Archived: Homecroft Residential Home

The inspection took place on 25 October 2018 and was unannounced. At the last inspection in November 2016 we rated the service Good. At this inspection we found the quality of the service had deteriorated. We found medicines were not consistently managed in a safe way and the quality and format of care plan documents and risk assessments needed improving. The service had had three managers in the last 12 months and needed stable management to ensure consistent policies, procedures and systems were established.

A registered manager was not 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. A new manager had been in post for two weeks. We found the new manager to be open and honest with us. They had recognised many of the issues we found during the inspection and were in the early stages of improving the service. We felt assured that they would continue to improve the service over the coming months.

People and relatives said they felt people received good care and were safe. Systems were in place to protect people from abuse. Most risks to people’s health and safety were appropriately assessed although this was not consistently the case. The new manager was in the process of reviewing the risks each person was exposed to, to further improve the service. Medicines were not consistently managed in a safe way as all medicines were not robustly accounted for.

There were enough staff deployed to ensure safe and appropriate care, although improvements were needed to the availability of ancillary staff such as cleaners, cooks and activities staff to optimise the function of these roles. Some staff training was out of date although a plan was in place to address this.

Overall, people’s nutritional needs were met by the service. People had access to a choice of food and people told us it was tasty. Where the service was reviewing people’s fluid input, this needed reviewing on a daily basis to ensure people were getting enough to drink.

Overall, the service was compliant with the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was sought before care and support was offered.

Staff were kind and caring and treated people well. Staff knew people well and engaged them in conversation. People’s views and choices were listened to.

People said they received appropriate care that met their needs. People’s healthcare needs were assessed and the service worked with a range of professionals to meet those needs. The quality and accessibility of care plans needed improving to fully evidence people had an up-to-date assessment of their needs. Some activities were provided but more interaction and stimulation was needed at times.

We made a recommendation relating to ensuring the service reviewed how accessible information was to people who used the service.

People said the management team listened to them. People’s complaints were responded to, but there was a lack of evidence that lessons were always learnt from complaints.

People and staff praised the new management team and said they were approachable and supportive. The new manager was aware of the areas that needed improving and had a plan in place to address. Audits and checks were undertaken, these needed further developing to ensure they were consistent and thorough.

We found one breach of regulation. You can see what action we asked the provider to take at the back of the full version of this report.

were 15 people living in the home.

A new registered manager had been appointed on 2 November 2016. 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate in any of the key questions. Therefore, this service is now out of Special Measures.

We found improvements had been made to the medicines management system. Medicines were safely managed and robust systems were in place to check medicines were given correctly.

People living at the home, relatives and staff told us they felt people were safe in the home. Staff understood how to recognise and report any allegations of abuse. Risks to people’s health and safety were assessed and clear plans of care put in place to assist staff to keep people safe.

The premises were well maintained and suitable for its intended purpose. Regular checks were undertaken on equipment and fittings to ensure they were in a safe condition.

There were enough staff deployed to ensure people were provided with safe and timely care. People received prompt assistance when they needed it. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

Staff were aware of the need to report incidents. Any incidents were logged, investigated and where appropriate actions put in place to prevent a re-occurrence.

Staff received regular training and support from the organisation. Staff had a good understanding of the people they were caring for. Use of agency staff had been reduced over recent months to help ensure consistency and continuity of care.

The service was acting with the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was gained before assisting with care and support.

The service ensured people had access to a range of health professionals to help ensure their healthcare needs were met.

People living at the home and relatives praised staff and said they were kind, caring and treated people with dignity and respect. Good, positive relationships had developed and staff knew people well.

The registered manager had put measures in place to ensure people felt listened to and had their views and opinions acted on. For example around food and activities.

Care plan documentation was much improved and demonstrated people’s needs had been fully assessed. People and relatives told us that care needs were met by the service.

The registered manager had improved the range of activities and social opportunities available for people, whilst acknowledging further work was needed in this area to ensure a more varied and consistent activity regime was in place.

Since the last inspection, a new registered manager had been employed and their presence in the home meant that people and relatives now had a permanent contact to address any concerns or complaints to. People and relatives said they were satisfied with the care provided and the manager had dealt effectively with any minor concerns they had raised.

The service was now better organised with staff having clear roles and responsibilities. Staff morale had improved and relatives and staff remarked that the home had significant improved in recent months. We found a pleasant and inclusive atmosphere within the home.

Systems were in place to regularly assess, monitor and improve the service including regular audits and checks both internally and externally. The findings of these were used to inform a service improvement plan to further improve the service.

We could not be assured that the service was well led, because the provider would have to demonstrate that the improvements and stable leadership and management were sustained over time.

This was an unannounced inspection which took place on 20 April 2016. On the date of the inspection there were 18 people living in the home.

A registered manager was not in place with the previous registered manager leaving in April 2015. A manager had been recruited in October 2015 however they left in April 2016 before registering with the commission.

During our previous inspection in October 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to Good Governance, Safe Care and Treatment and Person Centred Care. As part of this inspection we checked whether improvements had been made in these areas as well providing an updated rating for the service under the Care Act 2014. At this inspection, we identified the provider had not made substantial improvements and was still in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that a lack of management support still had a significant impact on the quality of the service. Like at the previous inspection, concerns remained about how risks were managed, the quality of care plans and the lack of robust audit procedures. There was a lack of established governance and audit systems at provider level to ensure the performance of the home was robustly monitored and improved.

Staff told us morale was affected by the lack of manager. We found that there was not a good working relationship between staff and senior management at the service.

Medicines were not managed in a safe way. A number of medicine errors had occurred and due to medicines being managed in a disorderly way, there was a risk that further errors would occur.

People said they felt safe from abuse in the home. Safeguarding procedures were in place and we saw these had been followed to help keep people safe. Staff understood the risks to people’s health and safety.

Safe recruitment procedures were in place. Overall, we identified there were sufficient staff to ensure safe care. However staff were very busy which meant care was very task focused.

People spoke positively about the environment. We saw it was pleasantly decorated and safety checks on the premises were undertaken.

The service was not acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) as staff and management were unaware of who had DoLS authorisations in place and the conditions attached. Consent was not consistently sought in line with the MCA.

People spoke positively about the food provided by the home. There was sufficient choice and action was taken to cater for any special requirements.

Staff had access to a range of training although some staff were overdue training updates in some subjects.

People’s healthcare needs were assessed and appropriate plans of care put in place. People had access to a range of health professionals.

Staff treated people with dignity and respect. People spoke positively about staff and this was confirmed in the interactions we observed.

Care records were not sufficiently robust to demonstrate that people received responsive care. Records needed updating to ensure they accurately reflected people’s needs. We saw a plan was in place to address this with more person centred care plans being put in place.

A programme of activities was in place. However some people told us there was not enough to do. Appropriate records were not kept of the activities people were involved in.

Overall complaints were appropriately managed, however we identified one complaint which had been missed by the provider and therefore not responded to.

Systems to assess, monitor and improve the service were not sufficiently robust. These systems kept changing which meant there was no consistent mechanism in place to drive improvement. Areas for improvement identified at the last inspection had not been acted on.

We found three breaches of regulation; you can see the action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.”

We spoke with four people who used the service. All told us they were happy with the home and staff were friendly towards them. One person told us 'Staff are very nice to me, if there is something you don't like, they sort it out for you. We have singers visit and lots of different activities.' Another person told us 'There is plenty to do, there is a television in the lounge, and I can choose what we watch.' Another person told us 'This place is marvellous, the food is good and I am very happy here.'

We found people were treated with dignity and respect and involved in the planning of their care. People were encouraged to participate in a range of activities by friendly and attentive staff.

We found people's needs were fully assessed and up-to-date care plans were in place where risks were identified.

We found the provider had systems in place to safeguard people from abuse and staff were aware of the correct procedure to follow in the event of an allegation.

We found staff were provided with the necessary support and training to undertake their role.

We found the provider had systems in place to monitor and evaluate the standard of its service through regular surveys and audits.

Overall, people's needs were assessed and care and support was planned and delivered in line with their care plan. However we noted that one person's preferences were not always taken into consideration. We raised this with a representative of the provider who agreed to review the person's care and support.

People said they were comfortable in their environment and could choose to spend time in communal areas or time in their room. One person said, 'It's very homely and always lovely and clean.'

Overall, there were enough qualified, skilled and experienced staff to meet people's needs. However, occasionally there had only been two seniors/care staff during the day which is not sufficient. People who used the service told us they didn't have to wait long if they wanted support.

Comments and complaints people made were responded to appropriately.