8 May 2017
During a routine inspection
Homefield House Nursing Home (to be referred to as Homefield House throughout this report) is a nursing home which provides nursing and residential care for up to 24 people who have a range of needs, including those living with epilepsy and diabetes and those receiving end of life care. The home provides specialist support to those living with dementia.
The nursing home comprises a large ground floor building set in secure grounds on the outskirts of Basingstoke town centre. The home comprises four distinct areas which are off the central corridor to the home known as ‘The Street’. The Street is a large, naturally lit area which runs the length of the home and has reading material, interactive items upon the wall, a fake bus stop to act as a focal and reminiscence point, sensory objects and chairs and tables for residents and visiting friends and family. The four distinct areas to the home each contain six bedrooms, a bathroom and toilet, as well as a shower room with toilet. There is also a small kitchenette area, a dining and living room. At the time of the inspection 19 people were using the service.
At our last inspection on 23, 25 and 26 February 2016 we made a recommendation that the provider ensured appropriate equipment was available to support people to manage infection control. We also made a further recommendation that the manager sought further guidance on the environmental factors in the home to ensure they could be adapted to meet the needs of those living with dementia.
At this inspection we saw action had been taken to ensure these recommendations had been completed. Additional work was also planned to ensure the home’s environment was developed further in order to continue to meet people’s needs.
Homefield House had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. However it had not always been clearly documented that where people lacked the capacity to make specific decisions for themselves that actions taken on their behalf were always in their best interests. Staff sought people's consent before delivering their care and support.
People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people. People's safety was promoted because risks that may cause them harm had been identified and guidance provided to staff to help manage these appropriately.
People were supported by sufficient numbers of staff to meet their needs. The provider was able to adapt their staffing levels appropriately when required in order to meet changes in people’s needs.
Recruitment procedures were fully completed to ensure people were protected from the employment of unsuitable staff.
People received their medicines safely, staff had received the appropriate training to enable them to complete their role safely and medicines were stored, administered, disposed of and documented appropriately.
Contingency plans were in place to ensure the safe delivery of people's care in the event of adverse situations such as a fire, flood or utilities loss. These were easily accessible to staff and emergency personnel such as the fire service, if required to ensure people received continuity of care in the event of an on-going adverse situation which meant the home was uninhabitable.
People were supported to eat and drink safely whilst maintaining their dignity and independence. We saw that people were able to choose their meals and were offered alternative meal choices where required. People's food and drink preferences were documented in their care plans and were understood by staff. People were supported to eat and drink enough to maintain a balanced diet.
People’s health needs were met as the staff and manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. The manager showed an understanding of what constituted a deprivation of a person's liberty and was able to discuss the processes required in order to ensure people were not deprived of their liberty without legal authority.
People told us that care was delivered by kind and caring staff who sought to meet their needs and ensure they were happy. We saw that people had friendly and relaxed relationships with staff who would stop and speak with them when they had the opportunity to do so.
Care plans and risk assessments contained detailed information to assist staff to provide care in a manner that respected each person's individual requirements and promoted their dignity. People were encouraged and supported by staff to make choices about their care including how they spent their day in the home.
People received care which was regularly reviewed to ensure contained the most up to date guidance for staff on how to effectively meet people’s needs. Care plans and risk assessments were reviewed monthly to ensure they remained accurate to enable staff to meet people’s needs.
People living with specific health conditions such as epilepsy for example were supported to manage these conditions safely. Guidance regarding the management and monitoring of people’s blood glucose levels was sought and we saw this guidance was followed in practice.
People knew how to complain and told us they would do so if required. Procedures were in place for the manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the manager.
The provider’s values and philosophy of care were communicated to people and staff. Staff understood these and relatives told us these standards were evidenced in the way that care was delivered.
The registered manager and staff promoted a culture which focused on providing care in the way that staff would wish to receive care themselves. The registered manager provided strong positive leadership and fulfilled the requirements which would be associated with their role as a registered manager.
The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe. Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided. People were assisted by staff who were encouraged to raise concerns with the manager.
The quality of the service provided was reviewed regularly by means of effective quality control audits. These were completed to identify areas where the quality of the service provided could be improved. We could see action had been taken to address where any shortfalls in the service provision had been identified