Archived: Homefield Court

Homefield Court is a residential care home providing personal and nursing care to people aged 65 and over at the time of the inspection. The home can accommodate up to 24 people in one adapted building. When we inspected 23 people were living at the home.

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

Prior to our inspection the home had been inspected by the London Fire Brigade (LBS). The provider had subsequently been served with a LBS enforcement notice requiring them to complete a range of safety improvements. Some improvements had already taken place. The registered manager assured us other improvements would be completed within the timescales provided in the enforcement notice.

Regular hot water temperature monitoring had taken place. However, the hot water temperatures for taps in five people's rooms were significantly higher than they should have been. The registered manager took action to address this during our inspection.

Quality assurance monitoring had taken place. However, this had not identified and addressed risks associated with fire safety and hot water temperatures.

Maintenance and checks of other safety systems at the home had taken place.

People told us they felt safe. The provider had systems to ensure people were safe and protected from abuse and harm. Staff knew how to recognise abuse and understood the importance of immediate reporting of concerns. Risks to people had been identified and staff knew how to reduce these. People’s prescribed medicines were stored and given safely.

Recruitment of staff was safe and robust. Pre-employment checks had been carried before staff could commence work. People told us there were sufficient numbers of staff to support them.

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 at the home supported this practice. People were regularly asked for their views about the support they received.

There were arrangements to ensure that people’s nutritional needs were met. People’s dietary requirements, likes and dislikes were assessed and known to staff. People were able to choose what they ate and drank.

Staff members received regular training and supervision to ensure that they were able to carry out their roles effectively.

People’s privacy and dignity were respected. Staff understood the need to protect and respect people's human rights. People’s personal, spiritual and cultural wishes and needs were respected and supported.

People received personalised care. Their care plans had been regularly reviewed and updated to reflect people's changing needs and wishes. Staff supported people to take part in activities that were relevant and appropriate to them.

People and family members told us that they had no complaints, but they knew who to speak to if they did.

People, family members and staff told us the home was well managed.

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 20 April 2017).

Follow up:

We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

Homefield Court is a care home situated in Brent which is registered to provide care for to up to 24 older people. At the time of our inspection there were 24 people living at the home, the majority of whom were living with dementia or mental health needs.

We last inspected Homefield Court on 10 December 2015 when we found that there were regulatory breaches in relation to safe care and treatment, staffing and fit and proper persons employed. At this inspection we found these breaches had been addressed.

There was a registered manager in post. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who lived at the home told us that they felt safe, and this was confirmed by a friend of a person whom we spoke with. People were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting.

The home had arrangements in place to ensure people’s safety. However, we found that risk assessments did not always reflect the information and guidance for staff that was included in people’s care plans. The registered manager told us that this was because people's conditions were stable but that they would develop assessments for potential risks.

Medicines at the home were well managed. People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained. Regular health checks had taken place.

Staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the physical and other needs of people living at the home. People who remained in their rooms were regularly checked on.

Staff who worked at the home received regular relevant training and were knowledgeable about their roles and responsibilities. They received regular supervision from a manager to ensure that they were supported in their roles. Checks in relation to suitability of staff had been carried out prior to appointment.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about people’s capacity to make decisions was contained in people’s care plans. Applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority where people were unable to make decisions. Staff members had received training undertaken training in MCA and DoLS.

People’s nutritional needs were well met. Meals were nutritionally balanced and met individual requirements as outlined in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day. People told us that they enjoyed the food.

The home environment was suitable for the needs of the people who lived there. We saw that a number of improvements had been made including refurbishment of bathrooms and communal areas.

The home provided a range of individual and group activities for people to participate in throughout the week. Staff members engaged people supportively to participate in activities.

People knew what to do if they had a complaint. We saw that complaints had been dealt with quickly and to people’s satisfaction.

Care documentation showed that people’s health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the support that they needed.

There were systems in place to review and monitor the quality of the service, and we saw that action plans had been put in place and addressed where there were concerns. Policies and procedures were up to date and reflected regulatory requirements and good practice.

People who lived at the home and staff members spoke positively about the management. The registered manager and deputy manager spent time with people and covered care duties where required.

We used a number of different methods to help us understand the experiences of people who used the service, because many of them had complex needs which meant they were not able to tell us their experiences. We spoke with six people who used the service and with a visiting relative. We spent some time observing the interactions between staff and people using the service in the communal areas of the home. We spoke with four members of staff, including the Registered Manager.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Care and support were planned and delivered in a way that was intended to ensure people's safety and welfare. Assessments were carried out and reviewed regularly for aspects of health and safety. Care plans and risk assessments, for example for mobility, personal hygiene and communication, provided details of how best to support each person.

The provider carried out regular health and safety audits of the premises to ensure that they assessed and managed any risks to the health, safety and welfare of people using the service and others.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw evidence that relevant staff were trained to understand when an application should be made, and how to submit one.

Is the service effective?

Staff we spoke with told us that they felt well supported and received appropriate training and supervision to enable them to carry out their responsibilities and to care for people appropriately.

People we spoke with told us that staff were able to support them appropriately with their personal care and health needs. One person who had a specific medical condition said, 'The staff manage my health condition well. They understand what I need.'

Is the service caring?

Care plans contained detailed information about each person's specific needs for staff to follow.

People expressed their views and were involved in making decisions about their care and support. Care plans showed how people preferred their care to be provided. A visiting relative said, 'The staff are very caring. They are always available if I need to ask any questions. They ensure that my relative is involved in all decisions about their care and treatment.'

We observed that staff interacted with people in a respectful and sensitive manner. They took time to assist people and spoke with them while they assisted them.

Is the service responsive?

The provider carried out satisfaction surveys and monitored the responses and any concerns. There were regular meetings for people who used the service and for staff. However there was no formal system for asking people for their views on their care and support and recording them and taking any consequent actions. The provider's complaints policy had not been updated since 2009 and contained some information that was incorrect and out of date. The last recorded complaint was in August 2008.

We saw that staff carried out monthly evaluations of each person's individual care plans. However any changes needed following the evaluation were not recorded in the original care plan. This meant that staff would need to read through all the monthly evaluations for each care plan to ensure that they had the most up to date information on how to understand and support the person.

Is the service well-led?

The Registered Manager supported and encouraged staff to understand the ethos of the home and to improve the quality of the services they provided. Staff we spoke with said that managers provided them with good support and they were clear about their roles and responsibilities.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They carried out regular health and safety audits of the premises and annual quality surveys of the views of people using the service and their family members. There were regular residents' meetings and staff meetings where people who used the service and staff could express their views about the service.

We found that people were cared for in a clean, hygienic environment. The home was clean in all the areas that we visited.

Most of the people who we spoke with and observed said that they were happy in the home and that they were consulted about their wishes. The care plans that we saw were written taking the person's views and preferences into consideration.

The care plans provided clear information on each person's health care needs. We spoke with a visiting community psychiatric nurse (CPN) who told us that the staff provided very good care for people with mental health needs. However care plans and risk assessments were not reviewed and updated regularly.

Medicines were safely administered, but they were not kept safely and were not disposed of appropriately.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive or to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Staff respected people's privacy and knew about their roles and responsibilities in meeting the needs of people that they supported in a sensitive and respectful manner. We saw people using the service approach staff without hesitation and they accessed their bedrooms and communal areas freely within the home.

Each person had a plan of care that had been regularly reviewed, and included information about the individual support and care that they needed. People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. There were enough skilled and experienced staff to meet people's needs.

Records were accurate and stored securely.