The Homestead

The Homestead is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care for up to 68 older people and is prepared to accommodate individuals living with dementia. On the day of our inspection 64 people were living at the home.

At our last inspection we had rated the service Good. At this inspection we found the evidence continued to support the rating of Good. According to the findings of our inspection and ongoing monitoring there were no serious risks or concerns relating to the functioning of the service. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last 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.

Why the service is rated Good.

The service was outstanding in their responsiveness. The service went the extra mile in providing people with a broad variety of activities to prevent social isolation. The service was extremely responsive to people’s needs and wishes. People and their relatives told us that staff went over and above their call of duty which made a profound difference to people’s lives. People emphasized the fact that they were delighted by the events organised by the service. People using the service and their relatives knew how to raise a concern or make a complaint.

The service continued to ensure people were safe. Staff understood potential signs of abuse, were aware of their responsibilities to report any concerns and knew how to do this. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Medicines were stored and administered safely. There were enough appropriately trained staff to meet people's needs. The provider followed appropriate recruitment procedures to ensure they employed staff who were suitable to provide care.

People continued to receive effective care. People were supported by staff who were suitably trained and supported in their roles. People were given choice and provided with support in accordance with the principles of the Mental Capacity Act. People had their nutritional needs met. We observed a lunch time meal and noted people were consuming appetizing food in a relaxed atmosphere.

The Homestead continued to provide a caring service to people. Staff consistently demonstrated kindness and compassion towards people. People and, where appropriate, their relatives were involved in making decisions about the care and support people received. People's choices

and preferences were respected.

The service continued to be well-led. People, their relatives and staff spoke highly of the management. There were systems in place that monitored the quality of the service, resolved issues and strived for continuous improvement. Staff felt engaged and empowered working at the service.

The Homestead can accommodate up to 68 people. The home is situated in the village of Carterton. The home has three units set over three floors. The ground floor and the middle floor accommodate people living with a dementia. The top floor accommodates people who require personal care.

There was a registered manager in place. 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 had been identified, assessed and were managed safely. Staff understood the signs of potential abuse and what action they needed to take if such suspicion arose. There were sufficient numbers of staff employed to meet people's needs and the service followed safe recruitment practices. People's medicines were managed safely and administered by adequately trained staff.

Staff received suitable training to ensure they could support people appropriately. Staff said they received sufficient training to do their jobs, and felt confident to raise any professional development needs at their regular supervisions and appraisals.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The registered manager and staff understood their responsibility to ensure people's rights were protected.

People received the support they required to meet their nutritional needs. Staff showed an excellent knowledge of the specialist diets people required and gave appropriate support to people who needed assistance with meals. Staff made referrals to and sought support from a range of health care professionals in a timely way. The relationships with the health professionals were positive and led to improved outcomes for people.

People had positive relationships with staff and were treated in a caring and respectful manner. Staff delivered their support in a calm, relaxed and considerate manner. People and their relatives were actively encouraged to participate in the planning of their care. Staff were empathic when dealing with people's privacy and dignity.

Care plans were person-centred and ensured the care and support suited people’s needs and expectations. People’s own preferences were reflected in the support they received.

The service was exemplary in responding to people's needs and preferences. People were supported by a service that was devoted to getting to know the people they supported. People participated in a range of activities and received the support they needed to do this.

People were able to choose where they spent their time and what they did. They were also able to raise complaints which were investigated and resolved promptly.

The culture of the organisation was open. Staff were aware of and adhered to the values of the organisation that were based on people’s welfare being of greatest importance. This was confirmed by the staff, people and their relatives. There was a quality monitoring system involving checks on the service provided to people. The system aimed to ensure people were able to express their views so improvements could be made.

During our inspection we spoke with eight people, five people's relatives and three visiting professionals. We also spoke with 11 care workers and the registered manager. We reviewed six peoples care files and documents made available to us by the manager around staffing levels and quality assurance. We also carried out a short observational framework for inspection (SOFI). This is used to capture the experiences of people who use the service where they may not be able to express this for themselves.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found;

Is the service Safe?

The service was safe because staff understood the needs of the people they supported. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

At our last inspection we found that there were not enough qualified, skilled and experienced staff to meet people's needs. At this inspection we found that improvements in relation to staffing had been made. We concluded that there were an appropriate number of staff with the necessary skills and experience to meet people's needs.

Appropriate arrangements were in place for obtaining and disposing of medicines safely. Medicines were stored safely in a locked cupboard and medicine trolleys which were secured to the wall when not in use. Staff had received management of medicines training. Suitable records were kept regarding medication administration. The home had appropriate systems in place to account for the amount of medicines given and for those left in stock. We saw that the amount of medication documented as being in stock on in the controlled drugs chart corresponded with the actual amount of medication in stock. This meant that medicines were handled safely and securely.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. While no applications have been submitted, proper policies and procedures were in place but no applications had been necessary. Relevant staff have been trained to understand when an application should be made, and in how to submit one. This meant that people's human rights were properly recognised, respected and promoted.

Is the service effective?

The service was effective because people told us they were happy with the care they received and felt their needs were understood and met. People's relatives were also complimentary about the care their relatives received. Our SOFI observations identified a number of warm and meaningful interactions that visibly had a positive impact on people's mood. One visiting professional told us, 'I have been seeing some of the people here for some time and have seen amazing improvements in people's self-esteem'.

Is the service caring?

This service was caring because people we spoke with felt cared for. One person told us, 'they [the staff] are wonderful, they understand me and know what I need.' Relatives we spoke with were also complimentary of the care their relatives received. One relative told us, 'If I only say one thing, it's amazing, the care here is amazing.' We observed a number of caring, warm and patient interactions between care workers and the people they supported.

Is the service responsive?

The service was responsive because people's needs were assessed when entering the home and were subject to on-going review of their needs. When people's needs changed the service responded and took the appropriate action. For example, advice and guidance was sought from other professionals when required. People's hobbies and interests were identified. We saw that people's lifestyle choices and religious beliefs were respected. People were offered a number of activities to participate in and also had access to music therapy.

Is the service well led?

The service was well led because staff we spoke with felt they had clear leadership from the registered manager who always had their door open and would listen to any concerns.

Robust systems were in place to monitor the quality and safety of the service. Systems in place ensured that care files were kept up to date and people's care plans/needs were reviewed. These systems also ensured that staff received regular training and support.

Where issues were identified appropriate action was taken. People told us they completed satisfaction surveys and attended relatives meetings. Actions from these meetings were carried out to make improvements to the service. We were told that the management consulted with people who lived at The Homestead as well as staff before changes were made.

Care and treatment was planned and delivered in a way that ensured people's welfare and safety. We looked at the care records for seven people who used the service. Care plans were person centred, regularly reviewed and gave care workers clear guidance on what care people required.

The home had systems in place to ensure staff absences could be covered and associated risks managed. However, we saw that these arrangements had not been effective in covering staff absences. Records showed that sufficient care workers had not been available on more than half of the shifts in the past three months. Staff told us when shifts weren't fully staffed they felt 'rushed' and 'not able to spend quality time with people while doing personal care'. They also told us that this meant that 'people's choices could not always be respected.

The home had systems in place to monitor the quality of the service provided and to monitor risks. Records showed that all pressure sores, falls and weight loss were formally monitored on a monthly basis.

We found that arrangements were in place to protect people who lacked mental capacity. Legal requirements under the Mental Capacity Act and Deprivation of Liberty Safeguards were being adhered to. People were receiving the care they required and potential and actual risks were being managed. People had access to external health care professionals when needed. People's nutritional needs were being monitored and met but the lunch time experience, for some, could have been improved. There was no evidence on the day of the inspection to suggest that there were not enough staff on duty to meet people's needs. Additional staff were employed to help the smooth running of the service. Complaints, concerns and comments of dissatisfaction were taken seriously. Complaints were acknowledged, investigated and responded to. Actions taken in response to these were recorded.