Homewood Care Home

The service had a registered manager in post. A registered manager is a person who has registered with 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.

There was a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences.

Staff understood how to identify, report and manage any concerns related to people’s safety and welfare. There were systems and processes in place to protect people from harm, while promoting their independence.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. Agency staff were being used to maintain sufficient numbers of staff to meet people’s current needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and competency assessments.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to eat and drink enough to meet their needs and to make informed choices about what they ate.

People and their relatives or representatives were involved in planning the care and support provided by the service. Staff listened to people and understood and respected their needs and wishes.

The service was responsive to people’s needs and there were systems in place to help ensure any concerns or complaints were responded to appropriately. Healthcare professionals were involved in people’s care when necessary.

The provider and the registered manager were promoting an open and inclusive culture and continued to look for ways to improve the service. There was a range of systems in place to assess and monitor the quality and safety of the service and to help ensure people were receiving appropriate support.

Homewood Care Home (to be referred to as Homewood throughout this report) is a care home which provides residential care for up to eight adults with learning disabilities. People receiving the service also live with complex emotional and behavioural needs including Autism. Some people living at the service also had additional health conditions such as epilepsy and deafness. The care home comprises of one floor with its own garden and is situated on the outskirts of Andover town centre. At the time of the inspection eight people were using the service.

Care was provided by support workers who will be referred to as staff throughout the duration of this report.

Homewood has a registered manager in post. 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.

The provider had not always fully completed robust recruitment processes to ensure people were protected from the employment of unsuitable staff however the registered manager had taken positive steps to ensure that files contained all the required information.

New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely. There were sufficient staff employed to ensure people’s individual needs were met.

People were not always supported by staff who had the most up to date training available to enable them to proactively meet people’s individual needs. Staff were able to demonstrate that they were able to meet people’s basic individual needs including communication. However the provider had not ensured that staff had received appropriate formalised training to ensure they could develop people’s preferred methods of communication such as British Sign Language where required.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as large scale staff sickness or accommodation loss due to fire or floods.

Relatives of people using the service told us they felt their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

The registered manager had recently started at the service and provided strong positive leadership however they had not always fulfilled the legal requirements associated with their role. The registered manager had not always informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe

People were protected from the unsafe administration of medicines. Staff responsible for administering medicines had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Staff skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.

People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. The home promoted the use of advocates where people were unable to make key decisions in their life. This is a legal right for people who lack mental capacity and who do not have an appropriate family member of friend to represent their views about health issues and where people wished to live.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager showed a comprehensive understanding of what constituted a deprivation of person’s liberty. Appropriate authorisations had been granted by the relevant supervisory body to ensure people were not being unlawfully restricted.

Staff sought people’s consent before delivering their care and support. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

People were supported to eat and drink enough to maintain a balanced diet. People were involved in developing the home’s menus and were able to choose their meal preferences. We saw that people enjoyed what was provided. People were supported to participate in meal times with the guidance provided by health care professionals being followed. Records showed people’s food and drink preferences were documented in their care plans and were understood by staff.

People’s health needs were met as the staff and the registered manager had detailed knowledge of the people they were supporting. Staff promptly engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

People were supported to participate in activities to enable them to live meaningful lives and prevent them experiencing social isolation. Personal external relationships were supported and a range of activities sought to enrich people’s daily lives. The registered manager and staff were motivated to ensure that people were able to participate in a range of external activities.

Staff had taken time to develop close relationships with the people they were assisting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These were practically demonstrated by the registered manager and staff.

People received personalised and respectful care from staff who understood their care needs. People had care and support which was delivered by staff using the guidance provided in individualised care plans. Care plans contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. People were encouraged and supported by staff to make choices about their care including how they spent their day within the home or in the community.

Relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way although none had been received since the last inspection. Relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the registered manager.

The registered manager and staff promoted a culture which focused on providing individuals with the opportunities to live their lives fully and promoting their independence. People were assisted by staff who encouraged them to raise concerns with them and the registered manager. The provider routinely and regularly monitored the quality of the service being provided.

The provider’s value of care was communicated to people and understood by staff. We saw these standards were evidenced in the way that care was delivered to people.

Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided.

Relatives told us and we saw that the home had a confident registered manager and staff told us they felt supported by the registered manager.

We found one breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (Part 4). You can see the action that we asked the provider to take at the end of the full version of this report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

We inspected against the regulated activity of accommodation for persons who require nursing or personal care. The provider is also registered to provide the regulated activity of treatment of disease, disorder or injury, however this was not being provided by the service. We met five of the eight people using the service and looked at care and support records for three people. We also spoke with the manager and three staff. This is a summary of what we found -

Is the service safe?

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. Care and support records contained clear and detailed guidance for staff. For example, there was information about how to respond to people's behaviours that may be challenging, using redirection techniques and communicating clearly. Other records showed how people should be supported safely when accessing the community. Staff we spoke with demonstrated their understanding of the needs of people using the service, their support plans and agreed approaches to working with them. There were enough qualified, skilled and experienced staff to meet people's needs.

There were arrangements in place to deal with foreseeable emergencies. In addition to people's support and health action plans, each person had a personal emergency evacuation plan.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We observed that staff communicated effectively with people using the service, including the use of sign language. One person's support plans contained detailed information for staff about how to respond to them having epileptic seizures. The guidance gave early warning signs to look for and what to do in the event of protracted seizures. During the inspection we observed staff responding swiftly to provide appropriate care and support for the person during and after a seizure.

Effective systems were in place to help ensure that people were provided with a choice of suitable and nutritious food and drink. Staff provided people with different options, including the use of pictorial menus and shopping lists, so that they were able to make an informed choice. We also saw that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Is the service caring?

We observed that staff interacted well with people using the service, promoting a friendly and inclusive atmosphere in the home. When a person became upset and anxious, staff took time to comfort and reassure them. Throughout the inspection we saw that staff treated people with dignity and respect.

Is the service responsive?

The rota was organised in advance and flexibly to take account of people's planned activities and the level of staff support required. People's support plans and risk assessments had been reviewed and updated to reflect their current needs and goals. Each person had a key worker, a named member of staff who participated in reviewing the person's care and support with them. As a result of reviews, some people had expressed a wish to move to alternative accommodation and were being supported to explore this option. We saw that people's health needs were monitored and referred to external health professionals appropriately.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. We saw that regular audits of the quality and safety of the service took place and were recorded. There was a monthly improvement log completed by the managers, which was a record of actions taken in relation to audits, incidents, and feedback from people using the service or others acting on their behalf.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. There were records of quality survey questionnaires, resident's meetings, and care reviews involving the individuals and their key workers.

There were clear lines of accountability within the service. Procedures were in place for reporting accidents and incidents, including a senior staff and management on-call system. We saw that learning from incidents took place and appropriate changes were implemented.

During this inspection we spoke with three people who used the service, two members of staff and the registered manager. We saw that people's support plans and risk assessments had been reviewed and updated to reflect people's current needs. In addition a full review of care and support plans had been carried out by the service, to ensure that people's personal records including medical records were accurate and fit for purpose.

People expressed their views and were involved in making decisions about their care and support. As a result of person centred planning reviews, some people had expressed a wish to move to alternative accommodation. Two people had moved on and another two people were planning to do so.

A person we spoke with told us that they enjoyed living at Homewood and that they were pleased to be moving into a larger room. We observed another person who used the service being supported by staff in ways that were agreed in the person's support plan. Staff we spoke with demonstrated a good knowledge of how different people communicated and of ways to engage with them and meet their needs.

People told us they received the care and support they needed and said they were well treated by staff. We observed staff communicating with people in their preferred method, for example, sign language and verbally. However, we found that the support plans were not kept up to date and did not provide accurate information to staff about the support that people needed. We have told the provider that action is needed to address this concern.

People who used the service said they felt safe in the home and were confident that staff would respond appropriately to any concerns or complaints they raised.