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We are carrying out a review of quality at The Homestead. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 16 February 2018

During a routine inspection

This comprehensive inspection took place on 16 February 2018. The inspection was unannounced which meant that the staff and provider did not know that we would be visiting.

At our last inspection in December 2015 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The Homestead 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.

The Homestead is a large detached property situated in a residential area of Exmouth. The home is set over three floors with access via a passenger lift. The main communal spaces are situated on the ground floor. The service provides accommodation for up to 24 older people. There were 22 people living at the home at the time of our inspection. The provider also provided a day care provision during the week at the home. This was not inspected as it was not part of the provider’s regulated activity.

Why the service is rated Good:

People told us they felt safe at the home and with the staff who supported them. Comments included, “I can’t fault them. They are superb.”

The home had a registered manager. 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.

Staff had received safeguarding training and were aware how to raise concerns if they felt people were at risk of abuse or poor practice.

Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed.

People were supported by adequate staff levels to meet their needs. The staff had the required recruitment checks in place. Staff received an induction and had received training and developed skills and knowledge to meet people’s needs.

People received person centred care. Staff knew people well, understood their needs and cared for them as individuals. They were familiar with people’s history and backgrounds and supported them fairly and without bias.

People were treated with respect and compassion by staff. They were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes.

People’s views and suggestions were taken into account to improve the service. Monthly residents meetings were carried out and an individual review with the registered manager each month.

People were referred promptly to health care services when required and received on-going healthcare support. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them. People knew how to make a complaint if necessary. There had been no complaints received at the service since our last inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safe

Inspection carried out on 21 and 23 October 2015

During a routine inspection

We carried out an unannounced comprehensive inspection on 21 and 23 October 2015.

The Homestead provides care and accommodation for up to 24 people. The house is a large detached property situated in a residential area of Exmouth, Devon. On the first day of the inspection there were 20 people staying at the service.

We undertook an inspection in July 2014 and found the service was compliant in the outcomes inspected.

Prior to the inspection we received three concerns relating to the management of the service, staff recruitment and staff levels. As a result of the concerns we brought the planned inspection forward and made the decision to visit the service unannounced early in the morning. These concerns were not substantiated at this inspection.

The service had a registered manager. 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. Everyone was positive about the registered manager and felt they were approachable and caring. The registered manager and the deputy manager were very visible at the service and undertook an active role. They were very committed to providing a good service for people in their care and demonstrated a strong supportive approach to staff.

People were supported by staff who had the required recruitment checks in place. Staff had shadowed senior staff at all times while waiting for all employment checks to be completed. Staff received a full induction and were knowledgeable about the signs of abuse and how to report concerns. The majority of care staff had undertaken recognised national qualifications in health and social care. Staff had the skills and knowledge to meet people’s needs. There were adequate staffing levels to meet people’s needs.

The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People were supported to eat and drink enough and maintained a balanced diet. Following concerns about the food the provider had been working closely with people and staff to provide a menu that all people at the service would be happy with. Staff relationships with people were strong, caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff supported people to follow their interests and take part in social activities. A designated activity person was employed by the provider and implemented an activity programme at the service.

The provider had a quality monitoring system at the service. The provider actively sought the views of people, their relatives and staff. There was a complaints procedure in place and the registered manager had responded to a concern appropriately. The premises and equipment were managed to keep people safe.

Inspection carried out on 10 July 2014

During a routine inspection

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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe because people we spoke with told us they felt safe living at The Homestead.

We saw risk assessments had been completed and action taken to reduce risk where this was necessary.

Staff told us they felt there was sufficient equipment to meet the needs of people being cared for, it was regularly checked and it was safe to use. We saw details of the contract the organisation had with an accredited engineer to check and service the mobile and bath hoists.

People who use services were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards (DoLS). The registered manager told us no one at The Homestead was subject to such a safeguard.

We saw doors were not locked and people had free access to leave the building. Staff told us they had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Is the service effective?

We spoke with five people living at The Homestead and each told us they were happy with the care they received. Staff we spoke with knew people well and understood people�s care and support needs. We saw comprehensive care plans had identified people�s needs and how these needs should be met.

Staff told us they had training in core areas such as manual handling, fire safety, food hygiene, safeguarding adults, Mental Capacity Act and Deprivation of Liberty Safeguards. They also had specific training to ensure care was appropriately given to people with particular needs. One staff member said �The district nurse came and gave us specific instruction in how to administer insulin for a particular person�.

We spoke with a district nurse who told us �Staff follow plans and advice and are very good at communicating within the team. They chase things up if they need to; they are good advocates for people here�.

One person we spoke with said �It is very good; they maintain my dignity and encourage me to be independent. They have time to talk with us and don�t rush us.

This showed the service was effective.

Is the service caring?

The service was caring because during our visit we observed staff treating people respectfully and with sensitivity. The atmosphere within the home was positive, light-hearted and relaxed. We saw people were given choices and asked where they would like to sit. People were encouraged to be independent but given help where this was required.

We spoke with five people and each told us they were happy with the care they received.

One person said �I have met nothing but kindness and good food. I get a good night sleep and have good neighbours. Staff are used to my kind of humour and they treat me respectfully. I have nothing to complain about but if I did I think they would listen�. Another person said �I am treated respectfully; staff have always been helpful when I have needed help. I have a very good room and brought some of my own things with me�.

We spoke with three relatives and each told us they had found the care given to people at The Homestead to be very good. One relative said �Staff are really good with my mother. They are very positive and never say anything negative. The environment is very clean and I can visit or speck to my mother at any time. Staff keep me informed, they always tell me if something has happened�.

Is the service responsive?

The service was responsive because people�s needs were assessed before moving into the home and we saw there were regular reviews of care plans.

Staff we spoke with told us there was good communication within the team with thorough handovers at each shift and good written information. There were clear processes for reporting any concerns about changes in the person�s health and good support from the GP and other professionals.

We were given an example of physiotherapist being contacted due to concerns about a person�s deteriorating mobility. The physiotherapist visited and recommended bed and chair raisers to make it easier for the person to get off the bed and chair. These had been provided by the organisation and we were told this had made life much easier for the person.

Is the service well-led?

The service was well led because staff we spoke with had a consistent understanding of what was expected of them.

The provider undertook an annual survey of people�s views. We saw where people had made comments on the survey about the care they received this had been responded to by the organisation.

The registered manager told us they wanted to create an open culture. All staff we spoke with told us they felt comfortable about reporting any concerns including where care practices might be improved.

Inspection carried out on 11 September 2013

During a routine inspection

21 people lived at The Homestead at the time of our inspection. We spoke with seven people who lived there the owner and four members of staff. People told us that staff were kind and helpful. Comments included, "They are so kind to me, they can’t do enough for me” and "its first class here, I am very lucky."

People took part in a range of activities and were encouraged to maintain independence. People and their relatives were involved in planning their care, as much as they wished to be. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were reviewed regularly and as necessary. Records showed that prompt referrals were made to health professionals and their advice was followed. Procedures were in place to deal with emergencies.

The Homestead was clean, homely and well maintained.

People told us they felt safe and well cared for. People received their medicines as they were prescribed, and were supported to manage their own medicines if they wished to.

There was an effective quality assurance system in place.

Inspection carried out on 16 January 2013

During a routine inspection

We found that people's privacy was protected and people were treated with respect. One person said �They seem to know who I am and what makes me tick, as a result they seem more like friends.�

People were able to make choices and decisions about their daily lives and be fully involved in planning their care.

People told us the care and support they received was �superb�, �faultless� and �very good indeed�. One person said �I really dreaded the thought of moving in here, but I have been surprisingly delighted with what it�s like.�

There was a wide variety of activities provided at the home and people were also encouraged to continue with existing hobbies.

People told us they felt safe living at The Homestead and told us that staff were �kind� �very caring� and �professional�. People also knew how to make a complaint and were also provided with opportunities to feedback their opinion of the service.

All comments about staff from people living in the home were extremely complimentary. One person said �They are all, without exception, very good.� People thought there were enough staff on duty and felt the staff were experienced and knowledgeable.

The home was very well managed. There were systems in place to monitor the safety and effectiveness of the service. There were effective training and staff supervision systems in place. All records seen were up to date and reflected the high level of service that people told us they received.

Reports under our old system of regulation (including those from before CQC was created)