Homefield

Homefield provides nursing and personal care and support to older people, some of whom were living with dementia. At the time of the inspection, there were 41 people using the service.

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

People were not always protected from risks associated with their care and support. Risks were not always comprehensively assessed and documented within care plans and records. The service did not always work within the principles of the Mental Capacity Act (MCA). Systems and processes in place for managing and administering medicines was not always safe. We have made a recommendation to the provider referring to best practice for medicines management.

Care plans did not always identify and or reflect details of individual preferences or contain correct information about people’s needs, wishes and the support they needed to make decisions. Systems and processes in place for monitoring the quality and safety of the service were not effective in identifying the issues and concerns we found at this inspection. Actions were taken during and after the inspection to address these issues and concerns.

People told us they felt safe. Staff knew what action to take if they had any concerns. Accidents and incidents were managed and acted on. Safe recruitment practices were in place. People were protected from the risk of infection. Staff were supported through training and supervision. People were supported to maintain a healthy diet and had access to health care professionals when required.

People told us staff were caring and kind and they respected their dignity and independence. Care records were reflective of individuals needs and preferences. People were aware of the complaints procedures and knew how to raise a complaint. The provider worked in partnership with health and social care professionals to ensure people's needs were planned and met.

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 18 November 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation for the need for consent, safe care and treatment and good governance. We have also made a recommendation about safe medicines management.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standard 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:

The provider screened all visitors to the home for symptoms of acute respiratory infection before they could enter the home. Visitors were supported to follow the government's guidance on hand washing, sanitising and wearing personal protective equipment (PPE) before entering the home and social distancing whilst on the premises.

The registered manager told us there had always been enough staff to meet people’s needs throughout the pandemic. All staff had received training on COVID-19, infection control and the use of PPE. The registered manager carried out checks on agency staff to make sure they had received training on infection control, and they had been fully vaccinated.

There was an enhanced COVID-19 testing program in place for people using the service and for staff. When people or staff showed symptoms of COVID-19 they were required to self-isolate.

We observed staff wearing appropriate PPE and socially distancing throughout our visit. During our visit we saw the home was very clean throughout. The home had a dedicated housekeeping team that facilitated a cleaning schedule at the home.

Black, Asian and Minority Ethnic COVID-19 risk assessments were carried out with people using the service and staff to ensure they could live and work safely at the home. The registered manager told us they worked with the GP, health care professionals, the Clinical Commissioning Group (CCG), the Local Authority Commissioning Team and UK Health and Security Agency to ensure people received appropriate care throughout the pandemic.

The provider had a COVID-19 specific contingency plan in place which they had followed throughout the COVID-19 pandemic. The registered manager told us there were no restrictions on visiting at the home in accordance with the current guidance.

We found the following examples of good practice:

Staff received training and competency assessments in infection prevention and control. They had also completed training in donning and doffing PPE and demonstrated a good understanding of this training.

The home had procedures in place to reduce the risk of the spread of infection from any visitors. These included carrying out COVID-19 tests and health screening checks prior to entry, and ensuring visitors had access to appropriate PPE during their visit.

People and staff were regularly tested for COVID-19, in line with national guidelines for testing in care homes. Staff were aware of the symptoms to look out for that may indicate a person had COVID-19 and the home had procedures in place to isolate people if they became symptomatic or tested positive, in order to maintain safety. The provider followed national guidelines when admitting people to the home during the pandemic.

People and staff were encouraged to maintain social distancing whilst in the home and staff breaks were staggered in support of this. The home was clean and hygienic. The registered manager carried out regular infection control audits to help identify and act on any potential risks. The home had infection prevention and control policies which were regularly reviewed and reflected current national guidelines.

Homefield is a care home providing nursing and personal care to up to 42 people. The home is purpose built and accommodates people across three floors. It specialises in supporting people living with dementia.

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

Improvement was required to ensure any issues identified by the provider’s quality assurance systems were addressed promptly.

People and relatives spoke positively about their experiences whilst living at the home. Risks to people had been assessed and staff knew how to support people safely. There were enough staff on duty on each shift to safely meet people’s needs. The provider followed safe recruitment practices. People were protected from the risk of abuse because staff were aware of the different types of abuse and the action to take if they suspected abuse had occurred. People’s medicines were securely stored and safely managed. Staff were aware of the action to take to reduce the risk of the spread of infections. The also knew to report any accidents or incidents that occurred. The registered manager reviewed accident and incident information to look for trends and identify learning.

People’s needs were assessed before they moved into the home to ensure they could be effectively met. Staff were supported in their roles through an induction, training and regular supervision. People were supported to maintain a balanced diet. They had access to a range of healthcare services when required and staff worked to ensure people received consistent support when moving between services. The home had been built and adapted to meet people’s needs. Staff sought people’s consent when offering them support.

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.

Staff were kind and caring in their approach. They respected people’s privacy and treated them with dignity. People and their relatives were involved in decisions about their support. The provider had a complaints policy and procedure in place. People knew how to complain and expressed confidence that any issues they raised would be addressed. People were also involved in the planning of their care. Their care plans reflected their individual needs and preferences. The home offered a range of activities which people told us they enjoyed.

People spoke positively about the management and working culture of the home. The provider sought people’s views through regular meetings and the use of surveys. The registered manager and staff were aware of the responsibilities of their roles. The service worked with other agencies, including the commissioning local authority. The registered manager sought learning opportunities which helped to drive improvements at the home.

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

Rating at last inspection (and update)

The last rating for this service was good (published 11 April 2017). The service remains rated good.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Homefield is a 44 bedded nursing home situated in the London Borough of Bromley.

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 and associated Regulations about how the service is run.

In May 2016, the areas of safe, effective and well-led required improvement, caring and responsive were good and there was an overall rating of requires improvement with one breach under effective. At this inspection we found that the breach of the regulation was rectified.

People and their relatives told us that this was a nice place to live and staff provided very good support and care that was delivered in a respectful way. People were given the opportunity to do what they wanted and joined in the activities provided if they wished.

The home’s atmosphere was warm, welcoming and inclusive. Visitors during the inspection told us that they were always made very welcome. The home provided a safe environment for people to live and work in, was well maintained and clean. The décor was currently acceptable, although looking a little tired and the home had begun a refurbishment programme with flooring being replaced.

There were thorough up to date records kept, although some historic records required archiving. The care plans contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties appropriately.

The staff knew the people they worked with well including their likes, dislikes, routines and preferences. During our visit people received the same attentive service and everyone was treated equally. Staff had appropriate skills, qualifications and were focussed on providing individualised care and support in a professional, friendly and compassionate way. Whilst professional they were also accessible to people using the service and their relatives. Staff said they had access to good training, support and career advancement.

People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. They said the choice of meals and quality of the food provided was very good. People were encouraged to discuss health needs with staff and had access to community based health care professionals, if they required them. Two people were however not prompted in a timely manner to eat their lunch or drink.

The home’s management team were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

We took urgent enforcement action in response to these concerns and imposed a condition on the provider’s registration, requiring them to send us information on a weekly basis to demonstrate that the service was monitoring and reducing the level of risk to people. We also rated the service Inadequate for the key question ‘Is the service safe?’ The provider has since met the conditions of their registration and submitted the information to us demonstrating how risks to people were being safely managed.

We also found further breaches of regulations because staffing levels did not meet the provider’s assessed level of need and an allegation of abuse had not been shared with the local authority safeguarding team.

At this inspection we found that the provider had taken action to address the breaches we had previously identified. However we found a further breach of regulations because whilst staff sought consent when offering support to people and understood the requirements of the MCA, people had not always been lawfully deprived of their liberty in line with legal requirements. You can see the action we have told the provider to take in respect of this breach at the back of our report.

Homefield provides accommodation, nursing and personal care for up to 44 older adults in Bickley, Kent. At the time of our inspection the home was providing support to 38 people. The home did not have a registered manager in post although the current manager was in the process of applying for the role. 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 that risks to people had been assessed and monitored and staff had taken action to manage risks safely. The provider had systems in place to monitor and mitigate risks to people but improvement was required to ensure audits of people’s care plans consistently identified errors. People were supported to maintain a balanced diet and risks associated with malnutrition were safely managed.

There were now sufficient staff to meet people’s needs, although improvement was required to ensure they were effectively deployed at all times within the service. Appropriate recruitment checks were in place to ensure applicants were suitable for the roles they were applying for, although improvement was required to ensure that any gaps in applicants’ employment histories had been considered by the service

Staff received training and supervision in support of their roles and told us this support gave them the skills to meet people’s needs. People were protected from the risk of abuse because staff knew the action to take if they suspected abuse had occurred.

People had access to a range of healthcare professionals in support of their health and well-being when required. Medicines were safely stored and people received their medicines as prescribed. Accurate records were maintained of the administration of people’s medicines but improvement was required to ensure people’s medicines care plans were reflective of their current needs.

Where people lacked capacity to make specific decisions about their care staff, relatives and healthcare professionals, where appropriate had been involved in making the decisions in people’s best interests.

People told us that staff were kind and considerate. Staff treated people with dignity and respected their privacy. People were involved in making day to day decisions about their care and staff respected their choices. They had individual care plans in place which had been developed by staff based on an assessment of their needs and feedback about their preferences.

The provider sought feedback from people and relatives which they used to drive improvements within the service. People told us they felt improvements had been made under the new manager and staff told us that the management team listened to them and provided them with support when required.

People and relatives knew how to raise concerns and told us they were confident that any issues they had would be addressed promptly and appropriately.

We found the provider had made improvements to ensure that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Families we spoke with told us that they were consulted about plans for relatives, including plans for end of life care and a some said they visited every day and were fully involved in caring for their relative, and in decisions about such issues as medication.

The provider carried out appropriate checks to ensure that staff were of good character, and had skills and experience in providing care for people before they started employment. Staff records we saw were well maintained, and contained all relevant recruitment and employment information.

We found that there were enough staff who were skilled and experienced to provide safe and responsive care for people who lived at the home. One person said: 'there are always enough staff around when we need them, they are caring and helpful'. Another person said: 'the manager is around most days, and comes in at weekends sometimes to meet relatives for care reviews or when we feel we need to talk'. This was reflective of comments we received from all of the people we spoke with.

However, on our recent visit we also found that the provider had not always correctly assessed people's capacity to make decisions.