the building throughout the inspection.

Staff received a thorough induction and ongoing training. Staff said that they felt supported by the management team to carry out their roles effectively.

We found that people’s nutritional needs were met. Most people preferred to have their meals in their rooms, but knew they co

The inspection visit took place on 19 July 2016 and was unannounced.

Newton Court Care Home is a purpose built care home located close to Middlewich town centre and is part of the Bupa Care Homes group. The home provides nursing care. All bedrooms are single with en-suite toilet and washbasins. Parking is available within the grounds. The home is registered to provide care for up to 60 people. At the time of the inspection visit there were 55 people who lived at the home.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the last inspection on 15 December 2013 we found the provider was meeting the requirements of the regulations inspected at that time.

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff told us and records seen confirmed safeguarding training had been completed by staff and they understood their responsibilities to report any unsafe care.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked at staff recruitment files. We found required checks were in place. They included an application form that required a full employment history and references. Recruitment records also included evidence of qualifications and criminal record checks.

We found sufficient staffing levels were in place to support people who lived at the home. We saw the registered manager and staff members on duty could undertake tasks supporting people without feeling rushed. A staff member we spoke with said, “If we had more people the manager would increase levels. At the moment I feel we have enough staff.”

We found medication procedures in place at the home were safe. Nursing staff responsible for the administration of medicines had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

Staff had received training and were knowledgeable about their roles and responsibilities. Staff told us access to training courses and opportunities to develop their skills was good. Records we looked at confirmed this.

People who lived at the home were happy with the variety and choice of meals available to them. We found cooks employed prepared homemade meals and comments were positive about the quality of food. Regular snacks and drinks were available between meals to ensure people received adequate nutrition and hydration. One person who lived at the home said about the quality of meals, “Food is very good, always a choice and you can eat where you want.”

Comments we received demonstrated people were satisfied with their care. One person who lived at the home said, “A very good home with caring staff around.”

The management team and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

A complaints procedure was available and people we spoke with said they knew how to complain. Staff spoken with felt the management team were accessible, supportive, and approachable and had listened and acted on concerns raised.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s wishes.

The people using the service who were able to tell us said that they were happy living in the home. Comments included; “the staff are looking after me”. We also received positive comments about the home and staff members from the visitors we spoke with. Comments included; “I am always made to feel welcome” and “the staff are fine”.

The home was in the middle of a complete refurbishment. Whilst this work had obviously caused disruption within the home, for example people have had to move out of their room whilst the work has taken place we do not have any concerns about how the process has been managed. Appropriate risk assessments have been completed where needed and ‘common sense’ arrangements have been made.

We asked about the staff working there, comments included, “staff are very nice; no worries”, “staff are very good” and “very attentive”.

Comments from family members who had recently written to Bupa about the home included; “I would like to thoroughly recommend and would like to commend the team there” and “They always put the needs of the residents first. They are also very considerate towards the families of residents and treat them with the utmost courtesy”.

An effective recruitment and selection system was in place and staff training was up to date.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis from feedback from the people who used the service and their representatives.

This inspection visit was carried out to check if improvements had been made following the previous review of compliance. During the previous review of compliance we found gaps in various aspects of the service delivery, such as; care plan documentation, staff supervision sessions, diet and nutrition monitoring and recording, and the overall monitoring of the quality of the service. During the course of the inspection, we found that improvements had been made.

We spoke and met with nine people who used the service, a family member and a visiting healthcare professional as well as the staff team.

We saw that people's dining experience had improved over the lunchtime period and people who used the service were very complimentary about the food. One person said: "It's really very tasty and you look forward to mealtimes here."

A visitor to the home told us: "The staff are very good they listen to your views." They told us that there were more activities available such as bringing a dog into the home to visit people.

Staff informed us that they had the opportunity to have supervision sessions, ‘informal' chats with senior staff members or the Manager and attend staff meetings.

At the time of our inspection 56 people lived at the home, 30 people were assessed as having nursing care needs and 26 residential care needs. We spoke to nine people who used the service and they told us that they felt that their privacy and dignity was maintained. Their comments about the care provided included:

"The staff are very nice and they are kind."

"In the time I've lived here some staff have come and gone but they've always been kind, I'd give them that."

When we asked about the activities as shown on the home's notice board, people told us they had not had activities organised for some time. On the day of our visit there were no social activities planned. People who used the service told us they were bored and there had been no organised activities for months other than the 'Diamond Jubilee meal'. Peoples comments included:

"It's boring in here we just watch each other, that's why I sometimes don't bother to come to the lounge before lunch. No-one talks to each other much."

"I enjoy my own company, television and my family or visitors, so I am quite content." They also said: "I did enjoy the armchair or exercise type of activity though. I hate bingo, and such."

People described the menu choices as 'to their taste' and the food was described as 'tasty’. We saw the menu and the menu choices and there was a choice of suitable and nutritious food available in sufficient quantity to meet people’s needs.