Homewards Limited - 48 Leonard Road

Updated 27 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

Two inspectors and a member of the CQC medicines team visited the service. An Expert by Experience was not used for this inspection because it is a small service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Homewards Limited – 48 Leonard Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. We gave the service two hours’ notice. This was because the service is small and people were often out. We wanted to be sure there would be somebody there to support the inspection and people at home to speak with us.

What we did before the inspection

We reviewed the information we had received about the service. This included details of its registration, previous inspection reports and any notifications of significant incidents the provider had sent us. We sought feedback from the local authority and professionals who worked with the service. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We used all of this information to plan our inspection.

During the inspection

We visited the service on 25 August 2021. We spoke with one person who used the service and one member of care staff. We spoke with the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We observed care and support provided in communal areas. One inspector returned to the service on 2 September 2021 to spend time understanding people’s quality of life.

We reviewed a range of records including medicine administration records and care plans for three people. We looked at two staff files in relation to recruitment, supervision and training. We also looked at incident and accident records, policies and procedures and records relating to the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. The registered manager sent us documentation we requested including quality audits, rotas and risk assessments. We spoke with one relative and two staff as part of the inspection.

Recording breaches of regulation:

Following up breaches

At the inspection carried out in August 2019, we found the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment. We found gaps in risk assessment and health and safety issues put people at risk of harm. During this inspection we found the provider had made improvements. Risk assessments were more detailed and the identified health and safety issues had been fixed. This meant the provider was no longer in breach of regulation 12.

At the inspection in August 2019, we found the servic

Updated 27 November 2021

Homewards Limited – 48 Leonard Road provides accommodation with personal care for up to four people with a learning disability or autistic people. At the time of this inspection there were three people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and/or autistic people.

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

The service could show how they met the principles of Right support, right care, right culture. The provider had made significant improvements to the service since the last inspection.

Right support:

The model of care and setting maximised people’s choice, control and independence. People lived in a small homely environment where they felt safe and comfortable. The provider had made improvements to the health and safety of the service in relation to the maintenance of the property and ensuring risk assessments were more detailed. Staff supported people to live up to their goals and aspirations. People were encouraged to make choices and decisions in accordance with their level of understanding.

Right care:

Care was person-centred and promoted people’s dignity, privacy and human rights. The provider had made improvements around staffing of the service in relation to recruitment checks, numbers of staff and their deployment. People were supported to maintain their privacy and dignity by a staff team who knew them very well. Staff demonstrated they provided kind and compassionate care to people and relatives. People were supported to maintain links with their culture and family. Staff engaged people in a variety of indoor and outdoor activities in accordance with individual care plans.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive and empowered lives. People’s representatives and staff spoke positively of the new registered manager and the positive changes they had made to the care provided. The provider had made improvements since the last inspection and now had a regular system of quality checks. People and their representatives were asked by the provider about their opinions of the service.

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’s care and support was provided in a safe, clean, and well-maintained environment which met people’s sensory and physical needs.

• People were protected from abuse and poor care. The service now had enough appropriately skilled staff to meet people’s needs and keep them safe.

• People had their communication needs met and information was shared in a way that could be understood.

• People’s risks were assessed regularly in a person-centred way. Risk assessments were now more detailed and robust. People had opportunities for positive risk taking and were involved in managing their own risks whenever possible.

• People who had behaviours that could challenge themselves or others had proactive plans in place to reduce the need for restrictive practices. Systems were in place to report and learn from any incidents where restrictive practices were used.

• People’s care, and support plans, reflected their sensory, cognitive functioning needs. Support focused on people’s quality of life and followed best practice.

• People received care, support and treatment from trained staff and specialists able to meet their needs and wishes. Managers ensured that staff had relevant training, regular supervision and appraisal.

• People and those important to them, including advocates, were actively involved in planning their care. Where needed a multidisciplinary team worked well together to provide the planned care.

• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

• Where people were at risk of placement breakdown there was a clear support plan and regular care reviews. Staff worked well with other services and professionals to prevent admission to hospital.

• People were supported by staff who understood best practice in relation to learning disability and/or autism.

• Governance systems ensured people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them, worked with leaders to develop and improve 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 25 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after this inspection to show what they would do and by when to improve.

We carried out an unrated targeted inspection (published 19 September 2020) due to concerns raised by a whistleblower about lack of activities, reporting of accidents and incidents and food and nutrition. We found no evidence at this time that people were at risk of harm from these concerns.

During this comprehensive inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 25 October 2019. 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this inspection to provide assurance that the service is applying the principles of Right support, right care, right culture.

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 Homewards Limited – 48 Leonard Road on our website at www.cqc.org.uk.

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.