Homelea Residential Care Home

We found the following examples of good practice.

The home was clean and tidy throughout. There was a cleaning schedule and this helped ensure the home was cleaned regularly including high touch points such as door handles and handrails.

People were supported to maintain contact with their family and friends. Visitors were able to visit people through an appointment system. A separate entrance for visitors had been created and they were supported to meet safely with their loved ones.

The testing program for people and staff was followed in line with government guidance. All visitors to the home, both family and professionals, were required to provide a negative test before entering. There was adequate supplies of PPE and this was available throughout the home.

Due to their dementia people were not always able to socially distance. The provider told us that during the outbreak staff would guide people through the home to minimise the risk of contact with others.

Homelea is a residential care home that provides accommodation and personal care for up to 28 older people, some living with dementia. At the time of the inspection, 27 people were living at the home. Three of these people were staying at the service on a short-term basis, otherwise known as respite.

Homelea is situated across three floors, with various communal areas and a large spacious garden. There were stair lifts to enable people to get to rooms on all floors. There was also a small room that had been turned into a hairdressing salon.

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

People told us they felt safe living at Homelea. One person said, “Yes I feel safe, it is good here, it is great here.” Relatives were confident their loved ones were safe and looked after. One relative told us, “The staff are very good, my relative is kept safe here. They get their medication on time and the staff always wear gloves and aprons for personal care.” Staff were aware of risks to people’s wellbeing and supported them to reduce these risks. People received their medicines from staff that were trained and competent. Staffing levels were regularly reviewed to ensure that people’s needs, and preferences could be met at all times.

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.

People and their relatives believed that staff received regular training and support to do their jobs effectively. One person said, “Definitely the staff have the skills to care for us here.” People’s nutritional needs were met, and they were complimentary about meals. Comments included, “The food is always great, the cook is very good” and, “Food is excellent, you get a choice.” People had access to a variety of health and social care professionals to ensure they felt happy and healthy. The building had been adapted to support those people living with dementia or physical support needs.

People and their relatives spoke highly of staff and described them as “Lovely”, “Sweet” and, “Interested in me.” A relative said, “Staff are very caring, they treat my relative very well. I am definitely happy with their care and they are well looked after.” Staff listened to and respected people’s preferences and choices, to ensure they were treated with dignity. They had a good understanding of maintaining people’s privacy and their independence was continuously promoted.

Since the previous inspection, significant improvements had been made to ensure people enjoyed activities that were centred around their preferences and hobbies. External entertainers visited daily and people told us they enjoyed these sessions and looked forward to them. Staff knew what activities people enjoyed doing and encouraged them to do these.

Staff knew about people’s communication needs and used a variety of tools to support with this. People and their relatives knew who they could talk to if they had any concerns and were supported to make complaints if required. Although no-one was receiving end of life support at the time of inspection, staff told us how they had supported people previously and personalised end of life plans were implemented that detailed people’s preferences.

Since the previous inspection, significant improvements had been made to the quality assurance process. Regular audits of people’s documentation, the environment, incidents and complaints meant that the management team had clear oversight of the service. An external professional visited monthly to do further audits. People, their relatives, staff and professionals spoke highly about the registered manager and deputy manager and their passion about providing the best care possible. Both managers had ideas of continuously growing and improving people’s experiences.

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 Requires Improvement (Published 17 July 2018) and there were two breaches of regulation. We issued two warning notices and met with the provider to discuss the improvements that were needed. The provider completed an action plan to show what they would do and by when to improve.

At this inspection we found improvements had been made, the warning notices had been met and the provider was no longer in breach of regulations.

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.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made improvements, we also wanted to check that the service now met legal requirements. We found some improvements had been made, however not all breaches of regulation had been met.

Homelea Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Homelea Residential Care Home provides accommodation and personal care for up to 27 people in one adapted building. At the time of the inspection there were 20 people living there. People living at the home were older people, some of whom were living with dementia. They had a range of needs associated with old age and their health.

There was a registered manager at the service who was also the provider. 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 inspection found improvements had been made across the service. However, these improvements were not, as yet all fully embedded in practice and need further time to be fully established in to everyday care delivery. The breaches of Regulations 9 and 17 had not been met.

Improvements had been made to the activities and there was now an activity session each day. However, there were periods of time where people did not have anything to do. Activities were not person-centred or meaningful.

People’s records did not fully reflect the care they required and received. Although staff could tell us about the care and support people needed and received and how people made choices, this had not always been recorded.

There was a quality assurance system in place. However, this had not identified all the shortfalls we found in relation to people’s records and what they done throughout the day. There had been no audit of the daily records to determine shortfalls within the recording.

There had been a lack of stability within the management team. Although staff told us recent changes meant they now felt supported, this lack of stability contributed to improvements not taking place in a timely way.

Other aspects of the quality assurance system had improved and these improvements were developing and on-going. We found improvements had been made and systems were in place to ensure accidents and incidents were managed safely. These were audited and analysed to identify any themes and trends across the home. The provider had also employed an external consultant to complete further audits. Where areas for improvement had been identified, action was being taken to address these.

At this inspection staff understood the procedures to safeguard people from the risk of abuse. Any concerns were reported and acted on appropriately. Staff understood their own responsibilities in reporting safeguarding concerns.

Staff had an understanding of the Mental Capacity Act 2005. Assessments had been made to determine peoples’ capacity and appropriate referrals were made to the local authority if people needed to be deprived of their liberty to ensure their safety and well-being.

Staff had a good understanding of the risks associated with the people they looked after. Risk assessments were in place to help and guide staff. Systems were in place to ensure medicines were ordered, stored administered and disposed of safely.

Staff received the training and support they needed to enable them to meet people’s needs. There were enough staff, who had been safely recruited, to meet people's needs.

People were supported to eat and drink a variety of food that met their individual needs and preferences. Nutritional assessments were in place to identify where people may be at risk of not eating or drinking enough.

People’s health and well-being needs were met. People were supported to have access to healthcare services when they needed them.

Staff had a good understanding of the care and support people needed. They treated people with kindness, respect and understanding. People’s privacy and dignity were respected and they were supported to make decisions and choices throughout the day.

There was a complaints policy and people told us they would raise any concerns with the owner.

The provider and deputy manager were striving to improve and develop the service and to create an open culture at the home.

You can see what action we told the provider to take at the back of the full version of the report.

Homelea Residential Care Home was taken over by a new provider in August 2016. We carried out an inspection in January 2017. Were we identified three breech of regulation and we told the provider improvements were needed. The service was rated as requires improvement. This inspection which took place on 12 and 13 September and was unannounced. The inspection was carried out by two inspectors.

At the time of the inspection the registered manager had been absent for a period of sickness and this was due to continue. Since the inspection we have been notified that the registered manager has now left the organisation. 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.

A deputy manager had been employed and had started the day the registered manager had gone off sick, so had received a minimal handover. Since the inspection we have been informed by the registered provider that the deputy manager has now left the organisation.

We found there was a lack of consistent and strong leadership or provider oversight. Quality assurance systems had not identified issues found during the inspection. Governance systems were not robust.

Accidents/ incidents and falls were not being responded to appropriately or reported to the local authority in accordance with safeguarding protocols. The registered provider and deputy manager did not have an understanding of the expectations in relation to safeguarding people. This included reporting accidents, incidents and falls to other external professionals. People’s safety had not been monitored and responded to appropriately.

People did not receive person centred care. Documentation had not been updated or maintained to ensure it was accurate, up to date and contemporaneous. Documentation did not support care that was individualised or person centred.

There had been a high number of unwitnessed falls and incidents. Staffing levels had not been reviewed in response to this. The provider had not ensured that staff had the appropriate, skills, knowledge or experience to meet people’s needs. Individual and environmental risk assessments were not in place when risks to people’s safety had been identified. Changes to peoples care needs had not been updated in care plans.

Information regarding Deprivation of Liberty Safeguard (DoLS), capacity and who was legally entitled to be involved in decisions had not been completed in care files. There was no information to show how decisions had been made regarding peoples care needs or who was legally entitled to be involved in decisions. Decisions regarding people’s dignity and choices were not always supported.

Activities were provided, however these were limited to set times with minimal access to activities or items to keep people occupied at other times.

Although work had taken place to ensure medicine procedures were in place, further improvement was needed to ensure medicines were consistently safe.

There was on-going improvement to the environment, maintenance and equipment checks were being completed although not all work was consistently documented. Staff interacted nicely with people and responded when people became upset or anxious. Staff were trying to support people with the information currently provided. People were offered a choice of meals, snacks and drinks throughout the day. Records were securely stored, and a complaints policy was in place.

We have been in contact with the local authority and quality monitoring team after the inspection regarding the concerns that we identified.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. And Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report

This inspection which took place on 16 and 17 January 2017 and was unannounced.

Homelea Residential Care Home was taken over by a new provider in August 2016. The previous registered manager had stayed in post at the home and had registered as manager under the new provider. 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.

At the time of the inspection the registered manager was absent for a planned period of time. During this period acting managers had been employed but currently the day to day running of the home was being overseen by the provider who told us they would remain in day to day charge until the registered manager returned.

Since taking over the service the new provider had carried out audits and identified a number of areas which needed to be improved. Although some new systems and documentation had been started this had not become fully embedded into practice. New documentation to record people’s daily care and support had not been fully completed by staff; this meant it was difficult to get a clear picture of how people were receiving care each day. Daily records were task orientated and did not consistently include details of people’s mood and behaviours or how they had spent their day. Some just stated ‘Fine’ or ‘Well.’ Other information was completed using tick charts to show care tasks carried out. Information was not person centred and it was difficult to follow the rationale behind some decisions that had been made.

Medication systems needed to be improved. We found topical creams which had prescription labels removed and creams which had been prescribed to a named person were found in other people’s ensuite bathroom and bedrooms.

Infection control best practice was not being adhered to by care staff. Staff did not wash or disinfect their hands in accordance with infection control guidelines to prevent the spread of infection.

We saw examples that demonstrated that staff had not considered people’s privacy and dignity. Staff spoke across communal areas regarding peoples care needs. Staff were not seen to respond in a timely manner when people requested assistance.

There was a four week menu displayed. There was one main meal choice but if people did not like this, alternatives would be provided. Mealtimes were chaotic and people did not receive appropriate support to ensure they ate and drank their meals. Staff did not speak to people to inform them what they were eating and when alternatives were requested staff did not ensure that this was responded to effectively.

Systems to record accidents and incidents were not being followed to give accurate details of incidents, injuries and actions taken. Body maps were not consistently completed. No information was in place regarding wound sizes and some documentation was not dated or signed.

Activities were taking place; however at times when visiting professional were not at the home, staff were responsible for providing this. A new staff member was due to have further training to assist in this role. We found that people in their rooms were at risk of becoming isolated and apart from the television and music access to meaningful activities was limited.

Staff had an understanding about how to recognise and report safeguarding concerns. Staff were clear that any concerns would be reported to the senior or manager. Referrals were made appropriately to outside agencies when required. For example GP visits, community nurses, chiropodist and speech and language therapists (SALT). And notifications had been completed to inform CQC and other outside organisations when events occurred.

Systems and plans were in place for the maintenance of the home, equipment and services.

There was a programme in place for on-going refurbishment of people’s rooms and communal areas. New furniture had been purchased for the lounge and new carpets and red oration was in progress in the hallways.

Recruitment systems had been reviewed to ensure future recruitment systems were robust. Staff received supervision and appraisals. Staff meetings had taken place to improve communication. Staff told us they enjoyed working at Homelea. Training had been reviewed and a new training programme was in place. Staff had received training in relation to the Mental Capacity Act (MCA) and had an understanding of Deprivation of Liberty Safeguards (DoLS). However decisions around people’s capacity needed to be improved to ensure that the rationale behind decision was clear involving people or their representatives as appropriate.

Relatives told us they felt happy with the care being provided and could see that improvements were in progress.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report