This inspection took place on 17 and 18 May 2016 and was unannounced. At our last comprehensive inspection of this service on 22, 23 and 25 September 2015 we found breaches of legal requirements because risks to people had not always been identified or assessed, and action had not always been taken to manage identified risks safely. People had not been protected from the risk of malnutrition and systems in place to monitor risks were ineffective. We took urgent enforcement action in response to these concerns and imposed a condition on the provider’s registration, requiring them to send us information on a weekly basis to demonstrate that the service was monitoring and reducing the level of risk to people. We also rated the service Inadequate for the key question ‘Is the service safe?’ The provider has since met the conditions of their registration and submitted the information to us demonstrating how risks to people were being safely managed.
We also found further breaches of regulations because staffing levels did not meet the provider’s assessed level of need and an allegation of abuse had not been shared with the local authority safeguarding team.
At this inspection we found that the provider had taken action to address the breaches we had previously identified. However we found a further breach of regulations because whilst staff sought consent when offering support to people and understood the requirements of the MCA, people had not always been lawfully deprived of their liberty in line with legal requirements. You can see the action we have told the provider to take in respect of this breach at the back of our report.
Homefield provides accommodation, nursing and personal care for up to 44 older adults in Bickley, Kent. At the time of our inspection the home was providing support to 38 people. The home did not have a registered manager in post although the current manager was in the process of applying for the role. 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.
We found that risks to people had been assessed and monitored and staff had taken action to manage risks safely. The provider had systems in place to monitor and mitigate risks to people but improvement was required to ensure audits of people’s care plans consistently identified errors. People were supported to maintain a balanced diet and risks associated with malnutrition were safely managed.
There were now sufficient staff to meet people’s needs, although improvement was required to ensure they were effectively deployed at all times within the service. Appropriate recruitment checks were in place to ensure applicants were suitable for the roles they were applying for, although improvement was required to ensure that any gaps in applicants’ employment histories had been considered by the service
Staff received training and supervision in support of their roles and told us this support gave them the skills to meet people’s needs. People were protected from the risk of abuse because staff knew the action to take if they suspected abuse had occurred.
People had access to a range of healthcare professionals in support of their health and well-being when required. Medicines were safely stored and people received their medicines as prescribed. Accurate records were maintained of the administration of people’s medicines but improvement was required to ensure people’s medicines care plans were reflective of their current needs.
Where people lacked capacity to make specific decisions about their care staff, relatives and healthcare professionals, where appropriate had been involved in making the decisions in people’s best interests.
People told us that staff were kind and considerate. Staff treated people with dignity and respected their privacy. People were involved in making day to day decisions about their care and staff respected their choices. They had individual care plans in place which had been developed by staff based on an assessment of their needs and feedback about their preferences.
The provider sought feedback from people and relatives which they used to drive improvements within the service. People told us they felt improvements had been made under the new manager and staff told us that the management team listened to them and provided them with support when required.
People and relatives knew how to raise concerns and told us they were confident that any issues they had would be addressed promptly and appropriately.