Homelands Nursing Home

Homelands Nursing Home is a care home providing personal and nursing care to up to 50 people with different health needs. The service provides support to elderly frail people with general nursing needs in The Manor House, also known as The Main House. There is a separate unit, The Coach House, for up to 12 people living with dementia. At the time of our inspection there were 37 people using the service.

People’s experience of using this service and what we found based on our review of Safe and Well-led

Staff did not always follow infection prevention and control procedures. Not all staff wore a mask or wore a mask appropriately. The provider and registered manager did not have oversight of staff practices in relation to PPE usage. The service was accessing COVID-19 testing in line with government guidance. Following this inspection, we have received assurances that staff are now following current guidelines.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. They understood and responded to people’s individual needs.

Staff knew and understood people well and were responsive, supporting them to live a quality life of their choosing. They placed people’s wishes, needs and rights at the heart of everything they did. People told us they felt involved in their care and support. One person told us, “[I] can choose how I spend my time.” Other comments from people included, “I love it here”, “The staff are very kind”, “I love the food”, and, “I’d say if I’m not happy.”

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 31 December 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 that the provider needs to make improvements. Please see the safe 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to infection control at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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

At our last inspection we rated the service good. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The service met all relevant fundamental standards.

The service had a positive culture that was person-centred, open and inclusive. Staff were enthusiastic and keen to talk about their role. Recruitment practices were robust, and staff received training appropriate to their role and the needs of the people living at the service. People had individual plans of care and risk assessments. Care was person centred.

It is a requirement of the provider's registration that they have a registered manager 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. The service had a registered manager in place. It was well led, and the registered manager was aware of their legal responsibilities.

Further information is in the detailed findings below.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. However, a further area was identified in order to improve some practices in relation to activities and meeting people’s social and recreational needs.

The overall rating for Homelands Nursing Home has been revised to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

Homelands Nursing Home is registered to provide accommodation and care, including nursing care for up to 50 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues and dementia. The majority of people were accommodated in the main building. A short distance away, there was a separate unit, the Coach House, for up to 12 people living with dementia. On the day of our inspection there were 27 people living in the main building and 12 people in the Coach House, who required varying levels of support.

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 and associated Regulations about how the service is run.

The home had some arrangements in place to meet people’s social and recreational needs. However, we could not see that activities were routinely organised for people living within the Coach House. Feedback from staff and our own observations clearly indicated this need was not being addressed. We saw that the provider had recognised the lack of activities for people in the Coach House, and arrangements were being made to employ a further activities co-ordinator to rectify this. However, we have identified this as an area of practice that needs improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe, because the staff make sure you are safe”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of people, including the care of people living with dementia and end of life care. Staff had received both one-to-one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “I’m all up to date with my training”.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The food is very good”. Special dietary requirements were met, and people’s weights were monitored with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “Nothing is too much trouble for them [staff]”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People said they felt listened to and any concerns or issues they raised were addressed. People were also encouraged to stay in touch with their families and receive visitors.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, visiting professionals, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Although there were enough staff on duty to meet the needs of the people living at the service, nursing levels had not been maintained to a level that allowed them to fulfil all their duties. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. On the day of our inspection an urgent application was being submitted and proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made to deprive someone of their liberty and how to submit one.

There was no system in place to make sure that the manager and staff learned from events such as accidents and incidents. This increased the risk of harm to people and failed to prevent such incidents in the future. A compliance action has been set in relation to this and the provider must tell us how they plan to improve in relation to learning from incidents and events that affect people's safety.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. One person told us, 'I've got a very bad leg and need assistance to get in my wheelchair. They use a frame to get me in my wheelchair. They know what they are doing'. A relative told us, 'The nurses meet X's (family member) needs in a very good way. They are always on top of things and keep us informed'. It was clear from our observations and from speaking with staff who worked in the main building that they had a good understanding of people's care and support needs and that they knew them well.

People's health and care needs were assessed, but some people who lived in The Coach House did not have care plans in place for identified needs. Therefore, there was a lack of information to support staff consistently to meet people's needs. Staff in The Coach House understood the basic care needs of people. However, they did not demonstrate understanding or show consideration when providing care to people with dementia. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People were supported to be able to eat and drink sufficient amounts to meet their needs. When we spoke to people about their views on the meals provided, the majority of people expressed satisfaction. For example, one person told us, 'They make sure everything is in position in the dining room so its runs smoothly. The meals are excellent. They are different every day'. Two people said that they were not happy with the meals provided. For example, one said, 'The food is not good'. Some staff had completed training to ensure they were competent to manage the nutritional needs of people and a nurse that we spoke with demonstrated knowledge and understanding of the nutritional needs of people who lived in the main building.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and in the main, gave encouragement when supporting people. People that we spoke with confirmed this. One person told us, 'The staff are very caring, very patient. Nothing is too much trouble for them'. Our observations confirmed this.

We noted that the lunch period in The Coach House was well paced and allowed people the time they needed to eat their meal. People were provided with protective aprons to ensure they did not dirty their clothes if they spilled any food. We observed good interactions between people and staff. Care staff who assisted people to eat their meal ensured the pace was dictated by the person. Encouragement was given where needed in a manner which enabled people to maintain their dignity and independence.

Is the service responsive?

Where staff had identified a concern about people's ability to swallow, a referral had been made to the speech and language therapy team (SALT). On the day of our inspection we observed staff in the main building following the guidance issued by the SALT team to reduce the risk of people choking. During our inspection we spoke with a member of the SALT team who was at the service. They expressed the opinion that the nurses who worked at the service took appropriate action to manage people's nutritional needs. They stated, 'I'd say they are pretty good. They make sensible decisions. They call when needed and appear to know the needs of people'.

During our inspection we also spoke with a visiting GP. They expressed the view that, 'The nurses are capable, people are treated with dignity and communication with us is good'. This meant that people were supported to maintain and manage changes in their health.

Is the service well-led?

Since our last inspection we found that improvements had been made in relation to the supervision of staff and quality monitoring systems. This was also confirmed by people that we spoke with and by examining records. However, we found that gaps in care planning and injuries to people who lived at the service were not known by the manager. This impacted on the safety of service delivery to people.

We found that people's individual needs were assessed and that care was planned and delivered to meet their needs. People we spoke with told us that they were satisfied with the care they received and a person's relative said "my relative is very happy here, I have no qualms about anything". We found that people's care was planned to ensure their safety and welfare, a person told us "staff help me to go down stairs - they have to be in charge of that to keep me safe"

People told us they felt 'safe' in the home and we saw that staff had completed training in safeguarding people from abuse.

People told us that they were satisfied with the standard of care they received from the provider's staff. One person said "they (staff) are very good and very helpful". Another person said "staff are lovely with personal care". We have asked the provider to make some improvements in the support they give to staff.

We found that people were asked about the quality of service they received and their feedback was responded to. However, we have asked the provider to make some improvements to their quality and safety monitoring system.

People told us they are happy with the care and support they receive. People told us that they were treated with respect and their privacy and dignity was maintained.

One person said, "Its a nice place to be. Staff treat me well and I have no concerns."

Another person said, "I've only been here a short time but everyone is so helpful, cheerful and friendly".

We spoke with with staff who told us that they are very happy working in a home which has a good atmosphere. They felt supported in their work and felt the management was open and supportive.