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Inspection carried out on 10 August 2017

During a routine inspection

Homewood Care Home provides accommodation and personal care for up to 8 people living with a learning disability or autistic spectrum disorder. People may also have physical disabilities. The home is specially converted to meet the needs of people living there. We inspected the home on 10 August 2017. The inspection was unannounced. There were seven people living in the home at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with 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 was a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences.

Staff understood how to identify, report and manage any concerns related to people’s safety and welfare. There were systems and processes in place to protect people from harm, while promoting their independence.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. Agency staff were being used to maintain sufficient numbers of staff to meet people’s current needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and competency assessments.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to eat and drink enough to meet their needs and to make informed choices about what they ate.

People and their relatives or representatives were involved in planning the care and support provided by the service. Staff listened to people and understood and respected their needs and wishes.

The service was responsive to people’s needs and there were systems in place to help ensure any concerns or complaints were responded to appropriately. Healthcare professionals were involved in people’s care when necessary.

The provider and the registered manager were promoting an open and inclusive culture and continued to look for ways to improve the service. There was a range of systems in place to assess and monitor the quality and safety of the service and to help ensure people were receiving appropriate support.

Inspection carried out on 26 July 2016

During a routine inspection

This inspection was unannounced and took place on the 26 and 27 July 2016.

Homewood Care Home (to be referred to as Homewood throughout this report) is a care home which provides residential care for up to eight adults with learning disabilities. People receiving the service also live with complex emotional and behavioural needs including Autism. Some people living at the service also had additional health conditions such as epilepsy and deafness. The care home comprises of one floor with its own garden and is situated on the outskirts of Andover town centre. At the time of the inspection eight people were using the service.

Care was provided by support workers who will be referred to as staff throughout the duration of this report.

Homewood has 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.

The provider had not always fully completed robust recruitment processes to ensure people were protected from the employment of unsuitable staff however the registered manager had taken positive steps to ensure that files contained all the required information.

New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely. There were sufficient staff employed to ensure people’s individual needs were met.

People were not always supported by staff who had the most up to date training available to enable them to proactively meet people’s individual needs. Staff were able to demonstrate that they were able to meet people’s basic individual needs including communication. However the provider had not ensured that staff had received appropriate formalised training to ensure they could develop people’s preferred methods of communication such as British Sign Language where required.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as large scale staff sickness or accommodation loss due to fire or floods.

Relatives of people using the service told us they felt their family members were kept safe. Staff understood and followed the provider’s 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 manage appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

The registered manager had recently started at the service and provided strong positive leadership however they had not always fulfilled the legal requirements associated with their role. The registered manager had not always 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

People were protected from the unsafe administration of medicines. Staff responsible for administering medicines had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Staff skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.

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. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. The home promoted the use of advocates where people were unable to ma

Inspection carried out on 24 April 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

We inspected against the regulated activity of accommodation for persons who require nursing or personal care. The provider is also registered to provide the regulated activity of treatment of disease, disorder or injury, however this was not being provided by the service. We met five of the eight people using the service and looked at care and support records for three people. We also spoke with the manager and three staff. This is a summary of what we found -

Is the service safe?

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. Care and support records contained clear and detailed guidance for staff. For example, there was information about how to respond to people�s behaviours that may be challenging, using redirection techniques and communicating clearly. Other records showed how people should be supported safely when accessing the community. Staff we spoke with demonstrated their understanding of the needs of people using the service, their support plans and agreed approaches to working with them. There were enough qualified, skilled and experienced staff to meet people�s needs.

There were arrangements in place to deal with foreseeable emergencies. In addition to people�s support and health action plans, each person had a personal emergency evacuation plan.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We observed that staff communicated effectively with people using the service, including the use of sign language. One person�s support plans contained detailed information for staff about how to respond to them having epileptic seizures. The guidance gave early warning signs to look for and what to do in the event of protracted seizures. During the inspection we observed staff responding swiftly to provide appropriate care and support for the person during and after a seizure.

Effective systems were in place to help ensure that people were provided with a choice of suitable and nutritious food and drink. Staff provided people with different options, including the use of pictorial menus and shopping lists, so that they were able to make an informed choice. We also saw that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Is the service caring?

We observed that staff interacted well with people using the service, promoting a friendly and inclusive atmosphere in the home. When a person became upset and anxious, staff took time to comfort and reassure them. Throughout the inspection we saw that staff treated people with dignity and respect.

Is the service responsive?

The rota was organised in advance and flexibly to take account of people�s planned activities and the level of staff support required. People�s support plans and risk assessments had been reviewed and updated to reflect their current needs and goals. Each person had a key worker, a named member of staff who participated in reviewing the person�s care and support with them. As a result of reviews, some people had expressed a wish to move to alternative accommodation and were being supported to explore this option. We saw that people�s health needs were monitored and referred to external health professionals appropriately.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. We saw that regular audits of the quality and safety of the service took place and were recorded. There was a monthly improvement log completed by the managers, which was a record of actions taken in relation to audits, incidents, and feedback from people using the service or others acting on their behalf.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. There were records of quality survey questionnaires, resident�s meetings, and care reviews involving the individuals and their key workers.

There were clear lines of accountability within the service. Procedures were in place for reporting accidents and incidents, including a senior staff and management on-call system. We saw that learning from incidents took place and appropriate changes were implemented.

Inspection carried out on 15 May 2013

During a routine inspection

Our inspection of 21 November 2012 found that the provider had not ensured that people using the service were protected against the risks of receiving care that was inappropriate or unsafe by planning care that meets people's individual needs and ensures people's welfare and safety.

During this inspection we spoke with three people who used the service, two members of staff and the registered manager. We saw that people�s support plans and risk assessments had been reviewed and updated to reflect people�s current needs. In addition a full review of care and support plans had been carried out by the service, to ensure that people�s personal records including medical records were accurate and fit for purpose.

People expressed their views and were involved in making decisions about their care and support. As a result of person centred planning reviews, some people had expressed a wish to move to alternative accommodation. Two people had moved on and another two people were planning to do so.

A person we spoke with told us that they enjoyed living at Homewood and that they were pleased to be moving into a larger room. We observed another person who used the service being supported by staff in ways that were agreed in the person�s support plan. Staff we spoke with demonstrated a good knowledge of how different people communicated and of ways to engage with them and meet their needs.

Inspection carried out on 21 November 2012

During a routine inspection

People who used the service told us that staff checked with them before providing any support or care to make sure they were happy with what was planned. People told us they were able to say they didn�t want care or support at certain times and staff respected this. One person told us, �Staff always check that I�m ok with what they�re doing�.

People told us they received the care and support they needed and said they were well treated by staff. We observed staff communicating with people in their preferred method, for example, sign language and verbally. However, we found that the support plans were not kept up to date and did not provide accurate information to staff about the support that people needed. We have told the provider that action is needed to address this concern.

People who used the service said they felt safe in the home and were confident that staff would respond appropriately to any concerns or complaints they raised.

Inspection carried out on 15 November 2011

During a routine inspection

People said they liked living at Homewood and said staff provided good support. People told us they were involved in reviews of their care plans and met with their key worker regularly to discuss the support they needed. People said they felt safe living at Homewood. People said they would talk to staff if they had any concerns and were confident that staff would help them to resolve any problems.

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