Homefield Grange

Updated 6 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and a nurse specialist advisor.

Service and service type

Homefield Grange is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Homefield Grange is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The service had a peripatetic home manager who was managing the service and they were in the process of recruiting a registered manager.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 8 people who used the service and 2 relatives about their experience of the care provided. We spoke with 14 members of staff including the regional support manager, deputy manager, nurses, senior staff, health care assistants, chef and housekeeper. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included 6 people’s care records and multiple medication records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 6 May 2023

About the service

Homefield Grange is a residential care home providing personal and nursing care for up to 64 people. The service provides support to older people, some of whom are living with a dementia. At the time of our inspection there were 45 people using the service.

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

Risks to people associated with malnutrition, dehydration and swallowing were not always managed safely. Medicines prescribed for as and when needed did not always have protocols in place to ensure safe administration. Some equipment was in a poor state of repair which meant cleaning to prevent infection was compromised. The service did not always meet their legal requirement to notify CQC of notifiable incidents. Governance systems were in place but had not identified areas for improvement identified as part of our inspection.

People told us they felt safe and had confidence in the staff team. Staff understood their role in recognising and reporting concerns of abuse or poor practice. People were supported by staff who had been recruited safely and there were enough staff, with the right skills and experience to meet people’s care and support needs.

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 were supported by staff that had completed an induction and had on-going training and support that enabled them to carry out their roles effectively. People described the food as good and told us they had plenty of choice and access to drinks. People had access to healthcare for both planned and emergency events. The accommodation provided an environment that enabled people to maximise their independence and provided safe spaces inside and outside.

Staff spoke positively about the home, understood their roles and responsibilities, and felt supported by colleagues and the senior staff team. Staff described communication as good and were kept up to date and involved in developments through a range of meetings. Quality assurance systems and processes collected information and feedback that was used to drive improvements.

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 good (published 14 December 2021).

Why we inspected

We received concerns in relation to risks associated with eating and drinking, medicines and management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Homefield Grange on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and governance of the service.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.