We carried out a review of the data available to us about Homestead Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Homestead Care Home, you can give feedback on this service.
We found the following examples of good practice.
¿ A pre-booked visiting system was in place and a visiting pod was used for relative visits. Relatives could access the pod from the outside, so they did not walk through the home which minimised the risk of infection being taken into the home.
¿ If people were unwell arrangements could be made for their relatives to visit them. Relatives were required to wear full Personal Protective Equipment (PPE) and take a COVID-19 test to ensure their visit could take place safely.
¿ Zoning was used where possible to reduce the number of staff and people in any one area to reduce the risk of any infection transmission within the home.
¿ Infection Prevention and Control (IPC) guidance had been followed when new people had been admitted to the home. This action helped to prevent infection being brought into the home.
¿ COVID-19 test kits were plentiful. Staff were required to take a COVID-19 test three times a week and people every 28 days. Where people or staff tested positive, they were required to self- isolate in line with current guidance.
¿ Changes to lounge and dining room areas had been made to allow some social distancing. A large wooden sturdy gazebo had been erected in the garden enabling a dry space for people to spend time outdoors.
¿ The premises were adequately clean. Appropriate cleaning products were used and staff followed the providers cleaning schedules.
Homestead is a ‘care home’ that is registered to provide personal care and accommodates up to 33 people. There were 26 people living at the home at the time of the inspection.
People’s experience of using this service:
Since the last inspection in April 2018 we found improvements had been made to address the areas we identified as requiring improvement and the breaches of regulation had been met. However, we did find that further improvements were required to ensure the consistency of care records and that management audits and checks are robust enough to identify all areas that require action to be taken.
People were supported by staff to stay safe and who treated them with respect and dignity and encouraged them to maintain their independence.
People were supported to receive their medicines as required and were supported by staff who were aware of the risks to them on a daily basis.
Staff had a good understanding of the importance of gaining consent from people before providing support and the registered manager had a good understanding of the principles of the Mental Capacity Act (MCA). However, we found that improvements could be made in the provider’s paperwork to record assessments to ensure the principles of the act were promoted consistently.
Staff received training that was appropriate to them in their role and supported them in providing care in the way people wanted.
Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing. Care was provided in the way that people preferred, and people felt able to raise any concerns they may have with staff.
People gave positive feedback about the choice of food provided which they told us they enjoyed.
We saw people were offered regular drinks throughout the day to support their wellbeing.
People, relatives and staff all told us there had been an improvement in the activities provided and we saw people enjoyed a range of activities.
Staff felt supported and said they could talk to management and felt confident any concerns would be acted on promptly.
People, relatives and staff spoke of improvement within the service since the last inspection. The provider worked in partnership and collaboration with other key organisations to support care provision.
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 requires improvement (published 28 November 2018) and there were two breaches of regulation and a warning notice was issued to the provider stating governance arrangements needed to improve. 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, although improvements needed to ensure the consistency of care records and that management audits and checks are robust enough to identify all areas that require action to be taken.
Why we inspected:
This was a planned inspection based on the rating at the last inspection.
Follow up:
We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
Homestead Care Home name 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 a maximum of 33 people in one adapted building.
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. There was a new manager who had recently joined and was present during our inspection. At the time of our inspection they had started their application to become registered manager and this was accepted on 9 May 2018.
People and relatives consistently told us the service was safe. The registered manager was driving necessary improvements to the safety of the service, such as recruitment processes, moving and handling support and medicines management. Although staffing levels had recently increased, staff were, still not always available to safely meet all people’s needs. We also found some approaches to risk management did not promote people’s freedom as far as possible.
Systems did not ensure people were always supported as needed with their meals and drinks to remain well, although we also received some positive feedback about this aspect of people’s care. Staff were not supported to develop the skills and knowledge needed for their roles which we saw impacted on how people were supported to make choices, and how people were supported to live with dementia and with behaviours that may challenge. Improvements were ongoing in this area. Staff reported improved support from the new registered manager who was addressing training and support needs. Overall people and relatives expressed satisfaction with the support provided and spoke positively about staff. People were supported to access healthcare support. Home developments were underway to enhance people’s comfort and experience.
We received consistent feedback about the caring approach of staff and there were genuine and positive relationships between people, relatives and staff. People were supported to express their views and choices about their care. We observed a respectful approach from staff and people were treated kindly. However, people did not receive a consistently caring service. The care and support provided did not always meet people’s needs and therefore ensure people were always treated with respect and to have their independence promoted as far as possible. Staff were also not always available to spend time with people and to reassure them if issues arose.
Relatives and staff told us group activities of interest were usually offered, however we did not find that people had good access to their interests and activities of choice. Continued improvements were required and ongoing to people’s care plans so these would reflect people’s current needs and wishes. People and relatives were involved in care planning processes and expressed satisfaction with the support provided. People and relatives felt comfortable making complaints and could be confident they would be addressed.
The provider’s systems to assess, monitor and improve the service were not always effective. Systems did not ensure incidents were always learned from and investigated, and that relevant partner agencies were always informed of safeguarding concerns when necessary. This was in breach of two regulations and we are deciding our regulatory response to this. We will publish a supplementary report once this decision is finalised.
We identified another breach of the regulations because people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
Systems and processes were not always effective to ensure the quality and safety of the service. A new registered manager had joined the service and was driving improvement in priority areas such as to people’s care planning, and support and training for staff. Improvements were underway with engagement from people, relatives, staff and other stakeholders. Feedback consistently showed the provider and new registered manager were open and committed to driving up the quality of the service. People, relatives and staff spoke positively about this, their current experiences of the service and the caring approach of staff.
You can see what action we told the provider to take at the back of the full version of the report.