This inspection was unannounced and took place on 5 and 6 November.
Homelands is registered to provide care and support for up to 20 adults and older people living with mental illness or dementia. At the time of this inspection, there were 14 people living at the home, five of whom were older persons living with dementia and nine were adults living with Korsakoff’s syndrome or mental illness. Korsakoff’s syndrome is a brain disorder commonly associated with misuse of alcohol.
A registered manager was not in post when we visited. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. This post has been vacant since 10 May 2014. Since then there has been three managers employed. The most recent manager was appointed approximately five weeks before our visit; they were present at this inspection. The provider has since notified us that this manager has left and another manager has been appointed. This has had an impact on the consistency and leadership of the service.
People said they felt safe at Homelands. We observed staff delivered care and support to people safely, with compassion and understanding.
Staff were able to identify signs of possible abuse and knew what to do if they witnessed them. However, not all staff had received up to date training in this area.
We observed that staffing levels ensured people’s immediate needs could be met safely. However, the feedback we had from people, staff and the manager was that the current staffing levels did not always ensure people had social stimulation and access to activities of interest. In addition there was no system to allow the provider or manager to assess the staffing levels required based on people’s needs.
Medicines were been stored, administered and managed safely.
People said the food was good and there was a choice. Where necessary, people were given appropriate support to eat.
Care records indicated risk assessments had been carried out but the information included in them was vague. Identified risks had not been transferred to care plans and records of care and treatment to be provided were not up to date or complete. Guidance for staff on how to mitigate risk was not clear or updated. This meant risks to people may not be effectively managed to reduce the likelihood of occurrence or recurrence.
Information held in care plans had not been kept updated to ensure it reflected people’s current needs. The details included in care plans to guide staff were not sufficiently clear or kept updated to ensure staff knew how to support people with their current needs. Although people said they were consulted in decisions about their care, there was not documentation of this to confirm how people or their representatives were involved.
A limited programme of activities had been provided. However, it was not clear how activities were provided for the needs of people who needed more staff support. This meant they were at risk of isolation and withdrawal.
Staff had not routinely received induction and supervision to ensure they had the necessary skills and knowledge required to carry out their work. Staff training records indicated training had not been kept up to date and some staff had received no training at all in some essential areas, such as understanding dementia, safeguarding and managing challenging behaviour such as aggression.
Staff had not received appropriate training to ensure they understood their role in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring that any restrictions to their freedom or liberty has been authorised by the local authority as being required to protect the person from harm. We did see examples of how best interest decisions had been made appropriately on behalf of people who did not have the capacity to consent to decisions about their care. However we found that appropriate mental capacity assessments had not been completed to determine people’s decision-making capacity before making a DoLS application for potential restriction of people’s liberty.
People and the staff had been asked for their views of the quality of the service. However, there was no evidence which demonstrated how comments and suggestions received had been considered and, where appropriate, implemented to improve the service.
A quality assurance system was not in place to monitor how the service had been provided and to identify and respond to shortfalls.
We have identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.