Homefield House

Homefield House is a residential care home providing personal and nursing care up to a maximum of 24 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 20 people using the service.

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

People views were not actively sought, and they were not always involved in the dining experience. Choices were limited and the environment was not well presented. We have made a recommendation about improving the dining experience for people who use the service.

The service required some decorating works completing and new flooring was required, this had already been identified by the provider and work would commence shortly.

People did not always receive their medication as required. ‘As and when’ (PRN) protocols were not in place for everyone. The deputy manager rectified this immediately and ensured all people had protocols in place. Staff had received medication training and we observed safe practice in the administering of medicines.

The service had effective safeguarding systems, policies and procedures in place. Staff have a good understanding of abuse and knew what to do to keep people safe. Staff had received safeguarding training.

Risk assessments were person centred and reviewed regularly. Staff were aware of people’s risks and how to manage them. Staff understood their responsibility to raise concerns and were supported to do so.

There was enough competent staff on duty and the service regularly reviewed staffing levels and adapted them to meet people’s changing needs. Staff told us staffing was much better and people were getting the care they needed.

Staff completed an induction and did not work unsupervised until they felt confident to do so. Staff had the right qualifications to carry out their duties and received regular supervision and appraisals.

Assessments of people’s needs were completed and regularly reviewed and updated. Referrals to external services were made to ensure people’s needs were met.

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.

People were empowered to make choices and be as independent as possible. People were encouraged and supported to carry out person centred activities. One relative told us [Person’s name] plays games and paints, they also take [Person] out once a week and [Person] her bake, [Person] loves it.”

People’s complaints were listened to and responded to in good time. People and their relatives told us they felt confident if they complained they would be listened to and taken seriously.

The provider had an effective governance system in place. Information from governance meetings and action plans support to drive improvement and improve outcomes for people.

The service has a positive culture that is person centred, open and empowering. People and their families are involved in the service in a meaningful way. The service engages and involves staff and ensures their views are acted on to shape the culture of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 27 July 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we also recommended the provider made improvements in providing staff with the necessary training for infection prevention and control (PPE). Processes required improving in how the provider responded to and learnt from complaints and guidance in relation to Accessible Information Standards (AIS). At this inspection we found the provider had acted on the recommendations and all staff had received training in PPE, processes had improved for responding to complaints and the provider was meeting people’s communication needs.

This service has been in Special Measures since 27 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 29 April 2022 and 4 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing.

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, effective, responsive and well-led which contain those requirements.

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 inadequate to good based on the findings of this inspection.

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.

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

Follow up

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

Homefield House is a residential care home providing personal care for to up to 24 people in one adapted building over two floors. The service provides support to older people and people living with dementia. At the time of our inspection there were 21 people using the service.

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

The provider and registered manager did not have effective oversight of the safety and quality of the service.

People were not protected from the risk of avoidable harm and abuse. Staff did not administer medicines safely and staff training was out of date. The provider had not deployed enough staff to meet people’s needs and people were at risk from the spread of infection.

Not all staff had received an induction before starting work at the service and they did not always have the information they needed to care for people effectively. People did not always receive timely support at mealtimes and areas of the premises was not decorated to accommodate people living with dementia.

People’s care plans were not person-centred and there were limited opportunities for people to participate in meaningful activities.

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.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about infection control, staffing levels and leadership and management. A decision was made for us to inspect and examine those risks.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding, staffing levels, staff training and the overall management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

• The service had signage displayed on all external doors to alert visitors of the restrictions of entering the building. Sanitising hand gel and disposable masks were provided for visitors.

• The service communicated well with relatives to promote people’s wellbeing.

• Staff were wearing PPE in line with government guidance and designated areas were set up within the service for staff to remove and apply PPE.

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

People’s experience of using this service: There were systems in place to monitor and improve the quality and safety of the service provided. However, these were not always effective. A safety issue in the environment had not been identified and addressed, which led to a minor injury for one person. Steps were taken to prevent similar incidents reoccurring following the incident. We have made a recommendation about keeping up to date with health and safety information.

There was a positive culture within the service and people felt the registered manager was approachable. Staff were knowledgeable about safeguarding and able to raise concerns. Steps were taken to minimise risk where possible. Staff supported people to manage their medicines safely. Systems were in place to recruit staff safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were supported through on-going supervision and accessed training relevant to people's needs, to ensure these could be met. Staff supported people to access healthcare and maintain a nutritious diet.

All the relatives we spoke with consistently told us they were happy with the care provided for their relatives. They spoke positively about the staff and the home being welcoming and homely. We saw people were relaxed in their surroundings and felt comfortable around staff. Staff were kind and promoted people’s independence and treated them with dignity and respect.

People’s care plans were kept up to date and reflected their individual needs and circumstances. People were supported in line with their preferences and supported to engage in social and leisure activities. The provider had a system in place for responding to people's concerns and complaints.

Rating at last inspection: At the last inspection the service was rated Good (report published 26 July 2016).

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

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

Homefield House is registered to provide care and support for up to 24 people, some of whom are living with dementia. The service is located in Grimsby. Accommodation is provided on two floors. There is a small car park at the service for visitors to use.

The service had a registered manager. 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.

Staff knew how to protect people from abuse and knew they must report concerns or potential abuse to the management team, local authority or to the CQC. This helped to protect people.

Staffing levels provided on the day of our inspection were adequate to meet people’s needs. Staff understood the risks to people’s wellbeing and knew what action they must take to help minimise risks. Staff were provided with training in a variety of subjects, which was updated periodically to help develop and maintain their skills. Supervision and appraisal was provided to all staff which helped support them and identify further development needs.

People’s nutritional needs were assessed and monitored, with special diets provided, where required. Staff encouraged and assisted people to eat and drink, where necessary. A pictorial menu helped people living with dementia to choose what they would like to eat. Advice was sought from relevant health care professionals to ensure people’s nutritional needs were met.

People were supported by staff to make decisions for themselves. Staff communicated with people in a way that could be understood. We saw people chose how to spend their time and gave consent to their care and treatment.

People who used the service were supported to make their own choices about aspects of their daily lives. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

A programme of activities was provided, this included talks delivered to help people reminisce about Grimsby. Activities were provided to help stimulate people and they were encouraged to maintain their hobbies and interests.

General maintenance was carried out and service contracts were in place to maintain and service equipment so it remained safe to use.

There was a complaints policy and procedure in place. This was explained to people living with dementia and their relations so they were informed about their rights. People’s views were asked for through formal surveys and informally on a daily basis by the staff. Feedback received was acted upon.

A variety of audits were undertaken to monitor the quality of the service. Issues found were addressed thoroughly. The registered manager had an ‘open door’ policy and an ‘on call' system was operated out of office hours to support people, relatives, visitors and staff. There was a homely and welcoming atmosphere within the service. The service had gained an award in 2015 from the local Clinical Commissioning Group for working in partnership to provide better outcomes for people.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, speaking to staff who supported people who used the service and from looking at records.

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

Is the service caring?

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Staff demonstrated a good understanding of the needs of the people who used the service and could describe how to maintain people's dignity and how to ensure people's choices were respected.

Risk assessments were completed which ensured staff knew how to keep people safe. People had been involved with the formulation of their care plans and where needed, people had been supported to make informed decisions. Health care professionals, for example doctors, district nurses, speech therapists and occupational therapists had been consulted and their advice sought when people needed specialist care and attention.

Is the service responsive?

The service had a complaints procedure which people could access. People were therefore assured that complaints were investigated and action would be taken as necessary. The provider consulted with people about how the service should be run and any issues were addressed. People were consulted about their care needs.

Staff followed instructions from visiting health care professionals, for example doctors and district nurses. This ensured people received the care and attention they required to meet their needs.

Is the service safe?

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly, therefore not putting people at unnecessary risk.

The manager set the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure people's needs were met.

The provider had policies and procedures in place for staff to follow to report any abuse they may witness or become aware of. Staff also received training about how to keep people safe.

Is the service effective?

People's health and care needs were assessed with them and they were involved in writing their plans of care. Plans were in place for staff to follow to support people who may be a risk to themselves and others. Health care professionals were consulted if required.

People's care plans detailed their preferences and method of communication. This enabled the staff to identify when the person was not happy or felt uncomfortable with any given situation.

People were provided with nutritious and wholesome food. People's dietary needs were assessed and where needed heath care professionals were consulted. People's dietary intake was recorded and their weight monitored.

Is the service well led?

The provider consulted with people about how the service was run and took account of their views. Relevant persons who had an interest in the care and attention people received had also been consulted and their opinions taken into account about how the service was run. Staff received training which equipped them to meet the needs of the people who used the service. The provider also gave staff the opportunity to gain further qualifications.

What people who used the service and those that matter to them said about the care and support they received.

People we spoke with told us they liked living at the service and found the care staff caring and kind. Comments included 'Its lovely here I've no complaints', 'The care are marvellous they just can't do enough for you' and 'I like living here and I have a really nice room.' They also told us they could exercise choice in the daily lives. Comments included, 'Yes I can come and go as please', 'I can get up when I want and can spend time in room which is important to me' and 'I just do as please really.' People told us they enjoyed the food. Comments included 'The food is lovely', 'the waitress bring our food it's all really nice' and 'The cook is marvellous we've never had a bad meal here.'

People's comments about their care were very positive. One person told us, "The care is very good,' and another person said," I can't fault the care." A relative commented, 'I am amazed at what they can do for my relative. I feel very fortunate we have been able to find such a caring home.'

People commented positively about the cleanliness of the service. Comments included, 'It is absolutely clean,' and 'The cleanliness is very good, I find it is very clean. ' A relative told us, 'The cleanliness is excellent and there is no odour.'

There were effective recruitment and selection processes in place and people spoke positively about the staff that worked with them. People's comments included, 'The staff are all very good,' and 'They are carrying out their duties properly.' A relative told us, 'The staff are really on the ball; the staff communicate very well.' A visiting healthcare professional told us, 'The staff are all very helpful.'

People were clear about how to make a complaint. One person told us, 'I would see the manager if I had a complaint but I haven't had a complaint yet.' A visiting healthcare professional told us, 'The relatives have never had any complaints about the care; I've never had anyone wanting to complain.'