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Inspection carried out on 25 November 2019

During a routine inspection

About the service

Homestead Care is a domiciliary care service providing care for people in their own home, in Gillingham and surrounding areas. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection 18 people were using the service.

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

People were supported by staff who had received safeguarding training and knew how to keep them safe from harm or abuse. People told us they felt safe. People’s individual risks were assessed and regularly reviewed with theirs and, where appropriate their relatives’ input. When people required support with their medicines this was provided by staff with the relevant training and competency assessments. The service had improved recruitment and selection procedures that helped ensure people were supported by staff with the required skills, values and character. Accidents, incidents and near misses were recorded and analysed to identify themes and trends with learning shared with staff to prevent a re-occurrence.

People felt fully involved and consulted on all aspects of their care including when this needed reviewing. People felt listened to and able to express their views. The service ensured people were at the centre of decisions affecting their lives. Staff received a formal induction that included shadowing and practice observations. This helped create confident, empowered care staff who delivered high quality care in line with standards, guidance and the law. Training covered a variety of topic areas to ensure each person’s needs were met. The service supported people to access health and social care services in a timely way in order to maintain their health and wellbeing. This included access to community nurses, GPs and dental services.

Staff had a good understanding of the principles of the Mental Capacity Act 2005 including how to support people to make informed decisions. 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. Staff always sought people’s consent before helping them.

People and relatives spoke positively about the care staff. They said staff were all consistently kind, caring and patient and had got to know them well. People told us staff arrived on time and stayed for the correct duration. Staff confidently described how they supported people’s privacy, dignity and independence.

People were supported by staff who enjoyed working for Homestead Care and felt supported by their colleagues and management. Staff felt recognised and valued. Records confirmed they received regular praise and encouragement; including to develop new skills and qualifications. Surveys were used as an opportunity to learn what the service was doing well and where it could improve. Feedback was unanimously positive from people, healthcare professionals and community services. A wide range of audits were carried out which had helped deliver improved oversight and identify areas where actions were required. These were then tracked and resolved.

The service had developed and maintained good working relationships with agencies and community resources such as GP practices, local authority, community mental health and reablement teams. This had helped people remain well in their homes for longer and supported successful transition from hospital. The service had recognised the role it could play in the community demonstrated by its sponsorship of a local school. This had enabled the school to produce books for their pupils on topics including bullying and internet safety.

Rating at last inspection and update

The last rating for this service was requires imp

Inspection carried out on 19 June 2019

During an inspection to make sure that the improvements required had been made

About the service

Homestead Care is a domiciliary care service providing care for people in their own home, in Gillingham and surrounding areas. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection13 people were using the service.

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

People said they felt safe and were supported by staff who knew them well. However, potential risks to people's health and wellbeing were not consistently assessed and were poorly documented. This meant people were not always safe.

There was ineffective leadership and oversight of the service. Provider quality assurance systems did not identify and rectify previously identified breaches of regulation, to ensure the quality of service provision and mitigate the risks to people.

Risk assessments and risk management plans did not describe the level of risk or how the risks were being assessed, monitored and reduced.

Medicines were not always managed safely. There were weak systems in place which failed to ensure staff administered medicines when they were due.

Recruitment checks were not always thorough to ensure people were only cared for by suitable staff.

The last rating for this service was requires improvement (published 18 December 2018), there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We carried out an announced comprehensive inspection of this service on 26 September 2018. Breaches of legal requirements were found we issued the provider with a warning notice . The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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

Enforcement

We found two repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a further breach of regulation 19. You can see what action we took at the end of this full report.

Inspection carried out on 26 September 2018

During a routine inspection

This announced inspection took place on 26 and 27 September and 19 October 2018. We gave the service 48 hours’ notice of the inspection visit because it is a small domiciliary care agency and the provider works as part of the care team.

At the time of our inspection, the service was providing personal care and support to seven people. The provider had put on hold plans to expand the service had been until further staff were recruited. The service was registered with the Care Quality Commission (CQC) in August 2017.

The last CQC inspection took place in November 2017 because of safeguarding concerns and the service was rated as ‘Requires Improvement.’ At that time there was a registered manager. 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. However, during the last CQC inspection, the registered manager resigned from their position. The service has been operating without a registered manager for eleven months. The provider advised a new manager started on 15 October 2018; their aim was for the new manager to be registered with CQC.

The service has been rated requires improvement on two consecutive inspections and CQC will arrange to meet with the provider to discuss further improvements. The service was not well led. During our inspection, we found a number of areas that needed to improve to maintain the safety and well-being of people that had not been identified by the provider. Quality assurance systems were not effective in recognising areas for improvement. The registered provider had not carried out regular quality assurance audits to ensure the service was providing good quality care.

Action was needed to improve medicine administration, recording and auditing. People said the staff made them feel safe because they were kind and reliable. However, potential risks to people’s health and well-being were not consistently assessed and were poorly documented. Risks linked to people’s nutritional needs were not always documented in people’s care plans. This meant there was potential for the risk of malnutrition to be inconsistently managed. The quality of the assessment of people’s care needs was variable and did not routinely take place before the service began. Further work was needed to ensure a consistent approach to how people showed their agreement to their care by signing their care plans.

Despite a small group of staff and the service was reliable. Staff understood their safeguarding responsibilities. People were supported by staff who treated them with kindness, respect and compassion. Staff had a good understanding of the people they cared for and supported them in decisions about how they liked to live their lives. People were supported by staff who respected their privacy and dignity. However, staff did not receive training to cover all aspects of their role to ensure the support they were delivering was safe and effective.

People were supported by staff who recognised each person’s individuality. Equality and diversity was understood to support people’s individuality. There were systems in place to gain people's views and to address concerns and complaints. People were supported to access health care professionals to maintain their health and wellbeing.

Systems in place for the recruitment and selection of staff had improved. Recruitment checks were routinely carried out before staff started their employment to ensure they were suitable to work with people using the service.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report. Full information about CQC’s regul

Inspection carried out on 20 November 2017

During a routine inspection

This inspection took place on 16, 20, 21 November 2017. This inspection was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults. Care Quality Commission, CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of our inspection, the service was providing care and support to 17 people. This was the first inspection of the service following registration in August 2017. There was a registered manager. 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. However during the inspection the registered manager resigned from their position. The inspection was therefore overseen by the manager who was also a director of the service.

The inspection was prompted in part by safeguarding alerts. The information shared with CQC about the alerts indicated potential concerns about the management of the service and risk to people in regards moving and handling. This inspection examined those risks. Some alerts had been brought to the attention of one of the Local Authority who also completed a visit to the service prior to the inspection taking place.

Quality assurance systems had not always been effective in recognising and rectifying issues. The registered provider had not carried out regular quality assurance audits to ensure the service was providing good quality care.

Systems in place for the recruitment and selection of staff were ineffective. Recruitment checks had not routinely been carried out before staff started their employment to ensure they were suitable to work with people using the service.

The care needs of people had been assessed prior to their using the service. However reviews of care packages had not taken place at the time of the inspection.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred.

Risks associated with people’s care and living environment were effectively managed to ensure their freedom was promoted. People were supported by consistent staff to help meet their needs. People’s independence was encouraged and staff helped people feel valued.

People received care from staff who had undertaken training to be able to meet their individual needs. People’s human rights were protected because the manager and staff had an understanding of the Mental Capacity Act 2005 (MCA).

People’s nutritional needs were met because staff followed people’s care plans to make sure people were eating and drinking enough and potential risks were known.

People were supported to access health care professionals to maintain their health and wellbeing.

People were supported by staff who continued to treat each person equally, as valued human beings, in a caring and respectful manner, and regardless of their beliefs or background.

Complaints and incidents such as medicine errors were learned from to ensure improvement. The manager promoted the ethos of honesty and admitted when things had gone wrong.