Homestead House

At our last inspection we found the provider was in breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found concerns relating to infection prevention and control. At this inspection, we found improvements had been made and the provider was no longer in breach of this regulation.

We found the following examples of good practice.

• The home and equipment were visibly clean and well-maintained. Cleaning schedules were in place that considered and actioned high traffic areas and touch points such as switches, handles and handrails which reduced the risks associated with infectious diseases.

• The risks associated with COVID-19 had been identified, assessed, managed and regularly reviewed. Staff and the people who used the service had individual risk assessments in place and other records, such as a business contingency plan and COVID-19 policy, were in place to help further manage the risks.

• Relatives told us the service had communicated well with them throughout the pandemic and supported them to maintain relationships with their family members. One relative described the service’s management of COVID-19 as, ‘”Excellent.”

• The management team demonstrated a robust understanding of current government guidance and policies and procedures and adhered to this.

• Staff told us the provider had supported them throughout the pandemic and that they felt valued through particularly difficult times. They received regular training, supervisions and staff meetings as well as access to emotional support. Through discussion, they demonstrated good knowledge of infection prevention and control policy and procedures.

• The service had never had a COVID-19 outbreak and the robust procedures in place, and the staff’s commitment and diligence, had contributed to this.

Homestead House is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 21 people in one adapted building.

People’s experience of using this service and what we found

There were not enough housekeeping staff to make sure all areas of the home were kept clean and free from offensive odours.

People were happy with the care home and the staff that provided their care. One person told us, “I like living here. It’s better than at home with no-one else, I’ve got company here.”

People felt safe living at the home. Staff had been trained, and cared for people in the way people wanted. Staff assessed and reduced risks as much as possible, and there was equipment in place to help people remain as independent as possible. There were enough care staff, and the senior staff also spoke with people regularly. The provider completed recruitment checks before new staff started work.

People received their medicines and staff knew how these should be given. Medicine records were completed accurately and with enough detail. Staff supported people with meals and drinks. They used protective equipment, such as gloves and aprons. Staff followed advice from health care professionals and made sure they asked people’s consent before caring for them. Adaptations had been made for people’s physical needs although there were no changes to meet the needs of people living with dementia. We have made a recommendation about consulting guidance for changes to the environment.

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

People told us that staff were kind and caring, staff involved people in their care and made sure people’s privacy was respected. Staff worked well together and understood the home’s aim to deliver good quality care, which helped people to continue to live as independently as possible.

People knew who to speak with if they had concerns and staff dealt with these immediately. Staff kept care records up to date, although there was little personalised information about some health conditions and end of life care. We have made a recommendation about personalising care records. Staff engaged people in activities throughout the day, although they did not have the opportunity to continue previous interests. We have made a recommendation about developing activities for people living with dementia.

Systems to monitor how well the home was running were carried out. Concerns were followed up and action was taken to try to improve any issues. Not all actions were recorded and if issues continued, further action was not always considered. People were asked their view of the home and action was taken to change any areas they were not happy with.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection - The last rating for this service was requires improvement (report published 25 July 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to infection prevention and control.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection carried out in 2015, we found that the provider was rated ‘Good’ in all areas except for well-led, which was rated, ‘Requires improvement’. This was because they had not submitted notifications when required. At this inspection we found that the registered manager had sent us notifications as required by regulation.

Homestead House is a care home providing personal care to up to 21 people, some living with dementia. There is one shared room. Some rooms have en-suite toilet facilities and there are communal bathroom facilities available. At the time of our inspection there were 17 people living in the home.

Homestead 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.

There was 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.

Risks to people were not always fully identified, assessed and mitigated. This included risks associated with falls and people’s conditions, as well as the management of some prescribed items. ‘As required’ (PRN) medicines were not always planned for and recorded appropriately. Not all of the staff had a thorough knowledge of safeguarding.

People did not always receive care that was in line with their individual preferences and these were not always recorded. There were some activities on offer for people, but these were not organised and planned in line with people’s preferences.

The auditing systems in the home did not always identify areas where further improvement was needed. These included medicines audits and audits for overseeing the content of care plans.

Medicines were stored securely at a safe temperature and were administered by trained staff. There were systems in place to keep the environment safe for people, however improvements were needed to the systems to mitigate risks associated with legionella.

There were enough staff to meet people’s needs and recruitment procedures which contributed to keeping people safe. Staff had training in areas relevant to their roles and new staff shadowed more experienced staff.

There was not a thorough understanding of the Mental Capacity Act (MCA), as mental capacity assessments were not always decision-specific, and best interests’ decisions had not been recorded.

People were supported with meals and drinks, however they were not always supported fully in line with their care plan. Meals were not always nutritionally balanced, and people did not always have access to a drink. However, people were offered drinks regularly throughout the day.

People’s needs were assessed prior to moving into the home. People had care plans which guided staff on how to meet their needs, although these were not always detailed with individual preferences and updated.

Staff knew people and their needs well, and adapted their communication to support people living with dementia.

Staff supported people to maintain their independence as much as possible, and supported their privacy and dignity.

People and their families knew how to complain and felt comfortable to raise any concerns with staff. Staff involved people in their care.

There was training in end of life care planned for staff, and the registered manager discussed people’s wishes with them, when they felt comfortable to do so.

There was good leadership in place and staff worked well as a team. People were asked for their views on the service.

The provider sent us an action plan on 9 August 2013 telling us that all the actions required at the last inspection would be completed by the end of August 2013. At the inspection of 1 November 2013 we found that the actions for improvement had been carried out as stated.

We found in the three care plans looked through that records had improved. Risk assessments held more detail and had been dated and signed. People were receiving care that was suitable and safe for them.

Improvements had been made to all of the meals on offer. Menus had been updated with more variety. Choices of nutritional meals were evident and people had pictorial menus to aid their decision making. Food and fluid consumed was monitored and people were assisted with supplement foods when required.

Staff support had improved with more planned supervision sessions and annual appraisals taking place. People using the service were assisted with their care needs by staff who were trained and supported to do the job required.

Improvements found in the system used to measure the quality of the service ensured that any concerns or improvements were carried out appropriately.

We found that the provider was not following published guidance with regard to assessing people's mental capacity and that there were inconsistencies in some care planning.

We found that people were not getting a choice of food at meal times. One person told us, “No, I just get what comes” when asked if they chose what they were having for their meal.

We found that the staffing level had improved, and staff felt better supported. Some staff told us they had supervision with their manager, but we could not view records of this.

We found that the provider had put in place regular audits, but that these were not effective and were not picking up issues. We found that the provider had paid no regard to comments and views expressed by people using the service.

We identified failures including numerical discrepancies in medicines, gaps in records, inadequate storage of medicines, inadequate handling of medicines with short shelf lives. We were concerned that some members of staff may still not have had recent medicines training which could affect their competency to handle and administer people’s medicines.

We found that the service was not following safe procedures for administering and storing medicines. The door to the medications room was left open and accessible and the medication cabinet within the room was also left open. We found numerous discrepancies in the records relating to medications. The temperature of the medications fridge was found to be consistently above what is recommended.

We found that people's care, welfare and safety was at risk through inaccurate or absent care planning and risk assessing. We found that for one person, who was at risk of falls, there was no planning to minimise this risk. We were told by a visiting health professional that many people had developed a new pressure sore in the weeks prior to inspection. However, we found no care planning about the prevention of pressure sores in care records.

We found that there were not enough staff to meet the care needs of those using the service. Two visiting health professionals and three members of care staff told us that they felt the staffing level was not sufficient to meet people's needs.

Staff told us that they had to work long shifts, and that they felt this was unsafe and could lead to mistakes. This was corroborated by the contents of a safeguarding concern received in February 2013.

We found that people using the service had an assessment of their needs and how their needs would be met were set out in a plan of care. However, we found that people's preferences were not taken into account when planning their care.

We found that people using the service were not given a choice of food and hydration at meal times, however, we saw people being assisted to eat their meal with dignity.

We found that people using the service or their relatives were not given the opportunity to give feedback on the service or suggest improvements regularly. The provider was unable to produce records of any feedback sought after 2010.