Homeleigh

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Some improvements had been made in the way medicines were handled since our last inspection, but we identified a continuing breach of regulation in relation to safe care and treatment. The systems and processes in place for managing medicines were still not effective. Infection prevention and control had improved. Regular cleaning schedules and audits were in place. The local authority infection control team had completed an audit in September 2023. The provider achieved a satisfactory level of compliance. The home also had a 5-star rating for food hygiene. The premises were in significant need of improvement throughout. Some work had been completed since the last inspection and further works were planned. However, the environment still fell short of the standards required. Some furnishings needed replacing, walls had cracks and the décor was in a poor condition. The flooring needed replacing and bedrooms, toilets and bathrooms were tired and worn and did not provide a pleasant environment. Staff had been trained and understood safeguarding and whistleblowing. Staff understood the Mental Capacity Act and gave examples of how they applied it in practice. People did not report any concerns about how risks in their care were managed. Care plans detailed what the risks were for each person and the measures in place to manage this safely. Systems were in place to record any incidents and accidents and staff reported a culture where actions were taken in response to any shortfalls identified. Staff were recruited safely and had the appropriate pre-employment checks in place before starting work. Staff were inducted and trained to carry out their roles and the majority were positive about the support they received.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us staff listened to them and they were encouraged to raise any concerns they may have.

Staff told us there was a culture of safety and learning. Good systems were in place with effective oversight from the provider. This ensured incidents and accidents were managed safely with actions taken to address shortfalls.

All incidents had been reviewed by a manager. An electronic system ensured a process was followed and authorisation was required before an incident could be closed.

People told us staff listened to them and understood their needs. They told us professionals involved in their care worked well together.

The registered manager was working collaboratively with different local authorities and families to support people to move to new premises. This was at an advanced stage and staff told us they were looking forward to the move to new premises.

A Performance & Quality Improvement Officer from Adult Social Care shared the most recent action plan used to support the home. There were no concerns shared about unsafe pathways or transitions.

Policies were in place to support admissions and transitions if people planned to leave. Plans were currently in motion for people to move to new premises and processes had ensured people and their families were involved.

People told us they felt safe. People were supported to understand safeguarding and what being safe meant to them.

Staff were supported through their induction and training to understand their safeguarding responsibilities. We discussed safeguarding with 6 staff and checked their learning in practice. They all understood what the different types of abuse were and when to report concerns. They were confident managers would respond appropriately. Staff understood the principles of the Mental Capacity Act. People’s capacity was assessed and where people lacked capacity best interest decisions were made.

We observed staff supporting people in line with their assessed capacity and any authorised DoLS.

The safeguarding and whistleblowing policies guided staff on when and how to raise concerns. Suitable processes were in place to safeguard people including oversight of people’s mental capacity and any DoLS applied for and granted.

People were supported to understand the risks they may be exposed to. Regular monthly reviews took place with staff. People told us staff involved them.

The guidance to manage risks in people’s care plans were clear. Staff told us, ‘Yes, they are clear. They have definitely improved.’

We spent time observing one person who had 1-1 staffing when at home. We also reviewed their care plan. Staff knew the resident well. There was a balanced and proportionate approach to risk that supported the resident and respected the choices they made throughout the day.

People had monthly key worker reviews and post incident reviews where the management of risk could be discussed. People had some restrictions in place, but these were kept to a minimum. However, the guidance in one care plan needed updating to ensure the information around one risk was clearer and complete.

People told us the environment was both clean and safe. However, we observed the premises were not maintained to the required standard and these concerns were shared by visiting professionals who had provided feedback. They told us, ‘‘The building is tired and old and it is my understanding that it is closing down so that it can have renovations’ and ‘I feel that the building is old and unkempt, it can sometimes smell of smoke. There is paint peeling off the walls.’ The building was old and its upkeep had been compounded by storm damage to the roof in 2023 which resulted in the 3rd floor remaining closed. Maintenance costs and the cost to fully renovate were too high. A positive decision had been made to relocate and plans were at an advanced stage to support people to move to new premises in the local area during 2024.

Senior management acknowledged a lot of work was required to improve the building and this is why a decision had been made to move to new premises. Staff told us there had been a big improvement since last year. The new regional manager was more proactive and this had resulted in a more consistent approach to maintenance. Staff reported no safety issues but had concerns about the overall condition of the premises. They told us, ‘It is a lot safer now. No concerns’ and ‘The environment is very poor and I understand the owners don’t want to spend money before they move but people have to live and work here. There have been some improvements.’

Effective environmental checks to ensure safety were now in place. A recent issue in relation to the safety of a side entrance, reported by family prior to the inspection, had been resolved. The home employed a maintenance worker, and the regional manager was very proactive and responded to any shortfalls. This included a prompt response to our concerns about the safety of a window in the medicines room. The air conditioning unit used the window as a vent. We were concerned, although the window was small, someone could gain access. Metal bars were put on the inside of the window to prevent this. It was acknowledged the new management team have made some positive improvements. However, the service has been owned by the provider for many years. During this time there has been significant deterioration in the property which had not been addressed sufficiently. This resulted in a very poor environment for both people living there and staff who had to work there.

Regular checks and systems were in place to ensure the environment was safe. This included daily walk arounds by the registered manager. Any shortfalls were quickly responded to, and the home had a maintenance worker onsite who could complete any required work. Proactive action had been taken to respond to the concerns raised by the fire service in May 2024. This included an updated risk assessment completed by an external contractor in August 2024 and immediate actions taken to address the shortfalls raised in May.

People told us staff had the skills to meet their needs. They told us, 'Most of them do’ and ‘Yes, the staff know me well and they know how to support me.' A family survey was completed by the family of one resident in May 2024. They stated they were confident their relative was supported by staff who have the right training and skills to meet their relative’s needs. One person completed a survey in May 2024 and confirmed the team had the right skills to support their needs and overall, they were happy with the support they received.

The home was fully staffed, and agency staff were not used. Staff retention was good, and staff knew people well. Staff told us they received the training and support required to carry out their role effectively. Staff had regular 1-1 supervision and they were positive about the support provided by senior managers. They told us, ‘They are brilliant, and they look after us’ and ‘Yes, they have supported me well and they really look after the staff.’ 14 staff completed a provider survey in November 2023 and 100% agreed they had the required skills to support people.

We observed safe staffing levels and good interactions between people and staff. Staff clearly new the residents well. There was a calm environment throughout the 2 days we spent on site.

There was a clear process in place to induct staff including a 90-day induction. Staff were safely recruited with all pre-employment checks completed prior to starting work.

People told us the environment was clean.

Infection, prevention and control (IPC) had improved since the last inspection, and this was confirmed by staff we spoke to. They told us, ‘The cleaning has improved in the last year’ and ‘Yes, there is more cleaning since the last inspection. It is better.’

The premises were in a poor condition and this made it harder to make it look clean and fresh. We observed some areas where improvement was required but we were in agreement that infection control and the cleanliness of the home had improved overall.

Regular cleaning schedules and audits were in place. A local authority Infection Prevention Control (IPC) audit was completed in September 2023. The provider achieved a satisfactory level of compliance. The home also had a 5-star rating for food hygiene and all staff had been trained.

We did not speak to people about their medicines support. Medicines administration was not managed safely. People were prescribed medicines that needed to be given at specific times in relation to other medicines or food according to the manufacturers’ guidance. This guidance was not followed, and people’s health was at risk because these medicines may not be effective as a result. Some people stayed away from the service for short periods to be with their families. When they returned to the service it was not always clear what medicines had been returned which meant that no checks had been made to ensure the medicines had been given as prescribed whilst on leave. When medicines with a ‘when required’ (PRN) dose was given, there was no record made of their effectiveness and sometimes the rationale for using it was not recorded as required.

The service completed audits; however, they had not identified the concerns highlighted during this assessment. Senior staff acknowledged the shortfalls identified during the assessment and took action to rectify the shortfalls post assessment. This included issues we had identified at the previous inspection.

Records about the administration of medicines were not always accurate. There were gaps in the records when staff had failed to sign if they had administered the medicine or not. Stock counts showed medicines had been given but had not been signed for. This placed people at risk of being given another dose of the medicine because the records looked as if they had not been given it. The process regarding monitoring people’s health conditions was not robust which placed them at risk of not having their health conditions safely managed.