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 good communication of how people’s needs had changed. There was a complaints policy in place, and people were confident in approaching managers with concerns, but the provider did not record informal concerns or verbal complaints. People were supported to speak up through keyworking, residents meetings and had access to advocacy services.
We made a recommendation about how the service records verbal complaints. We found breaches of regulations in relation to safe care and treatment and person centred care. You can see what action we told the provider to take at the back of the full version of the report.