Newton 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. The care home accommodates 12 people in one adapted building. At the time of the inspection 12 people were using the service. On the ground floor there is a large lounge, a dining area with a conservatory which opens onto a gated patio area with chairs and tables.

The home had an owner who was also 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.’

At our last inspection we rated the service ‘Good’, with the well led domain rated as requires improvement, at this inspection we saw improvements had not been made and the safe domain also required improvement. This is the first time the service has been rated requires improvement.

The provider did not always notify us of events which reflected when people were at risk of harm. Audits had not been consistently completed and when audits had been done it was unclear if the actions had been followed up and the improvements made.

Medicines had been managed safety; however some documentation was not available to provide information to support people who had ‘as required’ medicine. During the day there were enough staff to support people’s needs, however during the night there was concern in relation to meeting people’s increased needs and we could not be sure there was enough staff throughout the night time. .

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were able to make their preferences known, which had been documented in the care records. People were encouraged to make choices about how they spent their day. There was a complaints procedure and people felt able to raise any concerns.

People had established relationships with staff and felt cared for. People told us staff treated them with dignity and respect. Relationships and friendship that were important to people were maintained. People were protected from the risk of infection and staff understood the precautions to take in using protective wear.

Risk assessments had been completed and guidance provided. The provider ensured appropriate checks before people worked at the service. The fire procedures had been completed and each person had their own evacuation plan. People were able to personalise their space and people felt the home had a friendly feel.

We saw people had a choice of food and when required support and advice around health and nutrition had been considered. Support from health professionals was requested and available when needed. We saw that the previous rating was displayed in the reception of the home and on the website as required.

Staff felt supported and had been able get involved in projects to develop their knowledge. This had resulted in the home receiving some awards and praise from health care professionals

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We inspected the service on 1 March 2016. The inspection was unannounced. Newton House is located in the village of Shireoaks, which is close to the town of Worksop. The home is registered to provide accommodation for up to twelve people who require nursing or personal care. The care provided is mainly for people who have needs that are associated with memory loss and dementia. On the day of our inspection twelve people were using the service.

The service had a registered manager in place 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 2008 and associated Regulations about how the service is run.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff listened to them and cared about the individual they were supporting. People were supported to maintain and develop their hobbies and interests. There was a complaints process for people to follow and people knew how to raise concerns.

The systems designed to monitor the quality of the service were not fully effective. People were involved in giving their views on how the service was run and lived in an open and inclusive environment.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with six people who used the service and asked them for their views. We also spoke with two care staff, the deputy manager and the registered manager. We looked at some of the records held in the service including the care files for four people and observed the support people who used the service received from staff.

We found people gave consent to their care. A person who used the service told us, “I think we have our own lives here, we say how we want it.” People were provided with a varied and nutritional diet. A person told us, “There is a good variety, you can’t please everyone all the time, but they please me most of the time.” We saw people were regularly offered and given drinks throughout our visit.

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. We found there were sufficient staff to meet people’s needs and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, “Our staff are very good, you can go to them anytime and they will always talk to you.”

We spoke with three people who lived at the home, one relative who was visiting the home, three staff members and the manager. We also observed how people were supported with their care and looked at records. These included care plans and information about how the service operated.

People told us that they had enough information to tell them about what the home provided when they moved in. They also said they could express themselves in the way they wished and were encouraged to make their own choices.

When we asked people about the individual support they received one person told us that, "I know that I have a care plan. I know it contains my picture and important information about my personal needs. This helps them (staff) provide the care I need."

People said they felt safe living at the home. They told they were confident that staff had the right skills and experience for the job and that they were honest and trustworthy. One person said, “I really think they (staff) go out of their way to make sure it is a safe place to live.”

We found that people and staff felt confident taking any suggestions or concerns to the deputy manager and the manager. A relative of one person told us that, "I find the manager and staff approachable and they listen to us if we need to check on anything, which is great."