Homewood

Homewood is a residential care home for people living with a learning disability and autistic people It is registered to provide personal care for up to six people; at the time of inspection six people were living at the service.

People’s experience of using this service and what we found

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Each person had their own room, which were personalised to meet their needs and preferences. People were being supported to be actively involved in their day to day lives, cooking and doing their own household tasks with staff support. People valued these opportunities and they helped to maximise people’s independence.

The service had worked hard since the last inspection, with people, to plan for when they experienced periods of distress so their freedoms were restricted only if there was no alternative. Staff successfully did everything they could to avoid the use of restraint. The past year had seen no recorded incidents where people had needed emergency medication to help them when distressed. Improved staff knowledge and effective strategies had supported this positive improvement. Staff learned from those incidents and how they might be avoided or reduced.

Staff supported people to make decisions following best practice in decision-making.

Right care

People experienced an improved quality of care. People and their families told us staff were kind and supportive. We observed staff respecting people’s dignity and ensured people had the right to have their say on their care and support. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. People’s care, treatment and support plans mostly reflected their range of needs and this promoted their wellbeing. Staff and people worked together to assess risks people might face and were continuing to develop this area to encourage more positive risk taking.

Right culture

The formal governance system had been running for a year at the time of this inspection and was delivering assurances. There were areas which were identified at inspection the system had not picked up. Mainly some cleaning and maintenance shortfalls but the registered manager acted promptly to improve the areas the system looks at to avoid future issues.

People’s opportunity to lead inclusive and empowered lives had improved since the last inspection. This is because staff knowledge and understanding had improved due to the investment in training and the development of a coaching and reflective culture. Managers understood that further work was needed to support more people to develop skills and have the opportunity to all voice their aspirations and plan towards meeting them. Managers and staff clearly tried to deliver person centred support, people and their families were listened too and consideration of their views were reflected in the service delivery.

People received good quality health care, support and treatment because trained staff and specialists could meet their needs. Staff knew people well and the staff team was consistent in both numbers of staff and staff approach.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 01 November 2021) and there were breaches in the following regulations. Safeguarding service users from abuse and improper treatment, staffing and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

Why we inspected

This was a planned focused inspection based on the previous rating. We looked at the key questions of Safe, effective and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Homewood on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Homewood is a residential care home for people living with a learning disability and autistic people It is registered to provide personal care for up to six people; at the time of inspection six people were living at the service.

People’s experience of using this service and what we found

People were not always protected from the risk of abuse. The provider had not ensured managers and staff had suitable training, skills and knowledge to support people whose behaviours may challenge themselves or others in the least restrictive or most person-centred way. A training programme had begun but this was still in the early stages and was yet to be cascaded to all staff.

People's communication and sensory needs were not always assessed and this meant that people’s needs could not always be fully met.

People were not always supported by managers and staff who understood best practice in relation to learning disability and/or autism. Governance systems did not ensure people were always kept safe or that they received a high quality of care and support in line with their individual needs. Monitoring and assessments in relation to health and safety were not always undertaken or recorded.

Some people were not always supported to have maximum choice and control of their lives and guidance to staff did not always reflect how to support people in the least restrictive way possible and in their best interests.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence. The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The model of care and setting did not maximise people's choice, control and independence. The support was task focused and staff did things for people rather than encourage their independence. Managers had recently undertaken training in this area and had begun to develop staff to shift the focus to a more active support approach. This training had not yet been fully embedded into practice.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. People were supported by staff who knew them well, however the provider had failed to ensure staff had received suitable induction or training. This meant people may not always receive person-centred care or support which promoted their dignity, privacy and human rights. Care and activities did not focus on developing people's strengths and aspirations. Managers explained that recent training had prompted them to begin looking at people’s quality of life in order to identify and improve people’s experience of care.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. People were not supported by managers and staff who understood current best practice in relation to learning disability and/or autism. The provider had failed to ensure managers and staff received support to keep their knowledge and skills up to date. There were shortfalls in governance systems which did not ensure people remained safe, and lessons had not always been learned.

People gave mixed views of the service. Most people told us they were generally happy with the support they received and liked the managers and staff; they felt safe living at Homewood, but one person told us they like to “keep out of the way.” They felt there was too much shouting in the house for them. Everyone told us they liked going to the shops and local amenities.

There were enough consistent staff who knew people well.

People told us they liked the food and often had their favourite meals.

People had access to health care and were encouraged to lead healthy lives.

Relatives told us they were pleased with the communication with the managers and staff and felt confident their views were listened too.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 July 2019).

Why we inspected

This inspection was prompted in part due to concerns about people's safety we identified in another of the provider’s locations. We inspected in order to provide assurance people were safe and to check the service was applying the principles of Right support, right care, right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. Following the inspection, the provider had taken some actions to mitigate the risks. This is an ongoing process.

Ratings from previous comprehensive inspections for those key questions not inspected were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Homewood is a residential care home providing personal care for up to six people living with a learning disability in one adapted building. At the time of our inspection, the home was fully occupied.

People’s experience of using this service and what we found

People were safe living at the home and staff supported them to stay safe. Risks to people had been identified and assessed, with guidance for staff on mitigating risks. Staff followed this guidance. There were enough staff to support people and staffing levels were based on people’s care and support needs.

Medicines were managed safely. The home was clean and smelled fresh. Staff had been trained in infection control and food hygiene. Lessons were learned if things went wrong. Any incidents were shared with all homes of the provider, so that actions could be taken and improvements made.

People were supported to have a healthy diet and were involved in planning the menus. The lunchtime meal was a sociable occasion and people chose where they wanted to eat their meal. People had access to a range of health and social care professionals for support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were looked after by kind and caring staff who knew them well. Positive behaviour support was used to good effect, so that when people became upset or agitated, staff used distraction techniques. People were encouraged to be involved in decisions relating to their care; they were treated with dignity and respect.

People received personalised care that was responsive to their needs. Activities were individually organised according to what people wanted to do and in line with their interests and preferences. People were encouraged to go out and some people enjoyed going on holiday, supported by staff.

People were happy living at Homewood and a relative spoke highly of the care provided and how pleased they were. Visitors were made to feel welcome. People and relatives’ feedback was gained through annual surveys and all comments were positive.

Staff felt valued by the management team and staff meetings provided opportunities for staff to meet together. A system of audits monitored and measured all aspects of the home and were used to drive improvement. There were strong links with the community. The registered manager met with other managers of the provider and attended quarterly meetings with managers who supported people with a learning disability.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 3 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow-up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Homewood is registered to provide accommodation and care for up to six people with a learning disability, autism and other complex needs, including challenging behaviour. Some people had additional mental health needs. At the time of our inspection, the home was at full occupancy. Homewood is a large, detached, older-style property on the outskirts of Worthing town centre. It is close to public transport, a local park and the seafront. Communal areas at the service include two sitting rooms and a dining room. All rooms are of single occupancy and have en-suite facilities. Gardens surround the property.

A registered manager was in post. 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.

Relatives felt their family members were safe living at Homewood and staff had completed training on safeguarding adults at risk. People’s risks were identified, assessed and managed appropriately by staff. Risk assessments contained detailed information about how staff should support people and to mitigate risks. Staffing levels were sufficient to meet people’s needs and robust recruitment processes ensured new staff were safe to work at Homewood. Medicines were managed safely.

Staff received regular supervisions and attended staff meetings. New staff followed the Care Certificate, a nationally recognised qualification. Staff completed training in a range of areas and the training plan and certificates obtained by staff confirmed this. People gave their consent to specific decisions and the staff worked in line with the requirements of the Mental Capacity Act 2005 and associated legislation under Deprivation of Liberty Safeguards. People were supported to have sufficient to eat and drink and were encouraged in a healthy lifestyle. People had access to a range of healthcare professionals and services. People showed us their bedrooms, which were personalised, comfortable and homely.

People were looked after by kind and caring staff who knew them well. Relatives spoke highly of the staff who supported their family members. People and their relatives were encouraged to express their views and to be involved in making decisions about their care, treatment and support. People were treated with dignity and respect and their privacy was promoted.

Care plans provided comprehensive information about people, and their support needs, in a person-centred way. Staff had clear guidance on how to look after people in line with their preferences and choices. Care plans were written in an accessible format. People took part in a range of activities that met their individual needs and preferences, including social activities and holidays. The provider had a complaints policy in place.

People and their relatives were asked for their views about the service and the care delivered through questionnaires and surveys. Residents’ meetings were held on a monthly basis. Staff were also asked for their feedback about working at the service. Results for all surveys were positive. Good management and leadership were evident throughout the service and the culture was one of openness and transparency. A range of audit systems measured and monitored the care delivered and the service overall.

This inspection was carried out by one inspector. We gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People were treated with respect and dignity by the staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were told there were no applications made under DoLS that were currently in force.

The manager confirmed they understood when an application should be made to deprive someone of their liberty. Relevant staff had been trained to understand how it should be implemented to ensure people's rights had been maintained. This meant that people would be safeguarded as required.

Is the service effective?

Where possible, people's health and care needs were assessed with them, and they were involved in writing their plans of care.

When necessary best interest decisions had been made to ensure the health and wellbeing of individuals who lacked capacity to make decisions for themselves.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Senior staff arrange meetings for people to talk about their views and experiences and to sort out any problems. One person told us, 'We have meetings together. We can talk about things we want to. We can talk about living at the home. We can also talk privately with staff if we need to.'

Family members who completed satisfaction surveys reported they had no concerns about the care provided.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The activities provided have been in response to requests made by people who lived at the care home.

People's relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service well-led?

All staff received one to one supervision from the manager or from a member of staff in a more senior role. Staff we spoke with confirmed they felt well supported and well led by the manager.

People who lived in the home all told us "I like my room" and "I like my keyworker".

We looked at a selection of care records. We noted in two records that there was a lack of health monitoring to ensure that people's needs were being assessed and care planned appropriately.

We found although the service had some quality assurance systems in place, some were being developed. They did not protect people or others against the risk of unsafe care and treatment.

We viewed records relating to staff requirements and found that the provider was operating effective recruitment procedures.

We found the lack of consistent recording systems meant that there was a risk that information may not be kept up to date and people may not be protected against the risks of unsafe or inappropriate care and treatment.

An Operations Manager told us that the previous manager left the service last week. We saw that there were arrangements in place for the Operations Managers to cover the service whilst a new manager was recruited.

We found that there were robust systems to ensure that people were safeguarded from the risk of abuse and that the service responded appropriately to any allegation of abuse. Staff were trained in how to identify abuse and were aware of what action they needed to take.

We saw that staffing levels had been increased which meant that people at the home had the support they needed to meet their health and welfare needs.