We inspected Homeleigh on 16 and 17 May 2017. The first day of the inspection was unannounced. This meant the home did not know we were coming. The service was previously inspected in September 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.
Homeleigh is a twenty-seven bedded residential care home located in the Manchester area. There were 27 people living at the service when we inspected. It is a large Victorian, detached house set in its own private gardens. The bedrooms offer single and double accommodation, with some rooms converted into flats. There is a kitchen/diner/lounge on each of the three floors. There are a number of communal bathrooms/shower rooms located near to the bedrooms that are fully accessible.
The service provides accommodation for people who require nursing or personal care and have enduring mental health needs. The fundamental purpose of Homeleigh is to support people to recover, rehabilitate and become independent.
The home had a registered manager who was previously the deputy manager. At the time of our inspection the registered manager was not available, due leave of absence. 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.
We found that medicines were not managed safely. When comparing the Medication Administration Records (MARs) with the medicines in stock we found one had not received their prescribed medicines for 16 days. Another person’s strong pain relief tablet had been out of stock for two days. This meant the person would have been without their prescribed treatment if they had been in pain.
Each person receiving a service had a care plan in place. The risks identified through the provision of care had been assessed. However, we found one person’s care plan and risk assessments had not be reassessed when we noted an incident in February 2017 of this person choking and requiring staff assistance to dislodge the blockage. This action had not been addressed in a timely manner and potentially put this person at further risk of choking.
Care plans did not include people's goals and aspirations. We found no evidence documented of people’s setting goals and being supported to achieve them.
The fire safety management within the home required reviewing. We found people continually disregarded the homes rules of no smoking within the building. This meant the safety and wellbeing of other people living at the home and staff who worked there was compromised. We have asked the Greater Manchester Fire and Rescue Service to advise the provider on fire safety arrangements in the home.
The managers and staff understood their obligations under the Mental Capacity Act 2005 and Mental Health Act (MHA)1983 and worked within these legislative frameworks. Staff had received training in both subjects and were fully informed of any changes at team meetings to ensure they continued to provide care within the law. However, two people subject to Community Treatment Orders (CTOs) had not been informed about the reason for their CTO and their rights under the MHA.
Staff knew what action to take to ensure people were protected if they suspected they were at risk of harm. They were encouraged to raise and report any concerns they had about people through safeguarding and whistleblowing procedures.
People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals.
Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).
The service had quality assurance systems in place, however these were not always entirely effective and did not resolve the continued discrepancies we found with medicines at the service.
We found that there were enough support workers on duty to help people meet their basic needs in a safe and effective way.
An effective process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and their relatives told us they would raise any concerns with the manager.
Incidents and accidents were recorded and analysed, and lessons learnt to reduce the risk of these happening again.
People had access to advocacy services if they needed them. The locality manager told us that the home would provide end of life care when needed and had previously spoken to one person about their wishes in this regard.
We found four breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.