Homeleigh Residential Care Home

Homeleigh Residential Care Home is a small care home that provides accommodation and personal care support for up to five adults with learning disabilities and or autism and who may have enduring mental ill-health. At the time of our inspection five people were using the service.

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

People received their medicines as prescribed. However, there were discrepancies in the records relating how people’s medicines should be given. The medicines audit completed by the registered manager had not picked this up before our inspection.

Risks to people’s physical health and safety were assessed and appropriate actions put in place to mitigate such risks. Safeguarding procedures were followed to protect people from risks of abuse. The physical environment of the home was safe and suitable for people using the service. Health and safety systems were maintained. Records of incidents and accidents were maintained and reviewed by the registered manager.

There were sufficient staff on duty to meet people’s needs and safe recruitment procedures were followed. Staff told us and records showed staff were supported in their roles.

People’s needs were thoroughly assessed in line with recommended guidance. People were supported to eat and drink to meet their nutritional needs. People had access to a range of health and social care professionals to meet their needs.

People were supported to integrate in the home and social inclusion was promoted. The registered manager understood their responsibilities to safeguard people from abuse and had followed the provider’s safeguarding policies and procedures to address any safeguarding concern raised.

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.

Records showed consent was obtained from people and their representative for the care and support they received, where appropriate. Records showed people's legal rights were protected in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were supported to be independent as possible and do the things they wanted; and follow their interest. People’s human rights, dignity and privacy was respected. People were involved in the day-to-day decisions about their care and support. People received care tailored to meet their individual needs.

People knew how to make a complaint about the service and told us the registered manager addressed their concerns. The registered manager assessed the quality of the service through audits and checks. The registered manager worked in partnership with other organisation to meet people’s needs and improve the 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was Inadequate (published 31 December 2019) as there were breaches of regulations 9, 11, 12, 13, 16 and 17 and Warning Notices were issued for breaches of 11, 13, 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Homeleigh Residential Care Home is a small care home that provides accommodation and personal care support for up to five adults with learning disabilities and or autism and who may have enduring mental ill-health. At the time of our inspection four people were using the service.

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

Risks to people’s physical health and safety were not always identified and with appropriate actions put in place to mitigate such risks.

The registered manager continues to fail to put systems and processes in place to assess, monitor and improve the quality of the service. Records of incidents and care people received was not always maintained.

People were supported to integrate in the home and social inclusion was promoted. The registered manager understood their responsibilities to safeguard people from abuse and had followed the provider’s safeguarding policies and procedures to address any safeguarding concern raised.

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.

Records showed consent was obtained from people and their representative for the care and support they received, where appropriate. Records showed people's legal rights were protected in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was Inadequate (published 31 December 2019) as there were breaches of regulations 9, 11, 12, 13, 16 and 17 and Warning Notices were issued for breaches of 11, 13, 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 11, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Homeleigh Residential Care Home is a small care home that provides accommodation and personal care support for up to five adults with learning disabilities and or autism and who may have enduring mental ill-health. There is a communal lounge, kitchen, bedrooms and small garden area in the main home/premises with four people living there and another smaller separate unit opposite the main home. This has a small kitchen, lounge, bathroom and two small bedrooms. One person was living in the smaller unit. At the time of our inspection the service was fully occupied supporting five people across the two sections of the home.

At our previous inspection on 23 October 2018 we identified a number of breaches of regulations of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had failed to make the required improvements in all areas identified at our last inspection. At this inspection we found there had been a further deterioration in the quality of the service with further breaches of regulations identified.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

Feedback from people and their relatives were mixed and relatives did not always feel their family members were safe and well supported. People were not protected from avoidable harm. The provider continued to fail to report and respond appropriately and in line with safeguarding policies and procedures, where incidents had occurred causing potential harm to people. Policies and procedures for safeguarding adults and children were not up to date or robust.

Restraint, seclusion and segregation practices were unlawful used within the service. People consent was not always sought and the provider failed to assess capacity where appropriate and work within the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Risks to people's health, well-being and safety continued to be inadequately identified, assessed and reviewed to ensure people's safety and well-being. Arrangements to deal with foreseeable emergencies and to maintain the safety of the premises were not always robust or routinely completed in line with regulations and best practice. Accidents and incidents were inconsistently and inappropriately recorded and there was no analysis or monitoring tools in place to manage, monitor or learn from accidents and incidents.

People's legal rights were not protected because staff did not follow or act in accordance with the MCA and DoLS. The registered manager failed to notify the CQC that authorisations were in place as required by law. People's needs were not always reassessed or reviewed when changes in their needs occurred and this required improvement. People were not always supported to maintain a balanced diet and or were offered choice of foods. Staff knew the people they supported, however they did not always have or display the skills and knowledge to meet people’s needs appropriately in line with best practice.

The outcomes for people using the service did not reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. Aspects of staff practice was not always caring and staff did not always interact or communicate with people effectively. People were not always supported to make their own decisions or to be involved in planning and reviewing their care. People's privacy, dignity and independence was not always respected or supported.

Care plans were not always up to date and reflective of people’s needs and wishes. People did not always receive personalised care and the provider failed to maintain accurate, complete and contemporaneous records. The registered manager and staff lacked knowledge and understanding of the accessible information standards. The provider failed to produce information and documents in a format that met people’s needs such as easy to read assessments, care plans, service user guides and the complaints procedure. The provider failed to establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints.

The provider failed to ensure safe management oversight, to seek and act on feedback, assess, monitor and improve the quality and safety of the service. The registered manager did not fully understand their responsibility under the duty of candour and were not always open and honest during the inspection. They failed to take responsibility when things went wrong and did not keep their knowledge and understanding regarding best practice, or the changes in fundamental standards and regulations up to date.

Medicines were managed, administered and stored safely. There were enough staff to meet people’s needs and recruitment systems were in place to reduce identified risks. People were protected from the risks of infection and the home environment appeared clean and well maintained. People’s physical, mental and emotional needs were assessed and documented in their plan of care. The service was adapted in some areas to meet people’s needs and the garden and outside space was accessible to some people. People were supported by staff to access services such as, leisure activities to meet their needs and interests.

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 requires improvement (published on 23 October 2018) and there were three breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found there had been a further deterioration in the quality of the service with continued and further breaches of regulations identified.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection we identified continued breaches and new breaches in regulations. There are seven breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals are added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures.

This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this unannounced inspection on 30 August 2018. The service was last inspected in April 2016 and was rated Good. At this inspection we found three breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have rated the service requires improvement.

Risks to people were not always adequately managed to keep people safe. Risk assessments were not always carried out to identify risk of harm to people and management plans were not developed to minimise risks. Lessons were not learned from incidents or when things go wrong. People were not protected against the risk of abuse as safeguarding procedures were not followed. The registered manager did not raise alerts or investigate allegations of abuse in line with the provider’s safeguarding procedure.

People’s care and support were not always planned to meet their individual needs and preferences. Care records did not highlight support people needed with regards to their religious, sexual and cultural needs.

The quality of the service was not effectively monitored to drive improvement. The issues we identified during our inspection had not been picked up through audit systems.

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.

There were enough staff available on every shift to meet people’s needs. Recruitment checks were undertaken before staff started working with people. People’s medicines were managed in a safe way including the administration, recording, storage, and disposal of unused medicines. The health and safety of the environment including infection control were well maintained.

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 supported this practice. People gave consent to the care and support they received. The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s freedom was promoted. Staff understood how to recognise signs of abuse and how to protect people from the risk of abuse.

Staff told us they felt supported in their roles through induction, supervision; and training. People’s needs were assessed before they came to use the service. People’s nutritional needs were met. The service liaised with relevant professionals to ensure people received appropriate support and care that met their needs. People had access to healthcare services to maintain good health. The service had suitable facilities for people. The registered manager told us they would work closely with other services to deliver end of life care if needed. No one required end of life care at the time of our visit.

People told us staff treated them with kindness and respected their dignity. People and their relatives were involved in their care planning and these were reviewed and updated regularly to reflect people’s current needs and circumstances. Staff encouraged and supported people to maintain the relationships which mattered to them. People were engaged in activities they enjoyed.

People knew how to complain if they were unhappy with the service. The service gave people, their relatives and professionals opportunity to give their feedback about the service provided. Staff felt supported by the registered manager. The service worked closely with the local authority and with local services to improve the experiences of people.

At this inspection the service was providing care, accommodation and rehabilitation services for five people who have mental health needs and may also have learning disabilities.

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.

People using the service said they felt safe and that staff treated them well. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported. Staff were recruited safely

Medicines had been managed appropriately and equipment had been serviced on a regular basis to ensure that it remained safe for use. Risks to people were identified and monitored. There were enough staff to meet people’s needs and the provider conducted appropriate recruitment checks before staff started work.

Staff received adequate training and support to carry out their roles. They asked people for their consent before they provided care, and demonstrated a clear understanding of the Mental Capacity Act 2005(MCA) and the Deprivation of Liberty Safeguards (DoLS).

People and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people. People were supported to have a balanced diet. People had access to a range of healthcare professionals in order to maintain good health.

Regular residents and relatives meetings were held where people were able to talk to the manager about the home and the things that were important to them. People and their relatives knew about the home’s complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

People received support that was personalised, their wishes were respected and their needs were met. People were provided with information about the service when they joined. People were supported to be independent where possible. People’s support and care needs were identified, documented and reviewed on a regular basis.

Systems were in place to monitor and evaluate the quality and safety of the service. However they required some improvement as they had not identified the need for a business continuity plan to deal with foreseeable emergencies.

The provider took into account the views of people using the service, their relatives, and staff.Staff said there was a good atmosphere and open culture in the service and that both the registered manager and the deputy manager were supportive.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, 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?

Staff were aware of the importance of consent and people were asked for their consent before care was provided. People's needs were assessed and risk assessments were carried out before care was provided. These were regularly reviewed so that staff were aware of the best way to provide support.

The manager and deputy manager were available on a daily basis to oversee the staff, and monitor that people were being safely supported, for example with personal care and when travelling out in the community. Health care professionals and social services were involved in people's care planning and in responding to people's concerns when needed. People's health needs were included in their care planning to ensure they were healthy. There were always a minimum of two staff available to support people throughout the day and one person at night to respond to night support needs.

There were arrangements in place to deal with emergencies and to make sure people were safe. Fire safety equipment and procedures were in place to ensure people would be kept safe in the event of a fire. The staff and manager were trained in protecting people from neglect or abuse and people told us they felt safe in their home.

At our inspection of December 2013 we found that the staff did not have adequate medication policies and guidance available to them regarding their responsibilities in managing people's medication. At our inspection of 30 June 2014 we found that the provider had updated the medication policy and guidance for staff and staff were fully informed of their responsibilities. There were safe procedures in place to look after and administer medication and staff who were responsible for people's medication were trained for this task.

There were enough staff who were trained and experienced to provide support during the day and at night. Two people we spoke with told us they felt safe and secure at the home.

Is the service caring?

We spoke with three people who used the service and observed staff working with people. People told us that the staff and manager were very caring and supportive. We saw that staff always took the time to stop and speak with people and spoke with them in a manner they best understood, speaking slowly and using pictures to help people to understand. One person said, 'the staff are always helpful and respectful and they make living here easy for me, and they are good at helping me to do things for myself and to make choices about doing things.'

Is the service effective?

We saw from four people's records we looked at that people's needs were assessed and a care plan was drawn up to meet those needs. Two people told us they were happy with the plan provided. Regular reviews were made of the plan and people told us they were involved in the reviews of their care plans. There were suitable policies in place for example; consent to care, care planning and management of medication. One person told us, "the staff know how to support me well and I now travel by myself and I have got a job, which I love.'

People who used the service were consulted for their views on a regular basis, which involved them , their family or advocate and social services. Any changes they requested were included in a revised care plan.

Staff had been provided with adequate support, guidance and training to do their job. They were experienced in supporting people with learning disabilities and mental health support needs, and used effective systems to communicate with people.

Is the service responsive?

People we spoke with who used the service told us that the staff and the manager always listened to their concerns and do something to help sort out any problems they are experiencing. People were provided with a range of enjoyable activities and changes were made when necessary to try out new activities. People's support plans were reviewed and changed when necessary in response to changing needs, for example in helping people to become more independent in managing their medication and being involved in shopping and cooking. People told us they had lots of interesting activities and that the staff listened when they wanted to do something different.

Is the service well led?

The registered manager was involved in direct care and worked with all the staff almost every day. They felt this meant they could identify any issues quickly and address them if they arose. Staff we spoke with told us that they felt the home was very well managed and that they received direction and training to allow them to support people at the home.

People who used the service told us that they felt the manager was very good at managing the home and was always present to speak with them about any concerns.

There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed.

People's care records we looked at showed that external healthcare professionals along with people and the staff at Homeleigh were involved in planning and delivering people's care and welfare needs. We found risk assessments were thorough and ensured people were kept safe whilst maintaining their independence. People told us they were "happy with the care" they received and "felt supported by the staff."

We observed the medicine administration process and found that medicines were given in a timely manner. We saw that risk assessments in care records detailed any issues of people's non-compliance with medicines.

We found evidence that effective recruitment procedures were followed and people were cared for by staff who were fit and appropriately qualified to deliver safe and effective care. Staff told us they were "happy with the training they received."

Records for people and staff contained appropriate information and were detailed, accurate and stored securely.

Care plans considered people's preferences, likes and dislikes and were reviewed at regular intervals to reflect any changes that took place. People's comments were recorded in their care records. Care records contained risk assessments that ensured people were kept safe whilst balancing their right to make choices and maintain their independence. For example, we saw risk assessments relating to people's mental health needs, self harm and vulnerability to exploitation.

The home was clean, warm and well maintained. Health and safety checks were taking place at regular intervals and maintenance issues were addressed promptly.

There were sufficient staffing levels to meet people's needs effectively.

There was an effective complaints management system in place and one person told us they were encouraged to talk about their concerns at the house meetings that were held.