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Inspection carried out on 5 September 2018

During a routine inspection

Homeland 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. Homeland accommodates three people living with a learning disability in one adapted building. At the time of our inspection there were three people living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This announced comprehensive inspection took place on 5 and 7 September 2018. The provider was given short notice because we needed to be sure that someone would be in.

At our last inspection in February 2016 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.

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Why the service is rated good.

The service provided safe care to people. A relative commented: “(Person) is definitely safe and well cared for.” People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

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

Care files were personalised to reflect people’s personal preferences. People were supported to maintain a balanced diet. 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 relationships with people were caring and supportive. A relative commented: “(Person) receives individual care and staff are led by his needs. Lovely care and we are happy. Cannot praise them highly enough.” Staff treated people with dignity and respect when helping them with daily living tasks. The service ensured people led meaningful and fulfilled lives.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

Staff spoke positively about communication and how the registered manager worked well with them and encouraged their professional development.

A number of methods were used to assess the quality and safety of the service people received and continuous improvements were made in response to the findings.

Further information is in the detailed findings below.

Inspection carried out on 4 February 2016

During a routine inspection

This unannounced inspection took place on 4 February 2016. We returned on 8 February 2016 as arranged with the registered manager. At our last inspection in November 2013 we found the service to be meeting all the regulations of the Health and Social Care Act (2008).

Homeland is a residential care home which supports a maximum of three people with learning disabilities.

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.

People were safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet, which they enjoyed. 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 relationships with people were strong, caring and supportive. Staff were motivated to offer care that was kind and compassionate.

There were effective staff recruitment and selection processes in place. Staffing arrangements were flexible in order to meet people’s individual needs. Staff received a range of training and regular support to keep their skills up to date in order to support people appropriately. Staff spoke positively about communication and how the registered manager worked well with them, encouraged team working and an open culture.

A number of effective methods were used to assess the quality and safety of the service people received.

Inspection carried out on 9 December 2013

During a routine inspection

Staff we spoke with told us that they had training in the Mental Capacity Act 2005. Staff demonstrated an understanding of consent issues and how to support people who refused care.

One relative told us “There is a good programme of activities; I can’t praise staff enough. It is a very good home and well managed. We took a long time to find a good home and if we didn’t like it he wouldn’t be there”. We saw staff treating people sensitively and respectfully and we noted that there was a good rapport between the staff and people living at Homelands.

We asked care workers how they administered medication. One care worker told us they “put the medication into a pot, this is not touched by hand. The witness will check and we do this until all the medication is prepared. We lock the cupboard and go to the person and explain what is happening. We take time and explain what the person is having and check they are OK. If the person refuses we assess the person’s mood and give a little more time”.

The care workers we spoke with told us they had good opportunities for training. One care worker said “the training is second to none; I am very happy with the training I receive”.

Inspection carried out on 27 February 2013

During a routine inspection

People using the service had very complex care needs and were not able to talk to us about the service or the support they received.

During our inspection we were able to meet all of the people who lived in the home and observed the staff as they provided care and support.

A relative we spoke to said “Homeland is the best place my relative has ever lived, the staff are terrific and I hope they can always continue to live there”

We saw staff treating people in a dignified and respectful manner. Staff told people what they were doing as they provided support and also encouraged people to be independent whenever possible.

Staff had a good understanding of how people communicated and used this knowledge to encourage people to make choices about their care and lifestyle.

People were able to access a range of health care services and we received positive feedback from the health professionals we spoke to.

Staffing levels ensured that people were kept safe as well as being able to access opportunities within the local community.

The service ensured that staff were sufficiently skilled and trained to meet people’s needs. Systems were in place to regularly review the quality of the service, and changes had been made when improvements were identified.

Inspection carried out on 28 March 2012

During a routine inspection

We conducted an unannounced visit to Homeland on 28 March 2012 as part of our schedule of planned inspections. We met the people who use the service but they had very limited verbal communication and therefore could not fully express their views.

We spent time observing staff interaction with people. We also asked questions of the manager and two staff. We looked at people's care records, spoke to a visiting health care professional and another health care professional following the visit.

We saw that staff were able to communicate using various methods, including some signing and the interpretation of people's body language. We saw people responding to requests and information, as evidence of this communication.

We saw that risk was understood and managed; for example, the risk from choking or weight loss. We found that appropriate advice was sought from external health care professionals, such as physiotherapy and speech and language therapy. People's health needs were well met.

We found that people engaged in several off site activities, such as swimming and sailing. Staff could describe how they established if these activities were enjoyed. We saw that people spent time as they chose whilst in the home.

People's intimate care was provided in private and they were treated with respect. The manager ensured that decisions were made in people's best interest. She had taken the correct steps to ensure people's rights were protected through the legal safeguards which are in place for people unable to make decisions about their own welfare.

Staff were fully aware of how to protect people from abuse. They were delivering care in an environment where they were well supported and able to receive appropriate training and professional development.

The home was being managed using systems, such as schedules for staff training, supervision and equipment servicing, to ensure that care and safety standards were maintained. The manager led by example and engaged all stakeholders in decisions for the benefit of the people using the service.

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