Our inspection of Homefield Court took place on 11 January 2016. We returned to the home on 2 February 2016 to obtain further information. This was an unannounced inspection.

Homefield Court is a care home situated in Brent which is registered to provide care for to up to 24 older people. At the time of our inspection there were 24 people living at the home, the majority of whom were living with dementia or mental health needs.

We last inspected Homefield Court on 10 December 2015 when we found that there were regulatory breaches in relation to safe care and treatment, staffing and fit and proper persons employed. At this inspection we found these breaches had been addressed.

There was a registered manager in post. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who lived at the home told us that they felt safe, and this was confirmed by a friend of a person whom we spoke with. People were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting.

The home had arrangements in place to ensure people’s safety. However, we found that risk assessments did not always reflect the information and guidance for staff that was included in people’s care plans. The registered manager told us that this was because people's conditions were stable but that they would develop assessments for potential risks.

Medicines at the home were well managed. People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained. Regular health checks had taken place.

Staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the physical and other needs of people living at the home. People who remained in their rooms were regularly checked on.

Staff who worked at the home received regular relevant training and were knowledgeable about their roles and responsibilities. They received regular supervision from a manager to ensure that they were supported in their roles. Checks in relation to suitability of staff had been carried out prior to appointment.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about people’s capacity to make decisions was contained in people’s care plans. Applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority where people were unable to make decisions. Staff members had received training undertaken training in MCA and DoLS.

People’s nutritional needs were well met. Meals were nutritionally balanced and met individual requirements as outlined in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day. People told us that they enjoyed the food.

The home environment was suitable for the needs of the people who lived there. We saw that a number of improvements had been made including refurbishment of bathrooms and communal areas.

The home provided a range of individual and group activities for people to participate in throughout the week. Staff members engaged people supportively to participate in activities.

People knew what to do if they had a complaint. We saw that complaints had been dealt with quickly and to people’s satisfaction.

Care documentation showed that people’s health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the support that they needed.

There were systems in place to review and monitor the quality of the serv

Our inspection of Homefield Court took place on 10 December 2015 and was unannounced.

Homefield Court is a care home situated in Brent which is registered to provide care for to up to 24 older people. At the time of our inspection there were 23 people living at the home, the majority of whom were living with dementia or mental health needs. We last inspected Homefield Court on 4 July 2014 when we found that the service met the regulations that we assessed.

There was a registered manager in post. 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.

People who lived at the home told us that they felt safe, and this was confirmed by the family members and friends that we spoke with.

People were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

Medicines at the home were well managed. People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained.

Staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the physical and other needs of people living at the home. People who remained in their rooms for some or part of the day were regularly checked on.

Staff who worked at the home received regular relevant training and were knowledgeable about their roles and responsibilities. However, the staffing records that we viewed did not always provide evidence that appropriate checks had taken place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. Some staff members had not received regular supervision from a manager, although the staff members that we spoke with told us that they felt well supported.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about people’s capacity to make decisions was contained in people’s care plans. Applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. The majority of staff had received training undertaken training in MCA and DoLS, and those we spoke with were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions.

People’s nutritional needs were well met. Meals were nutritionally balanced and met individual health and cultural requirements as outlined in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day. People told us that they enjoyed the food.

The home environment was suitable for the needs of the people who lived there. We saw that a number of improvements had been made, including the redecoration of people’s bedrooms and a communal lounge and the provision of a shelter in the garden for people who wished to smoke. However, we had concerns about the cleanliness and condition of some of the flooring and a bathroom and toilet that had not yet been refurbished as these could compromise infection control measures within the home.

Care plans and risk assessments were person centred and provided guidance for staff. We saw that these had been regularly updated and reflected any changes in people’s needs.

The home provided a range of individual and group activities for people to participate in throughout the week. Staff members engaged people supportively in participation in activities.

People and their family members that we spoke with knew what to do if they had a complaint.

Care documentation showed that people’s health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the support that they needed.

There were systems in place to review and monitor the quality of the service, and we saw that action plans had been put in place and addressed where there were concerns. Policies and procedures were up to date and reflected regulatory requirements and good practice.

People who used the service, their relatives and staff members spoke positively about the management of the home.

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

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

We used a number of different methods to help us understand the experiences of people who used the service, because many of them had complex needs which meant they were not able to tell us their experiences. We spoke with six people who used the service and with a visiting relative. We spent some time observing the interactions between staff and people using the service in the communal areas of the home. We spoke with four members of staff, including the Registered Manager.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Care and support were planned and delivered in a way that was intended to ensure people's safety and welfare. Assessments were carried out and reviewed regularly for aspects of health and safety. Care plans and risk assessments, for example for mobility, personal hygiene and communication, provided details of how best to support each person.

The provider carried out regular health and safety audits of the premises to ensure that they assessed and managed any risks to the health, safety and welfare of people using the service and others.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw evidence that relevant staff were trained to understand when an application should be made, and how to submit one.

Is the service effective?

Staff we spoke with told us that they felt well supported and received appropriate training and supervision to enable them to carry out their responsibilities and to care for people appropriately.

People we spoke with told us that staff were able to support them appropriately with their personal care and health needs. One person who had a specific medical condition said, “The staff manage my health condition well. They understand what I need.”

Is the service caring?

Care plans contained detailed information about each person's specific needs for staff to follow.

People expressed their views and were involved in making decisions about their care and support. Care plans showed how people preferred their care to be provided. A visiting relative said, “The staff are very caring. They are always available if I need to ask any questions. They ensure that my relative is involved in all decisions about their care and treatment.”

We observed that staff interacted with people in a respectful and sensitive manner. They took time to assist people and spoke with them while they assisted them.

Is the service responsive?

The provider carried out satisfaction surveys and monitored the responses and any concerns. There were regular meetings for people who used the service and for staff. However there was no formal system for asking people for their views on their care and support and recording them and taking any consequent actions. The provider’s complaints policy had not been updated since 2009 and contained some information that was incorrect and out of date. The last recorded complaint was in August 2008.

We saw that staff carried out monthly evaluations of each person’s individual care plans. However any changes needed following the evaluation were not recorded in the original care plan. This meant that staff would need to read through all the monthly evaluations for each care plan to ensure that they had the most up to date information on how to understand and support the person.

Is the service well-led?

The Registered Manager supported and encouraged staff to understand the ethos of the home and to improve the quality of the services they provided. Staff we spoke with said that managers provided them with good support and they were clear about their roles and responsibilities.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They carried out regular health and safety audits of the premises and annual quality surveys of the views of people using the service and their family members. There were regular residents’ meetings and staff meetings where people who used the service and staff could express their views about the service.

We received information from an anonymous person of concerns including poor personal care provision, lack of cleanliness and hygiene, shortage of staff and lack of training, and lack of appropriate activities. We found no evidence to support most of these concerns, but people we spoke with confirmed that they did not have opportunities to take part in their choice of activities in the home and in the community.

We found that people were cared for in a clean, hygienic environment. The home was clean in all the areas that we visited.

Most of the people who we spoke with and observed said that they were happy in the home and that they were consulted about their wishes. The care plans that we saw were written taking the person's views and preferences into consideration.

The care plans provided clear information on each person's health care needs. We spoke with a visiting community psychiatric nurse (CPN) who told us that the staff provided very good care for people with mental health needs. However care plans and risk assessments were not reviewed and updated regularly.

Medicines were safely administered, but they were not kept safely and were not disposed of appropriately.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive or to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Most people that we spoke to were able to tell us about the service that they received. Some people gestured, nodded or shook their head in response to the questions that we asked. People told us that they felt safe and received the care they needed and wanted. People were positive about the staff who supported them. We saw signs of people’s well being. People smiled, and laughed. We saw people were supported to make decisions, which included what they wanted to eat, and what they wanted to do.

Staff respected people’s privacy and knew about their roles and responsibilities in meeting the needs of people that they supported in a sensitive and respectful manner. We saw people using the service approach staff without hesitation and they accessed their bedrooms and communal areas freely within the home.

Each person had a plan of care that had been regularly reviewed, and included information about the individual support and care that they needed. People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. There were enough skilled and experienced staff to meet people’s needs.

Records were accurate and stored securely.

During our visit to Homefield Court, we spent most of the time talking to people using the service to gain their views about what it was like living in the home. Some people due to their varied health and communication needs had difficulty in speaking to us but they gestured, nodded or shook their head when they answered our questions.

People told us they were happy living in the home; they liked their bedrooms, and enjoyed the meals. They informed us they felt safe and knew who to talk to if they had any worries or concerns. People confirmed they were listened to, had their needs met, and had the opportunity to participate in a number of activities of their choice. They told us they were given the care and support they wanted and needed, and they received advice and treatment from health and social care professionals.

During our visit people showed signs of ‘well being’. People were well dressed, they smiled, laughed, talked with other people using the service and approached staff without hesitation.

Comments from people using the service included; “I can go to bed when I want,” “I choose what I want to wear,” “I can choose what to do,” “It’s ok here,” “I like my bedroom,” “My room is good, I have a television and my things,” “I like listening to music, it’s good for the mind,” “I go to a café, I like to go out,” “The staff are nice,” “The food is good,” “The food is ok, I have the food that I like,” “I go out for walks,” and “I have things to do.”

We spoke with a social worker who spoke positively about the service provided to people.

Staff told us they enjoyed their job supporting and caring for people at Homefield Court. They confirmed there was good teamwork and they felt well supported by management staff.

Comments from staff included; “I had an induction,”” “We have a lot of training,” “We know the residents well,” “There is a good staff team,” “The manager is approachable,” and “We have supervision.”