This inspection took place on 15 February 2016, was unannounced and was carried out by one inspector. Homeville is a privately owned care home providing personal care and support to up to three people who may have learning disabilities and complex needs. People may also have behaviours that challenge and communication and emotional needs. There were two people living at the service at the time of the inspection.
The service is a terraced property close to the centre of Margate. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had access to a vehicle which was shared with the providers other nearby service, to access facilities in the local area and to access a variety of activities.
There was a registered manager working at the service and they were supported by a deputy manager. They were also the registered manager of the other service owned by the provider which was close by. 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. The registered manager and staff supported us throughout the inspection.
The registered manager had worked at the service for many years firstly as a support worker and then as the deputy manager. They became the registered manager of the service in August 2015. They knew people and staff well and had good oversight of everything that happened at the service. The registered manager and deputy led by example and promoted the ethos of the service which was to support people to achieve their full potential and to be as independent as possible. The registered manager and provider made sure there were regular checks of the safety and quality of the service. They listened to peoples’ views and opinions and acted on them.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some of people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLs authorisations for people who were at risk of having their liberty restricted and some approvals had been granted. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.
Before people decided to move into the service their support needs were assessed to make sure the service would be able to offer them the care that they needed. People indicated that they were satisfied and happy with the care and support they received. People were involved with the day to day running of the house. The service was planned around people’s individual preferences and care needs. The care and support people received was personal to them.
People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People had key workers that they got on well with. Staff had built up relationships with people and were familiar with their life stories, wishes and preferences. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.
Staff asked people if they were happy to do something before they took any action. They explained to people what they were going to do and gave them the time they needed to respond. Throughout the inspection people were treated with dignity, kindness and respect. People privacy was respected and they were able to make choices about their day to day lives.
People were involved in activities which they enjoyed and indicated that they wanted to do them again. Planned activities took place regularly. People had choices about how they wanted to live their lives. Staff respected decisions that people made when they did not want to do something and supported them to do the things they wanted to.
Throughout the inspection we observed people and the staff as they engaged in activities and relaxed at the service. Some people could not communicate fully by using speech and staff understood the needs of the people they supported. Staff were able to understand people through body language, facial expressions and behaviours and supported people in a discreet, friendly and reassuring manner. Staff anticipated or interpreted what people wanted and responded quickly. There were positive and caring interactions between the staff and people. People were comfortable and at ease with the staff.
Staff supported, monitored and recorded what people were achieving and how they were developing. People’s individual religious preferences were respected and staff supported people to attend church services.
Potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. We did find that some areas concerning risks to people needed reviewing and action needed to be taken to make sure people were as safe as possible. The registered manager told us these would be addressed immediately. On the whole there was guidance in place for staff on how to care for people effectively and safely and keep most risks to minimum without restricting their activities or their life styles and promoting their independence, privacy and dignity. The complaints procedure was on display in a format that was assessable to people. If people, staff or relatives made a complaint they would be listened to and action would be taken.
People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed. The registered manager monitored incidents and accidents to make sure the care provided continued to be right or whether it needed to be changed.
People said that they enjoyed their meals. People were offered and received a balanced and healthy diet. They had a choice about what food and drinks they wanted and were involved in buying food and preparing their meals.
People received their medicines safely and when they needed them. They were monitored for any side effects. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. On a few occasions the room temperature where the medicines were stored exceeded the recommended level. This had been identified by staff and action to rectify this was taken on the day of the inspection. People’s health was monitored. People had regular reviews and appointments with doctors and specialist services. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.
The management team made sure the staff were supported and guided to provide care and support to people enabling them to live fulfilled and meaningful lives. Staff said they could go to the registered manager at any time and they would be listened to. Staff had received regular supervisions (one to one meetings with a senior member of staff). They had an annual appraisal so had the opportunity to discuss their developmental needs for the following year. Staff were positive about the support they received from the registered manager to make sure they could care safely and effectively for people.
A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. There was enough staff to take people out to do the things they wanted to. New staff had induction training which included shadowing experienced staff, until they were competent to work on their own. Staff had core training and more specialist training, so they had the skills and knowledge to meet people’s specific needs. Staff fully understood their roles and responsibilities as well as the values of the service.
Emergency plans were in place so if an emergency happened, like a fire the staff knew what to do. Safety checks were done regularly throughout the building and there were regular fire drills so people knew how to leave the building safely.
Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support and to be part of the continuous improvement of the service. Staff told us that there was an open culture and they openly talk to the registered manager and the deputy manager about anything.
The provider had recently developed a programme for auditing all the systems used at the service. This had not yet been implemented. The registered manager was auditing the systems and when shortfalls had been identified they had been addressed and improvements had been made, although the provider was not always checking that action was taken.
The provider asked people, staff and relatives and other stakeholders like doctors or community specialists about what action they thought the provider could take to make improvements.
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