Archived: Homeville

Homeville is a residential care home that accommodates one person with a learning disability, autism and complex needs.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism.

Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

People’s experience of using this service:

Staff knew people well and gave them the reassurances they needed so they felt safe and any anxieties reduced. Staff and mangers knew how to recognise and report potential abuse to safeguard people.

Staff understood people's conditions and needs well and responded to provide the support they needed. Risks to people had been identified and risk assessments contained strategies to mitigate risks.

People's care was based on their needs and preferences. People were supported to do things they enjoyed

and independently choose how to spend their time. Care plans contained detailed information to guide staff how to provide the support people needed.

Medicines were stored and managed safely. Policies and procedures supported the safe administration of

medicines. People received their medicines when they needed them and staff who gave medicines were

trained and their competency checked.

Staff sought consent before providing care and knew the process to help those who lacked capacity to make 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 received training and support they required to enable them to fulfil their roles. Staff were recognised for their contributions and felt valued members of the staff team.

Feedback was regularly sought from people, relatives and staff about how the service could improve for people’s benefit. Managers understood and met their regulatory responsibilities.

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 27 February 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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.

Homeville is a privately owned care home providing personal care and support to people who may have learning disabilities and complex needs. People may also have behaviours that challenge and communication and emotional needs. There was one person living at the service at the time of the inspection.

The service is a terraced property close to the centre of Margate. People had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had access to a vehicle which was shared with the provider’s other nearby service, to access facilities in the local area and to access a variety of activities.

There was a registered manager working at the service and they were supported by a deputy manager. They were also the registered manager of the other service owned by the provider which was close by. 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. The registered manager and staff supported us throughout the inspection.

We previously carried out an unannounced comprehensive inspection of this service on 16 February 2016. Two breaches of regulations were found. We issued requirement notices relating to safe care and treatment and good governance. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found the breaches in the regulations had been met.

At the previous inspection risks to people were assessed but guidance had not always been available to make sure all staff knew what action to take to keep people as safe as possible. At this inspection improvements had been made. Risks to people's safety were assessed and there was guidance for staff on how to keep risks to a minimum. Risk assessments identified people's specific needs, and showed how risks could be minimised.

The registered manager and staff carried out other environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. On occasions the water temperature at the service had exceeded the recommended level and this had not been highlighted and no action had been taken. The deputy manager took immediate action to rectify this shortfall. Accidents and incidents were recorded and were reviewed to identify if there were any patterns or if lessons could be learned to support people more effectively to ensure their safety.

Emergency plans were in place so if an emergency happened, like a fire, staff knew what to do. There were regular fire drills so people knew how to leave the building safely.

At the previous inspection all systems within the service were not being checked by the provider. Records were not completed to demonstrate that when shortfalls had been identified action had been taken to make improvements. Feedback was not being gathered from all stakeholders to improve the quality of the service. At this inspection improvements had been made .The provider had systems in place to monitor the quality of the service. There were records to show that any identified shortfalls had been addressed and improvements made. The provider asked people, staff and relatives their opinion about the service and had included other stakeholders like doctors or community specialists about what action they thought the provider could take to make improvements

Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support, that promoted people’s independence and autonomy. Staff were part of the continuous improvement of the service.

People and staff told us they thought the service was well led. Staff told us that there was an open and inclusive culture within the service. They said they could talk to the registered and deputy manager about anything and they were always supportive.

Assessments were carried out before people moved into the service and people's care plans were accurate and up to date, reflecting the care and support people needed. If people were distressed or upset or exhibiting behaviours there was step by step guidance in place for staff telling them how to support people in a way that suited them best.

People were happy with the care and support they received. Care and support plans were personalised with detailed information for staff to follow to make sure peoples choices and preferences were upheld. People and their relatives had been involved in planning the care.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People had key workers that they got on well with. Staff had built up relationships with people and were familiar with their life stories, wishes and preferences. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.

People received their medicine safely and were supported to attend health care appointments when necessary. Detailed health care plans ensure that people remained as healthy as possible. When required, support and assessment was sought from health care professionals,

People were able to access their kitchen, whenever they wanted and were supported to prepare meals and drinks. People were supported to eat a healthy and balanced diet.

Staff understood how to report any concerns. They knew the possible signs of abuse and how to alert the registered manager or the local authority safeguarding team. There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there were any restrictions to their freedom and liberty, these had been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance.

Staff had the induction and training needed to carry out their roles. All staff had received training in how to manage people's behaviours safely, and how to prevent behaviours from occurring. Staff met regularly with their manager to discuss their training and development needs.

The complaints procedure was on display in a format that was accessible to people. People and staff felt confident that if they made a complaint they would be listened to and action would be taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Homeville is a privately owned care home providing personal care and support to up to three people who may have learning disabilities and complex needs. People may also have behaviours that challenge and communication and emotional needs. There were two people living at the service at the time of the inspection.

The service is a terraced property close to the centre of Margate. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had access to a vehicle which was shared with the providers other nearby service, to access facilities in the local area and to access a variety of activities.

There was a registered manager working at the service and they were supported by a deputy manager. They were also the registered manager of the other service owned by the provider which was close by. 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. The registered manager and staff supported us throughout the inspection.

The registered manager had worked at the service for many years firstly as a support worker and then as the deputy manager. They became the registered manager of the service in August 2015. They knew people and staff well and had good oversight of everything that happened at the service. The registered manager and deputy led by example and promoted the ethos of the service which was to support people to achieve their full potential and to be as independent as possible. The registered manager and provider made sure there were regular checks of the safety and quality of the service. They listened to peoples’ views and opinions and acted on them.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some of people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLs authorisations for people who were at risk of having their liberty restricted and some approvals had been granted. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

Before people decided to move into the service their support needs were assessed to make sure the service would be able to offer them the care that they needed. People indicated that they were satisfied and happy with the care and support they received. People were involved with the day to day running of the house. The service was planned around people’s individual preferences and care needs. The care and support people received was personal to them.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People had key workers that they got on well with. Staff had built up relationships with people and were familiar with their life stories, wishes and preferences. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.

Staff asked people if they were happy to do something before they took any action. They explained to people what they were going to do and gave them the time they needed to respond. Throughout the inspection people were treated with dignity, kindness and respect. People privacy was respected and they were able to make choices about their day to day lives.

People were involved in activities which they enjoyed and indicated that they wanted to do them again. Planned activities took place regularly. People had choices about how they wanted to live their lives. Staff respected decisions that people made when they did not want to do something and supported them to do the things they wanted to.

Throughout the inspection we observed people and the staff as they engaged in activities and relaxed at the service. Some people could not communicate fully by using speech and staff understood the needs of the people they supported. Staff were able to understand people through body language, facial expressions and behaviours and supported people in a discreet, friendly and reassuring manner. Staff anticipated or interpreted what people wanted and responded quickly. There were positive and caring interactions between the staff and people. People were comfortable and at ease with the staff.

Staff supported, monitored and recorded what people were achieving and how they were developing. People’s individual religious preferences were respected and staff supported people to attend church services.

Potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. We did find that some areas concerning risks to people needed reviewing and action needed to be taken to make sure people were as safe as possible. The registered manager told us these would be addressed immediately. On the whole there was guidance in place for staff on how to care for people effectively and safely and keep most risks to minimum without restricting their activities or their life styles and promoting their independence, privacy and dignity. The complaints procedure was on display in a format that was assessable to people. If people, staff or relatives made a complaint they would be listened to and action would be taken.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed. The registered manager monitored incidents and accidents to make sure the care provided continued to be right or whether it needed to be changed.

People said that they enjoyed their meals. People were offered and received a balanced and healthy diet. They had a choice about what food and drinks they wanted and were involved in buying food and preparing their meals.

People received their medicines safely and when they needed them. They were monitored for any side effects. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. On a few occasions the room temperature where the medicines were stored exceeded the recommended level. This had been identified by staff and action to rectify this was taken on the day of the inspection. People’s health was monitored. People had regular reviews and appointments with doctors and specialist services. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.

The management team made sure the staff were supported and guided to provide care and support to people enabling them to live fulfilled and meaningful lives. Staff said they could go to the registered manager at any time and they would be listened to. Staff had received regular supervisions (one to one meetings with a senior member of staff). They had an annual appraisal so had the opportunity to discuss their developmental needs for the following year. Staff were positive about the support they received from the registered manager to make sure they could care safely and effectively for people.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. There was enough staff to take people out to do the things they wanted to. New staff had induction training which included shadowing experienced staff, until they were competent to work on their own. Staff had core training and more specialist training, so they had the skills and knowledge to meet people’s specific needs. Staff fully understood their roles and responsibilities as well as the values of the service.

Emergency plans were in place so if an emergency happened, like a fire the staff knew what to do. Safety checks were done regularly throughout the building and there were regular fire drills so people knew how to leave the building safely.

Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support and to be part of the continuous improvement of the service. Staff told us that there was an open culture and they openly talk to the registered manager and the deputy manager about anything.

The provider had recently developed a programme for auditing all the systems used at the service. This had not yet been implemented. The registered manager was auditing the systems and when shortfalls had been identified they had been addressed and improvements had been made, although the provider was not always checking that action was taken.

The provider asked people, staff and relatives and other stakeholders like doctors or community specialists about what action they thought the provider could take to make improvements.

The regi

Is the service safe?

People were treated with respect and dignity by staff who focused on positive risk assessment to support people to maintain their independence. For example, risk assessments were designed to enable people to manage risks associated with what people could do, rather than limiting people's abilities by focusing on what they could not do.

People told us they felt safe and we observed staff who demonstrated that they understood how to protect people's rights and safeguard the people they supported.

Systems were in place to make sure that the manager and staff learned from events such as accidents, incidents, and concerns. This reduced the risks to people who used the service and helped the service to continually develop.

We found that the service was safe, clean and hygienic. We saw that the service was going through a renovation programme to ensure that the environment continued to meet people's needs safely.

People's care needs and the qualifications, skills and experience of the staff were taken into account when making decisions about staffing numbers required to the meet the needs of people who used the service.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in their plans of care. Specialist dietary, mobility and developmental needs had been identified in care plans where required. People who used the service said that they had been involved in the planning of their care and we found that the care plans reflected their current needs.

People's needs were taken into account with the layout of the service, which enabled people to move around freely and safely.

Is the service caring?

People were supported by kind and attentive staff. We observed that support workers showed patience and gave encouragement when supporting people. One person told us "The staff are good, they help me."

We found that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. We observed that people were supported by staff who focused on person centred support.

Is the service responsive?

People regularly completed a range of activities of their choice both in and outside of the service. We found that surveys were regularly sent to people who used the service, relatives and professionals. We saw that the feedback the service received was positive.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that the quality of service was maintained.

We found that overall people had positive experiences. The staff supporting them knew what support they needed and they respected their wishes The support that we observed being given to people matched what their care plan said they needed. Care and support was delivered in a person focused manner and we saw that staff created opportunities for people to make daily choices and decisions.