Homecroft Residential is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home houses up to 26 people in one adapted building with a garden to the front of the property.

The inspection took place on 25 October 2018 and was unannounced. At the last inspection in November 2016 we rated the service Good. At this inspection we found the quality of the service had deteriorated. We found medicines were not consistently managed in a safe way and the quality and format of care plan documents and risk assessments needed improving. The service had had three managers in the last 12 months and needed stable management to ensure consistent policies, procedures and systems were established.

A registered manager was not in place. 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. A new manager had been in post for two weeks. We found the new manager to be open and honest with us. They had recognised many of the issues we found during the inspection and were in the early stages of improving the service. We felt assured that they would continue to improve the service over the coming months.

People and relatives said they felt people received good care and were safe. Systems were in place to protect people from abuse. Most risks to people’s health and safety were appropriately assessed although this was not consistently the case. The new manager was in the process of reviewing the risks each person was exposed to, to further improve the service. Medicines were not consistently managed in a safe way as all medicines were not robustly accounted for.

There were enough staff deployed to ensure safe and appropriate care, although improvements were needed to the availability of ancillary staff such as cleaners, cooks and activities staff to optimise the function of these roles. Some staff training was out of date although a plan was in place to address this.

Overall, people’s nutritional needs were met by the service. People had access to a choice of food and people told us it was tasty. Where the service was reviewing people’s fluid input, this needed reviewing on a daily basis to ensure people were getting enough to drink.

Overall, the service was compliant with the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was sought before care and support was offered.

Staff were kind and caring and treated people well. Staff knew people well and engaged them in conversation. People’s views and choices were listened to.

People said they received appropriate care that met their needs. People’s healthcare needs were assessed and the service worked with a range of professionals to meet those needs. The quality and accessibility of care plans needed improving to fully evidence people had an up-to-date assessment of their needs. Some activities were provided but more interaction and stimulation was needed at times.

We made a recommendation relating to ensuring the service reviewed how accessible information was to people who used the service.

People said the management team listened to them. People’s complaints were responded to, but there was a lack of evidence that lessons were always learnt from complaints.

People and staff praised the new management team and said they were approachable and supportive. The new manager was aware of the areas that needed improving and had a plan in place to address. Audits and checks were undertaken, these needed further developing to ensure they were consistent and thorou

Homecroft Residential provides personal care for up to 26 older people. The home is situated in a quiet residential area within the town of Ilkley. The accommodation is provided in mostly single rooms with a small number of double rooms. Some rooms have ensuite facilities. The home has a range of communal areas including lounges, dining room and gardens. This was an unannounced inspection which took place on 15 November 2016. On the date of the inspection there

were 15 people living in the home.

A new registered manager had been appointed on 2 November 2016. 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate in any of the key questions. Therefore, this service is now out of Special Measures.

We found improvements had been made to the medicines management system. Medicines were safely managed and robust systems were in place to check medicines were given correctly.

People living at the home, relatives and staff told us they felt people were safe in the home. Staff understood how to recognise and report any allegations of abuse. Risks to people’s health and safety were assessed and clear plans of care put in place to assist staff to keep people safe.

The premises were well maintained and suitable for its intended purpose. Regular checks were undertaken on equipment and fittings to ensure they were in a safe condition.

There were enough staff deployed to ensure people were provided with safe and timely care. People received prompt assistance when they needed it. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

Staff were aware of the need to report incidents. Any incidents were logged, investigated and where appropriate actions put in place to prevent a re-occurrence.

Staff received regular training and support from the organisation. Staff had a good understanding of the people they were caring for. Use of agency staff had been reduced over recent months to help ensure consistency and continuity of care.

The service was acting with the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was gained before assisting with care and support.

The service ensured people had access to a range of health professionals to help ensure their healthcare needs were met.

People living at the home and relatives praised staff and said they were kind, caring and treated people with dignity and respect. Good, positive relationships had developed and staff knew people well.

The registered manager had put measures in place to ensure people felt listened to and had their views and opinions acted on. For example around food and activities.

Care plan documentation was much improved and demonstrated people’s needs had been fully assessed. People and relatives told us that care needs were met by the service.

The registered manager had improved the range of activities and social opportunities available for people, whilst acknowledging further work was needed in this area to ensure a more varied and consistent activity regime was in place.

Since the last inspection, a new registered manager had been employed and their presence in the home meant that people and relatives now had a permanent contact to address any concerns or complaints to. People and relatives said they were sat

Homecroft Residential provides personal care for up to 26 older people. The home is situated in a quiet residential area within the town of Ilkley. The accommodation is provided in mostly single rooms with a small number of double rooms. Some rooms have ensuite facilities. The home has a range of communal areas including lounges, dining room and gardens.

This was an unannounced inspection which took place on 20 April 2016. On the date of the inspection there were 18 people living in the home.

A registered manager was not in place with the previous registered manager leaving in April 2015. A manager had been recruited in October 2015 however they left in April 2016 before registering with the commission.

During our previous inspection in October 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to Good Governance, Safe Care and Treatment and Person Centred Care. As part of this inspection we checked whether improvements had been made in these areas as well providing an updated rating for the service under the Care Act 2014. At this inspection, we identified the provider had not made substantial improvements and was still in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that a lack of management support still had a significant impact on the quality of the service. Like at the previous inspection, concerns remained about how risks were managed, the quality of care plans and the lack of robust audit procedures. There was a lack of established governance and audit systems at provider level to ensure the performance of the home was robustly monitored and improved.

Staff told us morale was affected by the lack of manager. We found that there was not a good working relationship between staff and senior management at the service.

Medicines were not managed in a safe way. A number of medicine errors had occurred and due to medicines being managed in a disorderly way, there was a risk that further errors would occur.

People said they felt safe from abuse in the home. Safeguarding procedures were in place and we saw these had been followed to help keep people safe. Staff understood the risks to people’s health and safety.

Safe recruitment procedures were in place. Overall, we identified there were sufficient staff to ensure safe care. However staff were very busy which meant care was very task focused.

People spoke positively about the environment. We saw it was pleasantly decorated and safety checks on the premises were undertaken.

The service was not acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) as staff and management were unaware of who had DoLS authorisations in place and the conditions attached. Consent was not consistently sought in line with the MCA.

People spoke positively about the food provided by the home. There was sufficient choice and action was taken to cater for any special requirements.

Staff had access to a range of training although some staff were overdue training updates in some subjects.

People’s healthcare needs were assessed and appropriate plans of care put in place. People had access to a range of health professionals.

Staff treated people with dignity and respect. People spoke positively about staff and this was confirmed in the interactions we observed.

Care records were not sufficiently robust to demonstrate that people received responsive care. Records needed updating to ensure they accurately reflected people’s needs. We saw a plan was in place to address this with more person centred care plans being put in place.

A programme of activities was in place. However some people told us there was not enough to do. Appropriate records were not kept of the activities people were involved in.

Overall complaints were appropriately managed, however we identified one complaint

During the inspection we observed care in the communal areas of the home, spoke with staff, spoke with people who used the service and their relatives and reviewed the care records of five people who used the service.

We spoke with four people who used the service. All told us they were happy with the home and staff were friendly towards them. One person told us “Staff are very nice to me, if there is something you don’t like, they sort it out for you. We have singers visit and lots of different activities.” Another person told us “There is plenty to do, there is a television in the lounge, and I can choose what we watch.” Another person told us “This place is marvellous, the food is good and I am very happy here.”

We found people were treated with dignity and respect and involved in the planning of their care. People were encouraged to participate in a range of activities by friendly and attentive staff.

We found people’s needs were fully assessed and up-to-date care plans were in place where risks were identified.

We found the provider had systems in place to safeguard people from abuse and staff were aware of the correct procedure to follow in the event of an allegation.

We found staff were provided with the necessary support and training to undertake their role.

We found the provider had systems in place to monitor and evaluate the standard of its service through regular surveys and audits.

People said they were happy with the care and support they received and told us they could make decisions about their care and support. One person said, “We just please ourselves. I like to go to bed later than some of the others because I like to watch TV. The staff will tell us what’s on and then we decide what we are going to watch.” Another person said, “They look after us very well. Everything is very nice and nothing is too much trouble.” We spoke with one relative who told us they were quite happy with the standard of care that was provided. They said the staff were caring.

Overall, people’s needs were assessed and care and support was planned and delivered in line with their care plan. However we noted that one person’s preferences were not always taken into consideration. We raised this with a representative of the provider who agreed to review the person’s care and support.

People said they were comfortable in their environment and could choose to spend time in communal areas or time in their room. One person said, “It’s very homely and always lovely and clean.”

Overall, there were enough qualified, skilled and experienced staff to meet people’s needs. However, occasionally there had only been two seniors/care staff during the day which is not sufficient. People who used the service told us they didn’t have to wait long if they wanted support.

Comments and complaints people made were responded to appropriately.

All of the people we spoke to told us that staff looked after them very well and overall they were very satisfied with the care they receive and they were comfortable living at the home. People also felt safe and comfortable in speaking to staff about concerns or problems.

Homecroft Residential provides personal and nursing care for up to 26 older people. The home is situated in a quiet residential area within the town of Ilkley. The accommodation is provided in mostly single rooms with a small number of double rooms. Some rooms have with ensuite facilities. The home has a range of communal areas including lounges, dining room and gardens.

This was an unannounced inspection which took place on 16 and 19 October 2015. On the dates of the inspection there were 17 people living in the home.

A manager was registered within the commission as the registered manager for the service; however they had left employment at the home in April 2015 and had failed to cancel their registration with the commission. 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.

In the registered manager’s absence, the area manager was providing some management cover to the home. However due to other commitments they only spent limited time at the home. We found the lack of management support had a significant impact on the quality of the service. For example we identified concerns with how risks were manged, the quality of care plans and the lack of robust audit processes. There was a lack of governance and audit procedures at provider level to ensure the performance of the home was robustly monitored and maintained.

Staff morale was affected by the lack of management support. Staff said they lacked support and the home lacked leadership and direction.

People and their relatives told us the home was safe and did not raise any concerns with us. Staff understood safeguarding procedures and how to report and act on allegations of abuse.

We found some safety related incidents were not reported and investigated and plans of care were not put in place to keep people safe. This meant there was a risk that incidents would continue to occur.

Medicines were managed safely and people received their medicines when they needed them. The service needed to develop “as required” protocols to assist staff as to when to offer these kinds of medicines.

Safe recruitment procedures were in place. There were enough staff on duty to ensure people’s basic care needs were met, however improvements were needed to ensure sufficient management presence within the home.

People spoke positively about the food provided at the home. The menu varied on a three weekly cycle and people had the choice of two main meals at lunchtime.

Nutritional risks were not always robustly monitored as we identified two people’s weight was not being monitored in line with the requirements in their care plans.

The home was not consistently acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Although some DoLS applications had been made, possible deprivations of others people’s liberty had not been considered.

People had access to a range of healthcare professionals to help ensure their healthcare needs were met.

Staff were skilled and knowledgeable about the people they care for. The staff team was experienced with many of the staff working at the provider for a long time allowing them to develop a good insight into the people they were caring for.

People spoke positively about staff and said they were kind and caring. This was confirmed in the interactions we observed between people and staff.

Care plans provided evidence people’s needs were not fully assessed. We saw a number of key care plans and updates were missing. This meant there was a risk staff would not provide consistent and appropriate care.

A system was in place to record, respond to and audit complaints.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.