Homemead

Homemead is a care home that provides accomodation and personal care for up to 30 older people in one adapted building. At the time of our inspection there were 23 people using the service including those living with dementia.

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

People using the service, their relatives and staff told us that the home was a safe place to live. People had risks to them regularly assessed, reviewed and minimised meaning they could take acceptable risks, and enjoy their lives in a safely. Any safeguarding concerns, accidents, and incidents were reported, investigated and recorded, appropriately. The home had enough staff to support people and meet their needs. Staff were appropriately recruited and trained including how to safely administer medicines. The home used Personal Protection Equipment (PPE) safely, effectively and the infection prevention and control policy was up to date.

Homemead was managed and led positively, in an open, transparent and positive way with an honest culture. The provider had a vision and values that were clearly set out, staff understood and followed. Management and staff responsibilities and accountability were clearly defined, and a good service provided that was regularly reviewed. The provider audits were thorough, and records kept up to date. Community links and working partnerships were established and maintained to minimise people’s social isolation. The provider met Care Quality Commission (CQC) registration requirements. Healthcare professionals told us that the service was well managed and met people’s needs in a professional, friendly and open way.

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.

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 22 November 2018). The overall rating for the service remains good. This is based on the findings at this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We did not inspect the key questions of effective, caring and responsive.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

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

We found the following examples of good practice.

The home had robust and effective measures to prevent and minimise the risk to people, staff and those that visited from catching or spreading COVID-19.

During our inspection, staff and managers wore personal protective equipment (PPE) appropriately. Staff received up to date infection prevention and control (IPC) and COVID-19 training, that was routinely refreshed. There were adequate supplies of PPE that met current demand and foreseeable outbreaks.

Staff followed IPC and PPE regularly updated policies and procedures, that reflected ongoing changes to COVID-19 related guidance. This included contingency plans for managing adverse events, such as COVID-19 outbreaks and staff shortages. The registered manager conducted walkabout tours of the care home to ensure staff were using PPE, and following guidance.

Whilst access to the care home was restricted, due to an outbreak, designated people such as essential care givers and end of life could visit their relative or friend in line with Government COVID-19 care home guidelines. All visitors to the care home had to follow the home’s IPC guidance.

Alternative communication arrangements were made so people could maintain relationships with relatives and friends. Staff actively supported people to keep in touch with those who could not visit the care home by telephone and using video calls.

The care home was not currently accepting new referrals or people returning home due to a Covid-19 outbreak. Under normal circumstances new admissions or people returning after a hospital stay were required to have a negative COVID-19 test and self-isolate for a minimum 14 days to reduce the risk of the virus spreading.

The care home adopted a ‘whole home’ COVID-19 testing program. This made sure everyone living, working or visiting the care home was regularly tested for COVID-19. The provider knew how to apply for COVID-19 home testing kits and had adequate supplies.

The home was hygienic, clean and records were kept, in detail, of staff cleaning schedules. This included continuously cleaning high touch surfaces, such as light switches, grab rails and door handles as part of a rolling programme.

There were thorough assessments of infection risks to everyone living and working in the care home and if people were deemed to be disproportionately at risk from COVID-19, appropriate action was taken to reduce the impact. Staff with underlying health care conditions or other restricting factors, did not work on floors where people who had tested positive for COVID-19 had been or were self-isolating.

The provider had minimised the number of agency staff they used to those that had previous experience of the home to reduce the risk of spreading infection.

The provider's IPC policy was up to date.

Homemead is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Homemead provides accommodation and personal care for up to 26 older people with dementia. At the time of our inspection there were 23 people living in the home. The home is situated in its own grounds and has three floors, served by a lift.

At the previous inspection in August 2017 we found that the service was not meeting all the quality standards and was rated "Requires Improvement” in the key areas of safety and well-led. The inspection rated the service overall as “Requires Improvement”.

We asked the service to provide us with an action plan for improvement and we monitored improvement during this inspection. At this inspection we found that the provider and registered manager had made the necessary improvements to their service.

At the previous inspection we found that people were not always supported in a safe way when receiving their medicines. There were some occasions where people were not always given their medicines on all days and that the recording of medicines used was not always accurate.

During this inspection we found that the management of the recording of medicines had improved. We found that daily medication audits were completed and fed into a weekly audit, completed by one of the senior management team.

At the previous inspection we found that people were not always supported in a safe way at night due to the numbers of staff on duty. There were occasions when people had to be left unattended whilst staff were carrying out other duties.

During this inspection we found that the night staffing had improved because the provider had increased the numbers of staff on duty. This meant that people were more frequently monitored and have their needs met sooner.

At the previous inspection we found that the service had systems and procedures in place to help deliver high quality care. However, it did not always use its audits and information to make improvements or address issues that needed resolving.

During this inspection we found that the service had improved the way it used its quality assurance systems to help managers and staff understand what was important to people and how the service could develop and improve.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People who lived at the home were protected from the risk of abuse happening to them. People told us they felt safe and well cared for at the home and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing. Care staff could describe how they would report incidents of concern and records showed that training in safeguarding people had been updated.

Staff provided attentive care to people and risks to people’s health, safety and welfare were well managed. Risks had been assessed and where appropriate contributed to the person’s overall care plan.

Risk management plans clearly identified what the risk was and provided staff with instructions about how they needed to manage the risk to ensure people received safe care and support whilst enabling them to remain as independent as possible.

There were procedures and policies in place to control infection. We looked around the home and saw that all areas were clean and hygienic. Staff had received infection control training and records confirmed this.

People and their relatives spoke positively about the care and support provided by the staff working at Homemead. A relative's view was that there could be more stimulation for those with the mental capacity to benefit from it.

There was a consistent team of staff working at the home who were appropriately trained. There was some dependency on agency staff but efforts were made to minimise this using bank workers and overtime.

The home ensured that wherever possible people were asked for their consent before care plans were agreed, medicines given or access to their rooms or personal information was requested. Records of signed consent forms were contained in people’s care records including Do Not Attempt Resuscitation (DNAR) forms where people had requested these.

People received nutritious meals and could choose from a variety of dishes which took people’s cultural and religious preferences into account. At night people could request snacks, including cereal and toast, as well as having plenty of fluids such as tea or juice. However, we noted that no liquid was provided during one lunch session until after the meal was eaten. This was discussed with the quality and compliance manager and we were satisfied that this was an error that would be rectified.

People’s privacy and dignity were respected and promoted. There was a positive culture of inviting and encouraging people to socialise and take part in activities. However, people’s wishes were respected and some chose to spend time in their room at various times of the day.

Bedrooms were personalised with people’s belongings, such as ornaments, family photographs and small pieces of furniture. People received personal care either in their own room or bathrooms with doors closed. During our inspection we observed how staff interacted with people who used the home and found it to be respectful and sensitive. Examples included referring to people by their preferred name and knocking and waiting before opening doors to bedrooms or bathrooms.

People said they felt confident that any problems or complaints that might arise would be dealt with by the management in a satisfactory way. A copy of the complaint’s procedure was displayed near the main entrance to the home. This procedure told people how to complain, who to complain to and the times it would take for a response.

The home demonstrated good management and leadership through having an experienced registered manager in place with the support of a deputy manager and senior staff members leading on each shift. The registered manager understood their responsibilities and was supported by a wider managerial team.

Homemead provides accommodation and personal care for up to 26 older people with dementia. At the time of our inspection there were 25 people living in the home. The home is situated in its own grounds and has three floors, served by a lift.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People who lived at the home were protected from the risk of abuse happening to them. People told us they felt safe and well cared for at the home and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing. Comments included “They are all very kind” and “The staff are lovely.”

However, there was a risk to people that they may not always receive medicines in a safe way because of discrepancies in recording and reporting as well as a lack of clarity amongst staff of areas of responsibility towards aspects of medicines management.

Staff provided attentive care to people. However, we found that at times there were insufficient numbers of staff on duty and that reviews of staff ratios had not fully taken into account the needs of people or views of staff.

There were systems in place to audit and monitor the quality of the home. However, these were not used sufficiently well to enable the provider to evaluate and improve their practice.

Risks to people’s health, safety and welfare were well managed. Risks had been assessed and where appropriate a risk management plan had been put in place for aspects of people’s care and support. Risk management plans covered aspects of care such as, nutrition, choking, mobility, moving and handling, pressure care, physical and emotional health. These then formed part of the persons care plan.

Risk management plans clearly identified what the risk was and provided staff with instructions about how they needed to manage the risk to ensure people received safe care and support whilst enabling them to remain as independent as possible.

The premises were free from hazards and were clean. The outside areas had some debris, old leaves and general untidiness which could, if left unattended present a risk of slipping or other damage to people or visitors. The registered manager and operations director assured us that this would be quickly looked into.

There were procedures and policies in place to control infection. We looked around the home and saw that all areas were clean and hygienic. Staff had received infection control training and records confirmed this.

People spoken with were happy with the support provided by the staff working at Homemead. One person told us, “The staff are very helpful and do all they can.” A relative said, “I can’t fault them. They know exactly what to do and how to make [my relative] comfortable.”

There was a consistent team of staff working at the home who were appropriately trained. The provider had made improvements in reducing dependency on agency staff over the previous 12 months and all staff were now employees of the organisation.

The home ensured that wherever possible people were asked for their consent before care plans were agreed, medicines given or access to their rooms or personal information was requested. Records of signed consent forms were contained in people’s care records including Do Not Attempt Resuscitation (DNAR) forms where people had requested these.

We observed staff supporting people to choose and prepare their lunch as appropriate. The chef spoke passionately about how people were consulted about their meal preferences and how menus were planned with the aim of making the meals not only nutritiously balanced but presented in a way that encouraged people’s appetites.

When we visited at night we found that people were able to request snacks, including cereal and toast, as well as having plenty of fluids such as tea or juice.

People told us that the staff were kind and caring towards them and felt that staff had positive caring relationships with them. One relative told us, “The home is small and friendly. The staff work very hard and are very caring. We can visit anytime.”

People’s privacy and dignity were respected and promoted. Some people chose to spend time in their room, others chose to sit in quiet areas or move freely around the units. People and relatives told us it was their choice to spend time alone in their rooms and that staff respected their decision.

Bedrooms were personalised with people’s belongings, such as ornaments, family photographs and small pieces of furniture. People received personal care either in their own room or bathrooms with doors closed. During our inspection we observed how staff interacted with people who used the home and found it to be respectful and sensitive. For example, before entering a bedroom or bathroom, staff knocked and waited before opening the door.

People said they felt confident that any problems or complaints that might arise would be dealt with by the management in a satisfactory way. A copy of the complaint’s procedure was displayed near the main entrance to the home. This procedure told people how to complain, who to complain to and the times it would take for a response.

The home demonstrated good management and leadership through having an experienced registered manager in place with the support of a deputy manager and senior staff members leading on each shift. The registered manager understood their responsibilities and was supported by a wider managerial team.

You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

People told us they felt safe and secure.

The staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

We saw that the home was clean and well maintained. All the people we spoke to told us that this was always the case.

We saw that there were sufficient staff on duty to meet people's needs throughout the day. People received a consistent and safe level of support.

Recruitment procedures were rigorous and thorough.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager told us of any DoLS applications that had been made and was able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

People all had an individual care plan which set out their care needs. We saw that people had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. Assessments included needs for any equipment, mobility aids and specialist dietary requirements.

People had access to a range of health care professionals some of which visited the home. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented: "If you want something, you only have to ask and they will get it for you". A relative told us: "The care is excellent and I have never had any concerns. Sometimes they have had to sort out small issues like clothes, but they always sort them out".

Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is The Service Responsive?

People told us that they were able to participate in a range of activities both in the home and in the local community. The activities provided included ones people could enjoy as a group and others that meet their individual interests.

We saw that people were involved in reviewing their plans of care when their needs changed. One relative told us: "The staff keep you informed of everything and you can speak to them at any time".

Is the service well-led?

We saw that the service actively consulted people on their views of the service and acted on any concerns.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed. Prompt action had been taken to improve the service or put right any shortfalls they had found.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People's personal care records, and other records kept in the home, were accurate and complete.

We found that the home was clean and free from malodours. People were clean and appropriately dressed for the time of day and those people who required assistance with personal care were supported in a way that ensured their dignity and privacy.

Staff we spoke with confirmed that they had received safeguarding training and were aware of the different types of abuse that could happen to people and the procedures to follow. We looked at records in the home and these confirmed that procedures existed and that staff had received appropriate training.

The home was seen to be free from hazards and the layout was such that it afforded people free and unrestricted access to all parts of the home.

We observed appropriate positive interactions between staff members and people living at the home, and people were well supported within the home environment. We saw appropriate skills displayed by staff working with people.

We saw that there were thorough systems for making regular checks on all aspects of the service. These included checks on people's care, medication, activities, food, cleanliness, staff support and safety.