This inspection took place on 16 August 2016 and was unannounced. Homeleigh provides accommodation and personal care for up to 16 people who need support with their mental health. The service is situated in the town centre of Deal where all amenities are close by. There were 12 people living at the service at the time of the inspection. The care and support needs of the people varied greatly. There was a wide age range of people living at the service with diverse needs and abilities. As well as needing support with their mental health, some people were living with dementia and other people required more care and support related to their physical health. Some people were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out on their own.
There was registered manager working at the service. The registered manager was supported by a deputy manager and team of staff. 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 and associated Regulations about how the service is run. On the day of the inspection both the registered manager and the deputy manager where on annual leave for one week. A senior care worker supported the inspectors throughout the visit. We spoke with the registered manager after the inspection.
At the last inspection in August 2015 we found breaches of regulations. At this inspection improvements had been made.
Major building work was being under taken at the time of the inspection. Environmental risk assessments for most areas that were being affected by the work were in place to keep people as safe as possible during the building works. These were reviewed regularly to make sure they remained current. The fire risk assessment had not been reviewed or updated since 2014 and fire risks had not been considered in relation to the building work being done. We asked the local fire officer to visit the service. The fire officer visited the service and recommended that the fire risk assessment be updated. This was organised by the staff and an external company completed the assessment. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. Safety checks were carried out regularly throughout the building and there were regular fire drills so people knew how to leave the building safely. Some personal emergency evacuation plans (PEEPS) needed more information.
The registered manager and staff carried out other environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements as a result.
At the last inspection not all risks to people had been kept to a minimum. At this inspection improvements had been made. Risks to people's safety were assessed and managed appropriately. Risk assessments identified people's specific needs, and showed how risks could be minimised. When new risks had been identified the registered manager had taken action to prevent them from re-occurring. Staff had updated risk assessments and passed the information to staff so that people would be safe.
A system to recruit new staff was in place. This made sure that the staff employed to support people were fit to do so. At the last inspection recruitment processes were not fully adhered to. At this inspection improvements had been made but there was an area that needed further improvement. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.
People felt safe in the service. Staff understood how to protect people from the risk of abuse and knew the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken. The registered manager responded appropriately when concerns or complaints were raised. People were cared for in a way that ensured their safety and promoted their independence.
Staff had completed induction training when they first started to work at the service and had
completed other basic training provided by the company. There was also training for staff in areas that were specific to the needs of people, like epilepsy and end of life care. At the last inspection staff had not received all the specific training they needed. At this inspection improvements had been made. Staff still needed some specific training like dementia and mental health awareness. These courses had been booked for the coming months.
People received care and support from a dedicated team of staff that put people first and were able to spend time with people in a meaningful way. Staff received regular one to one meetings with the registered manager and an annual appraisal to discuss their training and development needs. Staff were supported by the registered manager and felt able to raise any concerns they had or suggestions to improve the service.
At the last inspection decisions about care, support and treatment had not been made in line with the legislation. At this inspection improvements had been made. The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance and had been approved.
People said that they enjoyed their meals. People were offered and received a balanced and healthy diet. They had a choice about what food and drinks they wanted. If people were not eating enough or needed specialist diets they were seen by dieticians or their doctor and a specialist diet was provided. People received their medicines safely and when they needed them and they were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.
Before people decided to move into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People said they were satisfied and happy with the care and support they received. People received care that was personalised to their needs. People's care plans contained information and guidance so staff knew how to care and support people in the way they preferred. People or their relative /representative had been involved in writing their care plans. Everyone had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person's care and support and promoted continuity of support between the staff team. The service was planned around people's individual preferences and care needs.
People were put at the centre of the service. They told us they received care that was individual to them. They felt staff understood their specific needs. Staff had built up relationships with people and were familiar with their life stories, wishes and preferences. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent. People were involved in activities which they enjoyed. People talked animatedly about social events they had taken part in or were planning. Contact with people’s family and friends who were important to them was well supported by staff.
People were settled, happy and contented. Throughout the inspection people were treated with dignity and kindness. People's privacy was respected and they were able to make choices about their day to day lives. Staff were respectful and caring when they were supporting people. People were comfortable and at ease with the staff. Staff encouraged and involved people in conversations as they went about their duties, smiling and chatting with people. Staff spent time with people.
People, staff, relatives and visiting professionals told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness and transparency within the service. Staff were clear about their roles and responsibilities and felt confident to approach senior staff if they needed advice or guidance. They told us they were listened to and their opinions counted.
The aims and vision of the service was to provide quality care and support for people adults with
mental health needs. Their aim was to provide a safe and fulfilling life for adults with mental health needs. People told that they felt safe and they lived their lives the way they wanted to.
There were quality assurance systems in place. Audits and health and safety checks were regularly carried out action was taken when shortfalls were identified. The registered manager had formally sought feedback from people, their relatives and other stakeholders about the service. Their opinions had been captured, and analysed to promote and drive improvements within the service.
Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. This is so we can check that appr