Homeleigh

About the service

Homeleigh is a 'care home' providing accommodation and personal care to older and younger adults with a diagnosis of either mental health and/or learning disability and autism. At the time of our inspection there were 15 people living at the home. Three people were in receipt of the regulated activity personal care.

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

Right Support:

The home did not give people care and support in a safe, clean, well equipped, well furnished and well maintained environment that met their sensory and physical needs.

The support for people to achieve their aspirations and goals were not consistent or effective. We could not be assured that care was person centred.

People were not supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture:

The culture had been impacted by changes to management and it was not clear if people were supported to live empowered lives.

The provider had submitted an application to CQC prior to the inspection to remove the service user band for learning disability and autism and were looking at alternative placements for people with this diagnosis.

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 26 July 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.

Enforcement

We have identified breaches in relation to safe care and treatment, person-centred care, premises and equipment and good governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

All staff received specialist training to ensure they understood how to prevent the spread of the Covid-19 virus. Staff were supervised and monitored to ensure they followed these guidelines.

The cleaning schedule for the home had been reviewed and domestic hours increased, however, processes to ensure frequently touched areas were cleaned more often needed to be strengthened.

Procedures for entering the home needed to be strengthened. The lobby area was not monitored robustly enough to make sure entry was supervised. This meant people could gained access without complying with the visitors Infection Prevention and Control (IPC) procedures the service had in place.

The procedure for entry was based on best practice guidance and included, completing a lateral flow 20-minute Covid-19 test, or (for health professionals only) evidence of a negative laboratory PCR test result within 72 hours of the visit. Visitors were also expected to have a temperature check, complete a health questionnaire; cleans their hands and put on appropriate personal protective equipment (PPE) before entering the main part the building and meeting staff or tenants. The results of all checks and tests had been recorded.

Risk assessments had been completed and mitigating action taken to promote the health and wellbeing of high-risk staff.

Systems were in place and action taken to ensure all stakeholder were kept informed of IPC rules. This included regular staff and tenant meetings, an ‘open door’ policy for discussions with individual staff or tenants, use of social media and strategically placed Covid-19 information posters.

Action was taken to keep friends and families in touch and regular video and phone calls were facilitated.

Staff and people were regularly tested in line with the current government COVID-`19 testing program and had received Covid-19 vaccinations in line with the government vaccination programme.

Homeleigh is a is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 32 people with mental health needs. At the time of our inspection there were 28 people living at the home, but just seven people were in receipt of the regulated activity personal care.

At our last inspection on the 16 and 17 May 2017 the overall rating of the service was 'requires improvement'. We issued two warning notices in relation to breaches of regulations concerning the provision of safe care and treatment and good governance. This meant we sent a formal notice to the provider that they must become compliant with the regulations by 30 August 2017. The provider sent us an action plan to tell us the improvements they would make in order to become compliant with the regulations. At this inspection we found the provider had made significant improvements and they were meeting the requirements of the regulations.

The service had a registered manager in place. 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.

We found arrangements in place for the safe management of people's medicines and regular checks were undertaken. However, we found the medicines clinic room temperature was exceeding the recommended temperature of 25 degrees. The provider attempted to resolve this problem with fans, but this had not been successful.

We found improvements in how the provider risk assessed people’s needs. Staff assessed and understood risks associated with people's care and lifestyle. Risks were managed effectively to keep people safe whilst maintaining people's rights and independence.

Recruitment included pre-employment checks to ensure people were of a suitable character to work in a care home environment. Staffing levels were consistently maintained to provide safe care and support to people.

People were protected from avoidable harm and abuse. Staff had good knowledge of the types of abuse and how to report them. Systems supported staff to record and take appropriate actions in line with their safeguarding policies and procedures.

People received effective care from staff who knew them well, and had the skills and knowledge to meet their needs. Staff monitored people's health and well-being and made sure they had access to social and healthcare services according to their needs.

People received personalised care and support, which was responsive to their current and changing needs. Care plans were developed with the input of people who were involved in decisions about their care and support. Care plans now captured people's goals and aspirations.

People were supported to enjoy an active lifestyle doing things that interested them and that they wanted to do.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). We saw that staff sought people's consent before providing care and support. Where people had been identified as lacking capacity to make certain decisions the service acted in accordance with legal requirements. Necessary DoLS applications had been made and subsequent conditions were complied with.

People living at Homeleigh were diverse and multi-cultural. Through talking to staff, we were satisfied the ethos and culture at the home was non-discriminatory and the rights of people from certain groups would be respected.

The home was well-led by an experienced registered manager. Staff were clear about their roles, responsibilities and values of the service. The provider had systems in place to monitor the quality of the service, seek people's views and make on-going improvements.

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.