Homefield Grange

Homefield Grange is a residential care home providing personal and nursing care for up to 64 people. The service provides support to older people, some of whom are living with a dementia. At the time of our inspection there were 45 people using the service.

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

Risks to people associated with malnutrition, dehydration and swallowing were not always managed safely. Medicines prescribed for as and when needed did not always have protocols in place to ensure safe administration. Some equipment was in a poor state of repair which meant cleaning to prevent infection was compromised. The service did not always meet their legal requirement to notify CQC of notifiable incidents. Governance systems were in place but had not identified areas for improvement identified as part of our inspection.

People told us they felt safe and had confidence in the staff team. Staff understood their role in recognising and reporting concerns of abuse or poor practice. People were supported by staff who had been recruited safely and there were enough staff, with the right skills and experience to meet people’s care and support needs.

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 supported by staff that had completed an induction and had on-going training and support that enabled them to carry out their roles effectively. People described the food as good and told us they had plenty of choice and access to drinks. People had access to healthcare for both planned and emergency events. The accommodation provided an environment that enabled people to maximise their independence and provided safe spaces inside and outside.

Staff spoke positively about the home, understood their roles and responsibilities, and felt supported by colleagues and the senior staff team. Staff described communication as good and were kept up to date and involved in developments through a range of meetings. Quality assurance systems and processes collected information and feedback that was used to drive improvements.

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 14 December 2021).

Why we inspected

We received concerns in relation to risks associated with eating and drinking, medicines and management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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 see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment and governance of the service.

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.

Homefield Grange is a residential care home providing personal and nursing care to 41 people aged 65 and over at the time of the inspection. The service can support up to 64 people. Homefield Grange is a purpose-built building providing accommodation and communal facilities over two floors. One floor specialises in providing care to people living with dementia.

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

People and their families told us they felt safe. Staff understood their role in recognising and reporting safeguarding or poor practice concerns. People had their risks understood by the staff team and actions to keep people safe from harm were followed, monitored and reviewed. Staff had been trained in infection, prevention and control and practices were in line with government guidance. People had their medicines administered safely. Recruitment practices included a variety of checks to ensure candidates were suitable to work with older people. Staffing levels ensured people had their care needs met.

People were supported to have maximum choice and control of their lives and staff supported did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff had an induction and on-going training and support which enabled them to carry out their roles effectively. People had their eating and drinking needs understood and met, including allergies and diets linked to health conditions. Effective working with other organisations meant that people received consistent care and had positive health outcomes. Building design, layout, adaptations and decoration maximised people’s level of independence.

People described the staff as friendly, kind and caring. Staff understood people’s individual communication needs which enabled them to involve people in decisions about their care. We observed staff respecting people’s dignity and privacy.

People were respected as individuals and received care that recognised their care needs, choices and lifestyles. Health and wellbeing staff provided a range of tailored activities that reflected people’s skills, interests and hobbies. People had an opportunity to be involved in end of life planning that included any cultural or spiritual needs. A complaints process was in place that people felt confident to use if needed.

People, families and staff spoke positively about the open and transparent culture of the service, visible leadership and teamwork. The management team understood their responsibility for sharing information with CQC and met the duty of candour requirements. This meant that they were open and honest and things that went wrong in the service. A range of meetings meant that people, relatives and staff had opportunities to be involved in service development. Quality assurance systems were robust and effective in identifying areas where outcomes can be improved for people.

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

Rating at last inspection

This service was registered with us on 12 June 2020 and this is the first inspection. The last rating for the service under the previous provider was good, published on 24 January 2018.

Why we inspected

This was a planned inspection based on the previous rating.

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 Grange 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.

People, staff and visitors to Homefield Grange were protected from risks of infection as policies and staff practices reflected government guidance. This included admissions to the home, staff deployment and people self-isolating when required.

Protocols for visiting were robust and overseen by trained staff ensuring health checks, protective personal equipment (PPE) and handwashing were carried out appropriately. PPE was used correctly, in good supply and available throughout the home.

Premises and equipment appeared clean and the correct cleaning products were being utilised. A cleaning schedule was in place, monitored daily and effective at identifying any actions needed to ensure people’s safety.

People and their families were kept up to date with government guidance through a weekly newsletter which included information on testing and vaccine arrangements. Legal requirements for obtaining consent for testing and vaccinating had been met.

People and the staff team were able to participate in regular testing in line with government guidance. Staff were up to date with IPC training including how to put on and take off their PPE safely. Training had included a simulated outbreak of Covid-19 enabling all staff to test their IPC knowledge and reflect on practice.

Further information is in the detailed findings below.

Homefield Grange is registered to provide accommodation for up to 64 people who require nursing or personal care. At the time of our inspection there were 32 older people living at the service. People required a mixture of residential and nursing care. The building provided single rooms with en-suite wet room facilities. The ground floor had a lounge area, garden room and dining room. The garden room and dining room had level access into a secure garden. Two specialist bathrooms were available, a treatment room and sluice area. Other amenities included a library, hair and beauty salon and cinema.

Homefield Grange 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 home had a registered manager. 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.

Medicines were ordered, stored, administered and recorded safely. One person had not received medicine for their bowels in line with their care plan. During the inspection this was investigated and actions taken to avoid a recurrence. When people were able to administer their own medicines risk assessments had been completed and reviewed regularly to ensure their safety. People had their risks assessed and reviewed regularly and staff understood the actions needed to minimise avoidable harm. Staff had completed infection control training and understood the actions needed to protect people from risks associated with infection control. Risks were discussed daily with the staff team which included reflective practice when things went wrong. People were supported by enough staff who had been recruited safely and trained to identify any signs of possible abuse and the actions they needed to take if they had concerns.

People had care and support plans that detailed their assessed needs and respected their individuality. Technology and equipment such as call bells and alert mats were available to support people’s safety and independence. Staff had an induction, on-going training and support that enable d them to carry out their roles effectively. People had their eating and drinking requirements met and were provided with a menu that offered a range of choices at each meal time. Both care and catering staff were aware of people’s likes, dislikes, allergies and specialist diets. The home had developed good working relationships with other professional agencies enabling positive outcomes for people when receiving care. When people needed access to healthcare they were supported by the service with both planned health check-ups and unexpected health issues.

All areas of the home were wheelchair accessible and any equipment people needed to help keep them safe or maintain their independence was available and in good working order. Signage had been placed around the home to help people orientate themselves independently.

People had their rights and choices respected in line with the principles of the Mental Capacity Act. When people were assessed as unable to make a specific decision these had been made in their best interest with the involvement of family, friends and health and social care professionals.

People and their families described the staff as kind and caring. We observed positive, friendly, patient interactions with people and the staff team and saw that people were treated with dignity and respect. Staff had a good knowledge of people and how they were best able to communicate which enabled people to share their views and be involved in decisions about their day to day care.

People and their families had been involved in initial assessments of peoples care and support needs. Staff had a good understanding of how people needed to be supported and the choices they made about their care. People had an opportunity to discuss their end of life wishes which respected their individuality. Assessments and care plans were reviewed monthly and any changes were communicated effectively to staff which meant people’s changing needs were understood and met.

The culture and communication systems promoted inclusion of people, families and the staff team who all spoke positively about the management of the home. Staff had a clear understanding of their roles and responsibilities and worked together as a team to drive improvements. Achievements and areas of improvement were discussed with staff and provided opportunities for reflecting on practice, learning and supporting sustainability. Information was shared with CQC and other statutory agencies in line with legal requirements.

Homefield Grange is registered to provide accommodation for up to 64 people who require nursing or personal care. At the time of our inspection there were 36 older people living at the service. People required a mixture of residential and nursing care. The building provided single rooms with en-suite wet room facilities. The ground floor had a lounge area, garden room and dining room. The garden room and dining room had level access into a secure garden. Two specialist bathrooms were available, a treatment room and sluice area. The first floor in addition had a library area, a shop selling sweets, toiletries, cards and gifts, and a cinema. There was also a hair and beauty salon.

The service did not have a registered manager. A manager had been in post for two months and was in the process of registering with the Care Quality Commission. 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.

People were at risk of harm as actions needed to minimise identified risks had not always been followed. Risk assessments did not always reflect the current practice being followed by care staff which meant people were not consistently protected from the risk of harm. Information collected to monitor risk was not always used to support reviews and evaluations of on-going risks.

People were at risk of harm as medicines were not always ordered, recorded or administered safely. Information had not been made available to care staff to ensure the correct administration of topical creams. Storage and administration safeguards for prescribed controlled drugs had not always been applied.

Management quality systems and processes were not effective in identifying areas of improvement which meant risks to people were not always being monitored. When actions had been identified they had not always been completed which placed people at risk of harm.

Staff understood how to recognise signs of abuse and understood their role in reporting concerns. People were supported by enough staff and they had been recruited safely which included criminal record checks and obtaining references.

A new manager had been in post for two months and staff spoke positively about the impact they were having on the service. Staff had been involved in setting values for the service and felt involved and appreciated.

Staff told us communication in the home had improved. Meetings had begun to be held with all staff teams and minutes had been shared with staff which identified actions agreed, who was responsible and a time deadline.

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

Homefield Grange is registered to provide accommodation for up to 64 people who require nursing or personal care. At the time of our inspection there were 32 older people living at the service. People required a mixture of residential and nursing care. The building provided single rooms with en-suite wet room facilities. The ground floor had a lounge area, garden room and dining room. The garden room and dining room had level access into a secure garden. Two specialist bathrooms were available, a treatment room and sluice area. The first floor in addition had a library area, a shop selling sweets, toiletries, cards and gifts, and a cinema. There was also a hair and beauty salon.

The registered manager had left their employment the week prior to our inspection and the operations manager was acting as the interim manager until the post was filled. 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.

People were not consistently protected from the risk of harm in relation to dehydration, malnutrition or skin damage. Actions and processes had been put in place to minimise the risk but these were not being consistently followed. People were at an increased risk of not having their medicine administered safely as errors had not been reported appropriately. People were not being protected from the risk of deterioriating skin or health conditions that were treated with topical creams as these were not being managed as prescribed. Auditing systems were in place but they had not highlighted that systems and processes in place to protect people from risk were not operating effectively. When actions had been identified through the auditing process they had led to positive changes for people.

Not all senior staff understood their responsibilities for reporting incidents which meant that information had not always been shared with other external agencies. This meant that processes designed to provide oversight and additional safeguards for people were not always being followed. People and their families did not feel the service had always been well led which impacted on communication. They were positive about the new management arrangements.

People using the service told us they felt safe and that their right to make choices about risks they lived with were respected.

People were supported by enough staff that had been recruited safely as checks had been made to ensure they were safe to work with vulnerable adults. Induction, on-going training and supervision provided staff with the skills to carry out their roles.

The service was working within the principles of the mental capacity act. This meant that people were supported to make decisions and when they had been assessed as not being able to decisions were made in their best interest with the involvement of family and other professionals.

People were supported with their eating and drinking requirements and were offered nutritious meals with snacks and light meals always available. Choices of what to eat and where to take meals were provided and when needed equipment was provided to support people to eat and drink independently.

People and their families described the staff as caring and kind. Staff had a good knowledge of people and the ways they were able to communicate which meant they were able to support people appropriately to make choices and decisions about their day to day lives.

Care and support plans provided clear information to care workers about how people needed to be supported. People felt involved in their care and supported by staff who understood their care needs. Activities were available both in the home and the community and were often linked to people’s interests. A complaints process was in place which people and their families were familiar with and felt able to use if needed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Homefield Grange is registered to provide accommodation for up to 64 people who require nursing or personal care. At the time of our inspection there were 27 older people living at the service. People required a mixture of residential and nursing care. The building is on three levels and people were living on the ground floor. The first floor had not started to accept admissions but was furnished in preparation. All the rooms were single rooms with en-suite wet room facilities. The ground floor had a lounge area, garden room and dining room. The garden room and dining room had level access into a secure garden. Two specialist bathrooms were available, a treatment room and sluice area. The first floor in addition had a library area, a shop selling sweets, toiletries, cards and gifts, and a cinema. There was also a hair and beauty salon.

The home did not have a registered manager at the time of our visit. The manager had submitted their application to the Care Quality Commission and was awaiting the outcome. 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 checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.

We found that the service was not always working within the principles of the MCA. We observed one person being given liquid medicine which staff had disguised as orange juice. The service had a policy for medicines being administered covertly. The policy included guidance on the MCA and DoLs and had not been followed by the nursing team. During our inspection the service organised a best interests meeting with the person’s GP and family who had an enduring power of attorney.

We checked a persons’ care file that stated they did not have mental capacity. They had a pressure sensor mat in their room due to a risk of falling and if it was stood on it alerted staff. Although this placed restrictions on the person a best interest decision had not taken place. Files contained copies of power of attorney legal arrangements for people but staff did not always understand the scope of decisions the POA could make on a persons’ behalf. We discussed our findings with the services quality manager who told us that their findings had been the same and staffs understanding of the MCA and power of attorney were on the quality action plan.

Deprivation of Liberty Safeguards (DoLS) had been applied for people who needed their liberty to be restricted for them to live safely in the home. Staff were aware of people who had a DoLs authorisation in place. Care records also contained signed consent for sharing information, use of moving and handling equipment, photographs and vaccinations. We observed staff seeking verbal consent before supporting people with care.

People and their families told us that they felt the service was safe. Staff had undertaken safeguarding training and understood what types of abuse people may be at risk from and how to recognise any signs of potential abuse.

Risk assessments had been completed for people. Where a risk had been identified actions had been taken to minimise the risk. We spoke to staff who demonstrated a good understanding of people’s individual risks and the actions they needed to take to support the person and keep them safe. People had the freedom to make choices about how they lived with identified risks. Risk assessments had been regularly reviewed.

Accidents and incidents had been recorded. This included notes of any investigations and follow up actions needed. We saw that actions had included referrals to other professionals, contacting the safeguarding team at the local authority, reviewing risk assessments and changing people’s care plans.

People had individual personal evacuation plans in place. Staff had received fire training and fire equipment was tested weekly. Records showed us that regular checks were made of hot water temperatures, pressure mattress settings and moving and handling equipment.

We observed staff supporting people in a timely way. Staff told us they felt there were enough staff to meet peoples’ assessed needs. The home had reduced the use of agency care staff following a successful recruitment campaign.

We looked at staff files and found that staff had been recruited safely. Files contained evidence of references, criminal record checks and eligibility to work in the UK. Procedures were in place to manage poor practice.

Medicines were stored and administered safely by registered nurses. Senior care workers had also received medicines training so that they could be a second signature on medicines records when needed.

New care staff completed the Care Certificate Induction. The Care Certificate is a national induction for people working in health and social care who did not already have relevant training. Senior care staff and nurses had an induction appropriate to their role.

Staff told us they felt they had the training they needed to carry out their jobs. Training records were kept for each person and included dates for refresher training. Staff had opportunities for personal development and training. Nurses had been supported with clinical updates.

Staff felt supported and received supervision. Annual appraisals had been planned.

People had a choice of what they would like to eat and drink and where they would like to have their meal. Staff had a good understanding of risks associated with peoples eating and drinking. We observed people being supported with their meals in a personalised way. Some people had specialist plate guards and drinking beakers to enable them to eat their meal independently. People who needed staff to help them with their meal were supported in an unhurried way. People were weighed regularly and any significant weight loss was actioned. This included setting up charts to monitor food and drink intake and referrals to GP’s and dieticians.

People had good access to health care which included hospital specialists, chiropodists, dieticians and occupational therapists.

People and their relatives told us staff were caring. We observed staff interacting in a positive, relaxed way with people and their families. Staff demonstrated good communication skills and knowledge of the people they were supporting.

People felt they were involved in decisions about how they received their care. We observed staff asking people if and how they would like to be helped and giving people the opportunity and time to decide. People had access to an advocacy service that would be able to speak up on their behalf.

People had their dignity respected and were supported to maintain their independence.

A complaints process was in place and records were kept of any formal written complaint. Included in the records were details of any investigation, action and the outcome. Verbal concerns raised were not always recorded. We discussed this with the manager who told us they would discuss with staff the importance of recording and sharing any verbal concerns raised in the future.

People told us they felt staff listened to them. A suggestion box had been placed in the entrance hall for people and in the staff room for staff to use. Information was on display in the foyer about the complaints procedure and included details of the local government ombudsman.

Assessments had been carried out prior to people moving to the service. People had a plan of care that was individual to their care and support needs. Care plans had been reviewed at least monthly. People, and when appropriate their families, had been invited to care plan reviews.

Staff had a good knowledge of people and their care and support needs. One person had complex health problems which impacted on their risk of falling. Staff understood how to support the person and the importance of gathering information to support the review of the persons’ health and care.

Information had been gathered from people about their lives and included their likes and dislikes. Activities had been organised for people in groups and on a one to one basis. Friends and family were able to visit at any time and people were supported to maintain links with the local community.

People, families and staff told us they found the manager approachable and listened to them. They described the service as well organised. All the staff we spoke with had a positive attitude about their work and the service. Staff had a good understanding of their roles and worked as a team. Staff consistently spoke highly of the team work. A ‘Carers Award’ had been introduced to recognise staff achievements.

The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

Audits had been completed and had captured any areas where action was needed. We spoke with the quality manager who explained that the service had a schedule of audits that they checked each month. Areas that audits had highlighted required some further improvement had been put into a quality action plan. The action plan reflected the findings of the inspection. This demonstrated that the service quality monitoring systems were effective.

A quality assurance survey was sent annually to people, their families, staff and other stakeholders. The process had been carried out by an external company. Results had been shared with people and their families. A copy of the staff survey r