The inspection took place on the 17 March 2016 and was unannounced. It continued on the 18 March 2016 and was announced. Homefield Grange is registered to provide accommodation for up to 64 people who require nursing or personal care. At the time of our inspection there were 27 older people living at the service. People required a mixture of residential and nursing care. The building is on three levels and people were living on the ground floor. The first floor had not started to accept admissions but was furnished in preparation. All the rooms were single rooms with en-suite wet room facilities. The ground floor had a lounge area, garden room and dining room. The garden room and dining room had level access into a secure garden. Two specialist bathrooms were available, a treatment room and sluice area. The first floor in addition had a library area, a shop selling sweets, toiletries, cards and gifts, and a cinema. There was also a hair and beauty salon.
The home did not have a registered manager at the time of our visit. The manager had submitted their application to the Care Quality Commission and was awaiting the outcome. 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.
We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.
We found that the service was not always working within the principles of the MCA. We observed one person being given liquid medicine which staff had disguised as orange juice. The service had a policy for medicines being administered covertly. The policy included guidance on the MCA and DoLs and had not been followed by the nursing team. During our inspection the service organised a best interests meeting with the person’s GP and family who had an enduring power of attorney.
We checked a persons’ care file that stated they did not have mental capacity. They had a pressure sensor mat in their room due to a risk of falling and if it was stood on it alerted staff. Although this placed restrictions on the person a best interest decision had not taken place. Files contained copies of power of attorney legal arrangements for people but staff did not always understand the scope of decisions the POA could make on a persons’ behalf. We discussed our findings with the services quality manager who told us that their findings had been the same and staffs understanding of the MCA and power of attorney were on the quality action plan.
Deprivation of Liberty Safeguards (DoLS) had been applied for people who needed their liberty to be restricted for them to live safely in the home. Staff were aware of people who had a DoLs authorisation in place. Care records also contained signed consent for sharing information, use of moving and handling equipment, photographs and vaccinations. We observed staff seeking verbal consent before supporting people with care.
People and their families told us that they felt the service was safe. Staff had undertaken safeguarding training and understood what types of abuse people may be at risk from and how to recognise any signs of potential abuse.
Risk assessments had been completed for people. Where a risk had been identified actions had been taken to minimise the risk. We spoke to staff who demonstrated a good understanding of people’s individual risks and the actions they needed to take to support the person and keep them safe. People had the freedom to make choices about how they lived with identified risks. Risk assessments had been regularly reviewed.
Accidents and incidents had been recorded. This included notes of any investigations and follow up actions needed. We saw that actions had included referrals to other professionals, contacting the safeguarding team at the local authority, reviewing risk assessments and changing people’s care plans.
People had individual personal evacuation plans in place. Staff had received fire training and fire equipment was tested weekly. Records showed us that regular checks were made of hot water temperatures, pressure mattress settings and moving and handling equipment.
We observed staff supporting people in a timely way. Staff told us they felt there were enough staff to meet peoples’ assessed needs. The home had reduced the use of agency care staff following a successful recruitment campaign.
We looked at staff files and found that staff had been recruited safely. Files contained evidence of references, criminal record checks and eligibility to work in the UK. Procedures were in place to manage poor practice.
Medicines were stored and administered safely by registered nurses. Senior care workers had also received medicines training so that they could be a second signature on medicines records when needed.
New care staff completed the Care Certificate Induction. The Care Certificate is a national induction for people working in health and social care who did not already have relevant training. Senior care staff and nurses had an induction appropriate to their role.
Staff told us they felt they had the training they needed to carry out their jobs. Training records were kept for each person and included dates for refresher training. Staff had opportunities for personal development and training. Nurses had been supported with clinical updates.
Staff felt supported and received supervision. Annual appraisals had been planned.
People had a choice of what they would like to eat and drink and where they would like to have their meal. Staff had a good understanding of risks associated with peoples eating and drinking. We observed people being supported with their meals in a personalised way. Some people had specialist plate guards and drinking beakers to enable them to eat their meal independently. People who needed staff to help them with their meal were supported in an unhurried way. People were weighed regularly and any significant weight loss was actioned. This included setting up charts to monitor food and drink intake and referrals to GP’s and dieticians.
People had good access to health care which included hospital specialists, chiropodists, dieticians and occupational therapists.
People and their relatives told us staff were caring. We observed staff interacting in a positive, relaxed way with people and their families. Staff demonstrated good communication skills and knowledge of the people they were supporting.
People felt they were involved in decisions about how they received their care. We observed staff asking people if and how they would like to be helped and giving people the opportunity and time to decide. People had access to an advocacy service that would be able to speak up on their behalf.
People had their dignity respected and were supported to maintain their independence.
A complaints process was in place and records were kept of any formal written complaint. Included in the records were details of any investigation, action and the outcome. Verbal concerns raised were not always recorded. We discussed this with the manager who told us they would discuss with staff the importance of recording and sharing any verbal concerns raised in the future.
People told us they felt staff listened to them. A suggestion box had been placed in the entrance hall for people and in the staff room for staff to use. Information was on display in the foyer about the complaints procedure and included details of the local government ombudsman.
Assessments had been carried out prior to people moving to the service. People had a plan of care that was individual to their care and support needs. Care plans had been reviewed at least monthly. People, and when appropriate their families, had been invited to care plan reviews.
Staff had a good knowledge of people and their care and support needs. One person had complex health problems which impacted on their risk of falling. Staff understood how to support the person and the importance of gathering information to support the review of the persons’ health and care.
Information had been gathered from people about their lives and included their likes and dislikes. Activities had been organised for people in groups and on a one to one basis. Friends and family were able to visit at any time and people were supported to maintain links with the local community.
People, families and staff told us they found the manager approachable and listened to them. They described the service as well organised. All the staff we spoke with had a positive attitude about their work and the service. Staff had a good understanding of their roles and worked as a team. Staff consistently spoke highly of the team work. A ‘Carers Award’ had been introduced to recognise staff achievements.
The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.
Audits had been completed and had captured any areas where action was needed. We spoke with the quality manager who explained that the service had a schedule of audits that they checked each month. Areas that audits had highlighted required some further improvement had been put into a quality action plan. The action plan reflected the findings of the inspection. This demonstrated that the service quality monitoring systems were effective.
A quality assurance survey was sent annually to people, their families, staff and other stakeholders. The process had been carried out by an external company. Results had been shared with people and their families. A copy of the staff survey r