Newton House is registered to provide accommodation for up to 126 people requiring nursing or personal care, including people living with dementia. The home is purpose built and is divided into four discrete ‘communities’ or units. The Watergate and Somerby units provide accommodation for people with general nursing and care needs whilst Castlegate and Brownlow are reserved for people living with dementia.

We inspected the home on 12 September 2017. The inspection was unannounced. There were 84 people living in the home at the time of our inspection. This was because, following our last inspection in December 2016, the registered provider had introduced an embargo on new admissions.

The home did not have a registered manager. The registered provider had appointed a new manager in July 2017. At the time of our inspection an application to register this person had been submitted to the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers (‘the provider’), 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.

In December 2015 we conducted a first comprehensive inspection of the home. We found the provider was in breach of legal requirements in two areas and rated the home as Requires Improvement in all five key questions and overall. In December 2016 we conducted a focused, follow up inspection to review the provider’s progress in addressing the two breaches of legal requirements. We found that the necessary improvement had not been made and the provider was now in breach of legal requirements in three areas. As a result, we reduced the rating in the Safe key question to Inadequate and initiated further action against the provider.

On this inspection we were pleased to find significant improvement had now been made and that the three breaches of regulations had been addressed. Reflecting our findings, the rating of the home is now Good.

There were sufficient staff to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively.

There was a friendly, relaxed atmosphere and staff supported people in a kind and attentive way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink of good quality that met their individual needs and preferences. The décor and facilities in the home had been refurbished to reflect the needs of people living with dementia.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. There had been significant reductions in the number of falls and violent incidents between people living in the home. Staff knew how to recognise and report any concerns to keep people safe from harm.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted DoLS authorisations for 45 people living in the home and was waiting for a further 17 applications to be assessed by the local authority. Staff had an understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Decisions that st

Newton House is registered to provide accommodation for up to 126 people requiring nursing or personal care, including people living with dementia. The home is purpose built and is divided into four discrete ‘communities’ or units. The Watergate and Somerby units provide accommodation for people with general nursing and care needs whilst Castlegate and Brownlow are reserved for people living with dementia. There were 108 people living in the home at the time of our inspection.

We carried out a comprehensive inspection of the service on 8 December 2015. At this inspection we found two breaches of legal requirements. This was because the provider had failed to establish and maintain effective systems of governance and to correctly identify the staffing levels required to meet people’s needs and deploy staffing resources effectively to keep people safe from harm.

After this inspection, the provider wrote to us to tell us what they would do to address these breaches. We undertook this focused, follow-up inspection on 15 December 2016 to check that they had followed their plan and to ascertain that legal requirements were now being met.

This report only covers our findings in relation to these issues. You can read the report from our comprehensive inspection by entering ‘Newton House, Grantham’ into the search engine on our website at www.cqc.org.uk.

We found that the provider had not addressed either of the breaches of legal requirements we identified in December 2015.

The provider was still failing to ensure staffing resources were deployed in a way that ensured people received safe, effective care that met their individual needs and preferences.

The provider was also still failing to implement and maintain effective systems of governance to ensure compliance with legal requirements in the provision of people’s care and support.

Additionally, we found that the provider was continuing to fail to protect people from the risks of falling and of harm from other people living in the home.

We are currently taking action against the provider to ensure that they make the necessary improvements to become compliant with legal requirements. 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.

Newton House is registered to provide accommodation for up to 126 people requiring nursing or personal care, including people living with dementia. The home is purpose built and is divided into four discrete ‘communities’ or units. The Watergate and Somerby units provide accommodation for people with general nursing and care needs whilst Castlegate and Brownlow are reserved for people living with dementia. There were 111 people living in the home at the time of our inspection.

We inspected the home on 8 December 2015. The inspection was unannounced.

The home did not have a registered manager. The registered provider had appointed a new manager in July 2015. At the time of our inspection an application to register this person had been submitted to CQC. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers (‘the provider’), 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had sought and obtained DoLS authorisation for 29 people living in the home.

During our inspection we identified a number of areas in which improvement was required to ensure people living at Newton House were provided with safe, person-centred care.

The provider had failed to correctly identify the staffing levels required to meet people’s needs and to deploy staffing resources effectively to keep people safe from harm. The provider had also failed to implement and maintain effective systems of governance to ensure compliance with legal requirements in the provision of people’s care and support. You can see what action we told the provider to take in respect of these two issues at the back of the full version of the report.

Although staff understood the issues involved in supporting people who had lost capacity to make some decisions, some staff did not have the necessary skills and knowledge to meet people’s care needs safely and effectively.

People were not provided with sufficient stimulation and some staff did not support people in a caring and person-centred way that promoted their privacy and dignity.

The provider worked closely with local healthcare services to ensure people had prompt access to any specialist support required. However, the management of people’s medicines was inconsistent and was not always in line with good practice or national guidance.

The provider met regularly with people and their relatives to discuss any concerns and suggestions. However, formal complaints were not always handled in accordance with the provider’s policy.

Food and drink were provided to a good standard and the provider had sound recruitment procedures in place.

Below is a summary of what we found when we inspected Newton House on 22 July 2014.

Our inspection team was made up of three inspectors and an expert by experience. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them. We also looked at people’s care records and other documentation.

If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

During our inspection on 10 and 11 March 2014 we found that people’s care and treatment was not always planned and delivered in a way that was intended to ensure people’s safety and welfare.

The provider was asked to send us an action plan which set out the actions they would take to meet compliance.

We saw evidence that people’s care was monitored through care plan audits and observational audits. This ensured that care was delivered as detailed in a person's care plan.

We found that staff had on-going refresher training that ensured they had the skills to carry out their role.

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when they supported people.

We observed staff interact with people and help people to maintain their independence.

People’s preferences, interests and diverse needs had been recorded in their care plan's. People told us that care and support had been provided in accordance with their wishes.

Is the service responsive?

We saw when staff had raised concerns about people's health and social care needs, that the provider had contacted appropriate health and social care professionals. The individual care files identified this and a record of actions taken were recorded.

We saw the provider had contingency plans in place in event of an emergency situation.

The provider had a complaints policy in place and information was displayed around the home, should people who lived there or their relative wish to raise a concern.

People completed a range of activities in and outside the home. We were made aware that the provider was currently recruiting a third member to their activities team which would ensure that all people had access to planned activities in the home.

Is the service safe?

The provider had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise.

The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

We saw the provider had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing.

We spoke with staff who understood what was meant by abuse and knew how to report their concerns.

Systems were in place to make ensure that the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

We reviewed the staffing rotas and we saw that they took into account people’s care needs, when making decisions about the number, qualifications, skills and experience required. We generally received positive comments about the staffing levels within the home from people and staff.

The provider had taken action to recruit additional members of care staff to reduce the number of agency staff currently working within the home.

Is the service effective?

We found staff attended training courses to meet the individual needs of people in their care such as the care of a person living with dementia.

People’s health and care needs were assessed. People, and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

We looked at people’s records which showed that care plans set out people’s individual care needs. They were current and the records showed they had been reviewed on a regular basis and amendments made when a person’s care needs changed.

During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Records showed people had access to a range of healthcare professionals.

Is the service well led?

During our inspection on 10 and 11 March 2014, we found that the provider had failed to notify the Care Quality Commission of incidents that affected the health, safety and wellbeing of the people who used the service. This meant that we could not be confident that important events were reported appropriately, or in a timely manner to us so that appropriate action could be taken if required.

We asked the provider to send us an action plan which demonstrated how they planned to address our concerns.

Since April 2014 we have continued to receive monthly records from the provider which documented all incidents that affected the health, safety and wellbeing of the people who lived at Newton House.

We saw evidence during our inspection on 22 July 2014 that the provider had implemented clear protocols for staff to follow as part of the notification process for the CQC.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service and the environment of the home were improving.

Staff told us they were clear about their roles and responsibilities. They told us that they felt supported and had access to a range of training to ensure they were equipped to carry out their role.

During this inspection we checked to see if the provider had complied with actions we took following our last inspection in September 2012. We reviewed all the information we had received from the provider including an action plan they sent us in October 2012 detailing how they would become compliant.

As part of this follow up inspection we spoke with the registered manager, two nurses, the regional manager, regional director and care specialist for the organisation.

On this inspection we did not speak with people who used the service.

Newton House is divided into four separate units. Two units for people with complex nursing needs and two units for people with dementia. There were 111 people using the service at the Nursing Home on the days of our inspection.

All units had secure access and were staffed individually. We visited for two days and inspected all four units. During our inspection we completed Short Observational Frameworks for Inspection (SOFI) on three of the four units.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with three people who used the service and three relatives and asked them for their views. We also spoke with 18 care workers, three activity co-ordinators, the head of hotel services, the training manager, the assistant deputy manager, the deputy manager, and the registered manager.

We also looked at some of the records held in the service including the care files for 16 people. We observed the support people who used the service received from staff and carried out a brief tour of the building. We also used observation to help us understand the experiences of people using the service in two of the units as we were unable to ask them their views

A person who used the service told us, “It is lovely. The staff are brilliant. They are very caring and that is why I chose to come here.”

A relative told us, “Care is perfect. Could not be better. All staff are very kind and caring.”

We found that people who used the service did not always experience effective, safe and appropriate care treatment and support that met their needs.

We found that people who used the service were not always supported to have adequate nutrition and hydration to meet their needs.

We found that equipment was not always available to ensure the health, safety and welfare of the people who used the service.

Staff we spoke with confirmed that they had a support structure in place for supervision which included one-to-one sessions and group meetings.

People who used the service, their representatives and staff were asked for their views about the care and treatment they received and these were acted upon.