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Inspection carried out on 20 March 2018

During a routine inspection

Care service description

Homelands is a residential care home for 8 people with learning disabilities. The service is a detached house, in a rural location.

Homelands 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 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 using the service can live as ordinary a life as any citizen.

There was a registered manager at the time of our inspection. 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. The service was run day to day by a service manager, who will be refered to as ‘the manager’ throughout the report.

Rating at last inspection

At the last inspection, the service was rated Good.

Rating at this inspection

At this inspection we found the service remained Good.

Why the service is rated …

Some people at the service managed their own medicines, and others managed their own creams. People received their medicines safely and at the right time. People were supported by sufficient levels of staff, that knew people well and had been recruited safely. Risks to people had been assessed and mitigated. Accidents and incidents were reviewed with improvement plans implemented and learning shared with staff. People were involved in the running of the service, including ensuring the service was clean and protected by the prevention and control of infection.

Staff had the necessary training to safeguard people from potential abuse. People’s needs and choices had been assessed and staff understood and worked to the principles of the Mental Capacity Act (MCA). People were encouraged to live healthy lives, and supported to eat and drink sufficient amounts. Staff worked with health care agencies to ensure people had access to other health care professionals including ensuing everyone was registered with a GP and dentist. The service met people’s needs, and people’s rooms were personalised.

People were treated with dignity, kindness and respect, and encouraged to be as independent as possible. People were partners in their care planning, people had signed their care plans and had regular reviews with staff, relatives and care managers. Staff took time to interact with people, using their preferred communication methods and having meaningful interactions.

People received personalised care, specific to their needs. People’s care plans were detailed, individualised and reviewed regularly with them. There had been no complaints since our last inspection, however people and relatives were regularly given the opportunity to feedback any complaints or concerns. The service was not supporting anyone with end of life care at the time of our inspection.

People, relatives and staff told us the service was well led. There was a registered manager in post, however the service was run by the manager day to day. Staff and managers had a shared vision of the service. People enjoyed living at the service, and staff told us they enjoyed working there. There were regular audits completed by staff and the manager. The manager had created a development plan which contained actions for this year, as well as successful implementations from the previous year. Staff told us they were involved in driving improvements at the service, and understood their roles and responsibilities. Feedback was sought from people and relatives

Inspection carried out on 18 January 2016

During a routine inspection

This was an unannounced inspection carried out on 18 January 2016. The previous inspection on 5 November 2014 found breaches in medicines management and these had been addressed.

Homelands provide accommodation and personal care for up to eight people with a learning disability who may have an autism spectrum disorder. At the time of the inspection there were no vacancies. The service is provided in a detached house. It is set back from the road, up a small incline and next to another service owned by the same provider. Car parking is available and it is in a rural location approximately 20 minutes’ walk from Aldington village centre. Each person has a single bedroom with a wash hand basin and one person has an ensuite shower. There are two bathrooms, one of which also has a shower unit and separate toilet, a kitchen, dining room, lounge, pool room (with pool table) and there is also a seating area on the landing. People have use of a patio area with tables and chairs and also a grass area to the side of the premises.

The service is run by a registered manager, who was not present in the service on the day of the inspection. 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. The management arrangements in place at the time of the inspection were satisfactory.

People received their medicines safely and when they should. Risks were assessed and staff took steps to keep people safe whilst encouraging their independence.

People were involved in the planning of their care and support. Care plans contained information about people’s wishes and preferences. They detailed people’s skills in relation to tasks and what support they required from staff, in order that their independence was maintained. People had regular reviews of their care and support where they were able to discuss or express any concerns or aspirations.

People were supported to make their own decisions and choices and these were respected by staff. Staff had received training in the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The acting manager understood this process.

People were protected by safe recruitment procedures. New staff underwent an induction programme, which included shadowing experienced staff, until staff were competent to work on their own. Staff received training relevant to their role. Staff had opportunities for one to one meetings, team meetings and appraisals, to enable them to carry out their duties effectively. All staff had gained or were working towards qualifications in health and social care. People had their needs met by sufficient numbers of staff. Staff rotas were based on people’s needs, health appointments and activities.

People were relaxed in staff’s company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and patient in their approach, but also used good humour. Some staff had worked at the service for some considerable time and had built relationships with people and were familiar with their life stories and preferences.

People had a varied diet and were involved in planning, shopping, preparation and cooking the meals. Staff encouraged people to eat a healthy diet. People had a varied programme of interactive and leisure activities that they had chosen; they regularly accessed the community.

People were supported to maintain good health and attend appointme

Inspection carried out on 5 November 2014

During a routine inspection

The provider of this service is Canterbury Oast Trust and is referred to throughout this report as the trust.

This was an unannounced inspection carried out on 5 November 2014. The previous inspection took place on 13 August 2013 and there were no breaches of the legal requirements.

Homelands provide accommodation and personal care for up to eight people with a learning disability who have an autism spectrum disorder. At the time of the inspection there were eight people living at Homelands.

The service is run by a registered manager, who was not present in the service on the day of the inspection. 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. The management arrangements in place at the time of the inspection were satisfactory.

People told us they received their medicines when they should. However we found shortfalls in some areas of medicine management. Where people were prescribed medicine “as required”, there was a lack of proper guidance to enable staff to administer these medicines safely and consistently. Staff did not always record the detail of the amount of prescribed medicines that had been administered. You can see what action we told the provider to take at the back of the full version of the report.

The service was well maintained. There were systems and checks in place to help ensure that the equipment and premises remained in good condition and working order.

People felt safe living at Homelands. The service had safeguarding procedures in place, which staff had received training in. Staff demonstrated a good understanding of what constituted abuse and how to report any concerns.

People were protected by robust recruitment procedures. Staff files contained the required information. New staff underwent a thorough induction programme, which including relevant training courses and shadowing experienced staff, until they were competent to work on their own.

People were supported by sufficient numbers of staff on duty, in order to meet their needs and facilitate their chosen activities. Staff received effective supervision, training and appraisals as well as having staff meetings, although supervision was not in line with timescales within the provider’s supervision policy.

Risks associated with people’s health and welfare had been assessed and guidance was in place about how these risks could be minimised. Risk assessments did not restrict people, but were used to promote their independence. There were systems in place to review any accidents and incidents and make relevant improvements, to reduce the risk of further occurrence.

People had opportunities for a wide range of work and leisure activities that they had chosen. Staff were familiar with people’s likes and dislikes and used different communication methods with people, to enable people to make their own choices.

People said they “liked” the food. They had a variety of meals and adequate food and drink. People were involved in the planning, preparation and cooking of meals.

People were supported to make their own decisions and choices. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), so were aware of the process, where people lacked the capacity to make their own decisions, to ensure these decisions would be taken in their best interests, although to date people had been able to make their own decisions.

People were involved in planning their care and support and some had chosen to involve their relatives. Care plans included people’s preferred routines, their wishes and preferences and skills and abilities. They had regular review meetings to discuss their support and aspirations. People’s health care needs were monitored; they had access to a variety of healthcare professionals and were supported to attend healthcare appointments to maintain good health.

People were relaxed in the company of staff, who listened and acted on what they said. People’s privacy was respected. People told us they liked the staff. Staff were kind and caring in their approach and knew people and their support needs well.

The trust had various systems in place to obtain people’s views including meetings, questionnaires and informal discussions. There were also systems in place to monitor and audit the quality of service provided. Trustees and senior managers carried out visits to the service and staff undertook various regular checks. People felt comfortable in complaining, but did not have any concerns.

Staff were aware of the vision, mission and values of the trust. They worked together as a team to support people to be as independent as possible, demonstrate respect and uphold people’s dignity.

Inspection carried out on 13 August 2013

During a routine inspection

We spoke with four people who used the service, the registered manager and two staff.

People told us they were able to make their own decisions and choices in their day to day lives. People gave their consent to care and support by talking through their choices each day with staff.

People told us they had been involved in developing their care plans to ensure the care and support was delivered in the way they chose. People were entirely happy with the care and support they received. One person said, �I like living here� and another said, �I love it here�. People said they had an annual review meeting where they discussed their aspirations and any concerns.

People told us they felt safe living at Homelands and when they were being supported by staff. People said they felt comfortable speaking to the staff if they had any concerns and were confident they would �sort things out�.

People thought highly of the staff and thought there were enough staff on duty to meet their needs. They said staff were on hand and helped them when they needed help.

People had been able to express their views and give feedback about the service during residents� meetings, at their review meeting and through completing questionnaires.

Inspection carried out on 18 March 2013

During a routine inspection

We spoke to five people who used the service, two relatives and two staff.

People told us they were able to make decisions and choices in their day to day lives. They said their privacy was respected.

People said they were satisfied with their care and support and liked living at Homelands. One person said, �I like it here, I like everything about it�. They told us they were not aware of their care plans, but felt they had discussed their care and support needs with staff. We found that care plans were in need of updating and not all people�s support needs had been assessed.

People told us that they helped with the cleaning and that the house was always clean and tidy. Some people talked about how they had been supported to manage their own medicines safely and whilst other people�s were managed by staff.

People thought highly of the staff and said staff supported them when they needed support. Comments included, �The staff are alright� and �They�re (the staff) are OK�. Relative comments included, �The staff are absolutely brilliant. They go out of their way and they do it with heart� and �The staff are so dedicated, you can�t fault them�.

People had been able to express their views and give feedback about the service during residents� meetings and their review meeting. A few people had completed questionnaires.

Inspection carried out on 23 May 2011

During a routine inspection

People and their carers said they were involved in decisions and that staff supported them with their needs, provided the service they wished to receive and treated them with respect and dignity.

People and relatives spoken with knew about their care plan and had been central to the yearly reviews of care carried out by the home. Relatives said that they were kept well informed about their relative when there had been concerns.

People spoken with said that they had discussed their support and preferred routines with staff. They told us they received care and support from a small team of staff and were happy with the care received and had no concerns relating to workers.

People thought that they had an active say on ways to improve their care and the Commission had received no complaints at the time of the review.

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