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Reports


Inspection carried out on 6 February 2017

During a routine inspection

This inspection was unannounced and took place on 6 February 2017. This service provides accommodation and personal support for up to six people with learning disabilities and autistic spectrum disorder.

Accommodation is laid out over a single ground floor bungalow and each person had their own bedroom. At the time of inspection this was an all-male household and there were no vacancies.

This service was last inspected on 25 November 2015 when we found the provider was not meeting all the regulations inspected at that time in regard to ensuring staff had the right information about peoples specific health needs, staff recruitment and ensuring the quality monitoring and assessment of service quality was more effective. We asked the provider to send us an action plan of what they intended to do to address these shortfalls which they did. This inspection found that the provider had implemented all the improvements they had told us about.

There was a long established registered manager in post who gave continuity to the way in which the service operated and was managed. A registered manager is a person who is 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.

People told us they were happy and settled living at the service; some had aspirations to move to greater independence, and staff helped people to set achievable goals for themselves for things they wanted to learn or do. Staff were proactive in helping people to maintain and develop independence but their focus was for this to happen at a pace to suit each person.

People were provided with a safe, clean environment that was maintained to a high standard, with all safety checks and tests routinely completed. There were enough skilled staff to support people and the low staff turnover provided continuity to people of staff who knew them well. Recruitment processes ensured only suitable staff were employed. A training programme was in place so that new staff were inducted appropriately into their role. Staff received training to give them the knowledge and skills they needed to meet people’s needs. Staff felt listened to and supported and were given opportunities to meet regularly with the registered manager on an individual basis and with other staff in staff meetings.

Staff understood how to keep people safe and protect them from harm, they understood how to respond to emergencies that required them to evacuate the building quickly and safely. It was recognised that for people, with behaviour that could be challenging, some restrictive practices were necessary to maintain their safety, for example people only going into the community when accompanied by staff. There was a clear culture of least restrictive practice embedded in the service and restraint was not used except in an emergency to keep someone safe. Risks were appropriately assessed to ensure the control measures implemented kept people safe and were kept under review. Medicines were managed appropriately.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider and registered manager understood when an application should be made and one person had a DoLS authorisation in place. The service was meeting the requirements of the Deprivation of Liberty Safeguards and staff understood and were working to the principles of the Mental Capacity Act (MCA) 2005.

People’s privacy and dignity was respected. Whilst there was an element of banter between people and staff, interactions were positive and staff were respectful in the way they spoke about and to the people they supported. Staff intervened discreetly if they observed situations that might escalate. Staff demonstrated kindness and

Inspection carried out on 26 November 2015

During a routine inspection

The inspection was unannounced and took place on 26 November 2015. This service provides accommodation and personal support for up to six people with learning disabilities and autistic spectrum disorder. Accommodation is laid out over a single ground floor bungalow and each person had their own bedroom. At the time of inspection this was an all-male household and there were no vacancies.

This service was last inspected on 18 December 2013 when we found the provider was meeting all the regulations.

There was a registered manager in post who had managed the service for a number of years. A registered manager is a person who is 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.

Improvements were needed to the recruitment procedures for new staff to ensure these protected people from the appointment of staff who were unsuitable. People’s records did not make clear strategies for managing specific health conditions people needed support with. Improvements were also needed to the frequency of fire drills for staff to ensure they knew how to keep people safe in the event of a fire, and the recording of medicines received to ensure processes were guided by good practice. The effectiveness of staff training and supervision were also areas for improvement to ensure all staff felt engaged in and valued these processes.

People were routinely asked to comment about the service and their views were analysed, the registered manager told us that issues raised by people within these surveys were discussed at house meetings but these discussions and how they informed either staff practice or service development were not recorded. Quality assurance audits were undertaken on a weekly, monthly and six monthly basis to highlight and address shortfalls in service quality, but were not sufficiently effective to highlight the issues we found at inspection.

People were supported to develop and maximise their potential for independence at a pace to suit themselves and that they were comfortable with. Staff were guided in the support they gave to people through the development of individualised plans of care and support; risks were appropriately assessed to ensure measures implemented kept people and others safe.

Staff retention was very good and nearly all staff had been with the service for more than eight years. There were enough staff with the right skills to support people properly. Staff received induction and completed a range of on line training to give them a basic knowledge and understanding of how to deliver appropriate care and support. Staff felt listened to. Staff were very experienced and knowledgeable about the people they supported and the routines of the service. Staff said they were provided with regular staff meetings and they valued these, they felt they worked well together as a team and felt confident of raising issues within the staff meeting.

People’s medicines were well managed by trained staff. Staff were able to demonstrate they could recognise, respond and report concerns about potential abuse. The premises were maintained to a reasonable standard with further planned upgrade works underway but taking time to achieve. All necessary checks tests and routine servicing of equipment and installations were carried out.

People ate a varied diet that took account of their personal food preferences; most participated in some way in the preparation and cooking of meals if they wanted to. People’s health and wellbeing was monitored by staff that supported them to access regular health appointments when needed.

People communicated well with staff and those around them; staff understood their moods and expressions that informed staff how they were on a day to day basis and staff responded accordingly with the level of support and interaction they offered.

People made everyday decisions for themselves, but staff were available to offer support if they needed prompting.

People showed that when they were unhappy about something they made this known to staff. Relatives told us they found some staff really nice and approachable and felt confident they would inform them if there were any issues of concern regarding their relative, or if they wanted an update of what their relative had been doing.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider and registered manager understood when an application should be made and one person had a DoLS authorisation in place. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

People were treated with kindness and respect; their needs were attended to by staff when and if they required it. People respected each other’s privacy. People were supported to maintain links with the important people in their lives and staff supported some people to make visits home to their families.

We have made two recommendations:

We recommend that the registered manager reviews NICE guidance around administration of medicines in care home in relation to handwritten changes to medicine records.

We recommend that the registered manager reviews the required frequency of fire drills for night staff in accordance with the

Regulatory Reform (Fire Safety) Order 2005.

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

Inspection carried out on 20 December 2013

During a routine inspection

There were six people living at Homeleigh Farm at the time of our inspection. People told us they were happy with the support they received and felt involved in making decisions about their care and support. People told us that the staff knew how to look after them, that they had confidence in the staff and trusted the staff who supported them. One person told us �I have no complaints, I am happy here� and another person said �I feel the support I get is right for me�.

We looked at people�s care plans, they had been reviewed when needed and we saw that the people who the plans were about had been involved in this process. We saw that where people could, they had consented to the care and treatment they received and processes were in place to protect people where they could not give consent.

We looked at the management and administration of medicines. People received the medicine they required when they needed it. Medicines were stored safely and all of the records kept about medicines were clear and up to date.

Staff records confirmed that appropriate recruitment processes had been followed. Checks made sure that the staff employed were suitable to work with vulnerable people.

We saw that there was a complaints process in place, although it was not displayed within the service. People told us they did not want to complain, but knew what to do if they felt they wanted to do so.

Inspection carried out on 30 January 2013

During a routine inspection

Five people were living at the service at the time of the inspection. We spoke with all the people using the service. People said they liked living at Homeleigh Farm and that they were able to make choices about their lives. One person said they chose if they wanted to stay at home or go out. They told us �I preferred to stay in today, it�s freezing outside� and that they were spending their time listening to the radio at home, staff had respected their decision and were supporting them at home.

People had been asked how they liked their care and support to be provided and were supported to learn and maintain independence skills. People told us about how they helped with household tasks. One person said �I clean my fish tank out� and another said �Staff help me clean my room�.

People told us about things they liked to do such as swimming, bird watching and supporting their favourite football team and they all had belongings in their rooms that reflected their interests.

People told us they liked living at the service and said they were happy with their newly redecorated rooms. They had chosen the colour schemes for the rooms.

Staff understood people�s needs and had the training they needed for their roles. People had good relationships with staff and were comfortable in their company.