Newark Care Home
Recorded Key Question grade range: 2–4 — Weak View on Care Inspectorate
Key Question scores
Requirements & recommendations
1. To ensure people consistently receive timely and responsive support, the provider should improve shift allocation and organisation. This should include clear leadership on each shift, effective deployment of staff based on people’s assessed needs, and robust oversight of how care tasks are prioritised and completed. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS), which state: "My needs are met by the right number of people" (HSCS 3.15) and "I am confident people respond promptly, including when I ask for help" (HSCS 3.17).
1. By 9 November 2025, the provider must implement safe and effective medication management systems. This is to ensure people’s health and wellbeing is safe and protected. To do this, the provider must, at a minimum: a) Complete a full audit of medication stock and ensure all prescribed medications are available. b) Carry out regular counts of medication to ensure prescribed medication and homely remedies are available. c) Implement robust systems for checking in new medication and maintaining accurate stock balances. d) Ensure staff competency in medication administration and competence in use of the electronic medication system is regularly observed and recorded. e) Establish a process for notifying and investigating missed medication doses, and ensure this is consistently followed. This is to comply with SSI 2011/210 Regulation 4(1)(a) (Welfare of users) of The Social Care and Social2. By 9 November 2025, the provider must improve mealtime arrangements and ensure effective support is provided with eating and drinking. This is to ensure people are supported well with their nutritional needs and to reduce the risk of potential harm. To do this, the provider must, at a minimum: a) Ensure staff provide timely and coordinated mealtime support, including appropriate postural support for people, particularly people who eat their meals in bed. Risk should be minimised to promote safe swallowing, reducing risks of choking or aspiration. b) Ensure staff are aware of and follow current guidance on the International Dysphagia Diet Standardisation Initiative framework (IDDSI), food fortification, diets and preferences. c) Maintain up-to-date care plans that clearly reflect people’s nutritional needs and support, and ensure daily records clearly reflect their support. d) Ensure snack stations are consistently stocked and accessible. e) I1. By 7 December 2025, the provider must use effective governance and quality assurance systems to identify, respond to, and learn from adverse events and risk of harm. This is to ensure people’s safety and wellbeing. To do this, the provider must, at a minimum: a) Ensure that adverse events, including medication errors, are consistently escalated and investigated to identify patterns and risks. b) Analyse audit findings and clinical governance data to identify where changes can be made that improve people’s care and experiences. c) Ensure there are clear procedures for reporting and learning from adverse events. d) Ensure notifications are made timeously to relevant bodies, including; the local authority, adult protection teams, and Care inspectorate in accordance with Care Inspectorate’s "Guidance on records you must keep and notifications you must make, Marc1. By 4 January 2026, the provider must improve staffing arrangements and ensure staff are appropriately inducted and deployed. This is to ensure people receive safe, effective, and person-centred care. To do this, the provider must, at a minimum: a) Ensure staffing levels and deployment are responsive to people’s assessed needs, including peak times in the day and non-direct care duties. b) Demonstrate understanding and application of the Health and Care (Staffing) (Scotland) Act 2019 to support safe staffing decisions. c) Ensure agency and new staff receive a robust induction to support continuity of care. d) Implement systems to monitor staffing pressures and take action to support staff wellbeing and morale. This is to comply with Regulation 4(1)(a) (welfare of service users) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/
22. By 4 January 2026, the provider must strengthen accountability and support staff to reflect on and improve their practice. This is to ensure the risk of errors and performance issues are reduced and promote a culture of learning. To do this, the provider must, at a minimum: a) Ensure staff involved in incidents, including medication errors and adverse events receive appropriate follow-up and support to improve practice. b) Ensure staff have an understanding of their roles and responsibilities across all staff levels for reporting and resolving issues, this includes concerns that may cause harm to people. c) Provide staff with regular opportunities for support through consistent supervision and reflective learning. This is to comply with Regulation 4(1)(a) (welfare of service users) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services). This is to ensure care a
1. To identify deterioration in people’s health and respond appropriately, the provider should ensure clinical monitoring tools such as NEWS and RESTORE2 are used effectively. This should include, ensuring staff are trained and competent in using these tools, and there is clear systems for escalation and follow-up when concerns are identified. This is to ensure care and support is consistent with the Health and Social Care Standards (HSCS), which state "I am protected from harm, neglect, abuse, bullying and exploitation by people who have a clear understanding of their responsibilities". (HSCS 3.20)
1. To support continuous improvement and effective oversight, the provider should develop and implement a structured service improvement plan that is Specific, Measurable, Achievable, Relevant and Time-Bound (SMART). This should include identifying recurring issues from internal and external audits and stakeholder feedback, ensuring the plan is accessible and used to inform provider-level support. This is to ensure care and support is consistent with the Health and Social Care Standards (HSCS), which state "I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes" (HSCS 4.19) and "I use a service and organisation that are well led and managed" (HSCS 4.23).
1. To ensure safe and person-centred care, the provider should improve pre-admission assessments to capture key health and wellbeing information and inform care planning. This should include developing care plans that reflect individual risks and support needs, and assessing whether staff have the necessary skills and information to provide effective support. This is to ensure care and support is consistent with the Health and Social Care Standards (HSCS), which state: "I am confident that the right people are fully informed about my past, including my health and care experience, and any impact this has on me." (HSCS 3.4)