About the service: Homefield House is a residential care home that is registered to provide support to 24 older people, including people living with dementia. The service was supporting 22 people at the time of our inspection.

People’s experience of using this service: There were systems in place to monitor and improve the quality and safety of the service provided. However, these were not always effective. A safety issue in the environment had not been identified and addressed, which led to a minor injury for one person. Steps were taken to prevent similar incidents reoccurring following the incident. We have made a recommendation about keeping up to date with health and safety information.

There was a positive culture within the service and people felt the registered manager was approachable. Staff were knowledgeable about safeguarding and able to raise concerns. Steps were taken to minimise risk where possible. Staff supported people to manage their medicines safely. Systems were in place to recruit staff safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were supported through on-going supervision and accessed training relevant to people's needs, to ensure these could be met. Staff supported people to access healthcare and maintain a nutritious diet.

All the relatives we spoke with consistently told us they were happy with the care provided for their relatives. They spoke positively about the staff and the home being welcoming and homely. We saw people were relaxed in their surroundings and felt comfortable around staff. Staff were kind and promoted people’s independence and treated them with dignity and respect.

People’s care plans were kept up to date and reflected their individual needs and circumstances. People were supported in line with their preferences and supported to engage in social and leisure activities. The provider had a system in place for responding to people's concerns and complaints.

Rating at last inspection: At the last inspection the service was rated Good (report published 26 July 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

The inspection took place on 29 June 2016 and was unannounced. The last inspection of this service was carried out on 6 June 2014 when no breaches of regulation were found.

Homefield House is registered to provide care and support for up to 24 people, some of whom are living with dementia. The service is located in Grimsby. Accommodation is provided on two floors. There is a small car park at the service for visitors to use.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff knew how to protect people from abuse and knew they must report concerns or potential abuse to the management team, local authority or to the CQC. This helped to protect people.

Staffing levels provided on the day of our inspection were adequate to meet people’s needs. Staff understood the risks to people’s wellbeing and knew what action they must take to help minimise risks. Staff were provided with training in a variety of subjects, which was updated periodically to help develop and maintain their skills. Supervision and appraisal was provided to all staff which helped support them and identify further development needs.

People’s nutritional needs were assessed and monitored, with special diets provided, where required. Staff encouraged and assisted people to eat and drink, where necessary. A pictorial menu helped people living with dementia to choose what they would like to eat. Advice was sought from relevant health care professionals to ensure people’s nutritional needs were met.

People were supported by staff to make decisions for themselves. Staff communicated with people in a way that could be understood. We saw people chose how to spend their time and gave consent to their care and treatment.

People who used the service were supported to make their own choices about aspects of their daily lives. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

A programme of activities was provided, this included talks delivered to help people reminisce about Grimsby. Activities were provided to help stimulate people and they were encouraged to maintain their hobbies and interests.

General maintenance was carried out and service contracts were in place to maintain and service equipment so it remained safe to use.

There was a complaints policy and procedure in place. This was explained to people living with dementia and their relations so they were informed about their rights. People’s views were asked for through formal surveys and informally on a daily basis by the staff. Feedback received was acted upon.

A variety of audits were undertaken to monitor the quality of the service. Issues found were addressed thoroughly. The registered manager had an ‘open door’ policy and an ‘on call' system was operated out of office hours to support people, relatives, visitors and staff. There was a homely and welcoming atmosphere within the service. The service had gained an award in 2015 from the local Clinical Commissioning Group for working in partnership to provide better outcomes for people.

The inspection was carried out by one inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, speaking to staff who supported people who used the service and from looking at records.

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

Is the service caring?

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Staff demonstrated a good understanding of the needs of the people who used the service and could describe how to maintain people’s dignity and how to ensure people’s choices were respected.

Risk assessments were completed which ensured staff knew how to keep people safe. People had been involved with the formulation of their care plans and where needed, people had been supported to make informed decisions. Health care professionals, for example doctors, district nurses, speech therapists and occupational therapists had been consulted and their advice sought when people needed specialist care and attention.

Is the service responsive?

The service had a complaints procedure which people could access. People were therefore assured that complaints were investigated and action would be taken as necessary. The provider consulted with people about how the service should be run and any issues were addressed. People were consulted about their care needs.

Staff followed instructions from visiting health care professionals, for example doctors and district nurses. This ensured people received the care and attention they required to meet their needs.

Is the service safe?

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly, therefore not putting people at unnecessary risk.

The manager set the staff rotas, they took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure people’s needs were met.

The provider had policies and procedures in place for staff to follow to report any abuse they may witness or become aware of. Staff also received training about how to keep people safe.

Is the service effective?

People’s health and care needs were assessed with them and they were involved in writing their plans of care. Plans were in place for staff to follow to support people who may be a risk to themselves and others. Health care professionals were consulted if required.

People’s care plans detailed their preferences and method of communication. This enabled the staff to identify when the person was not happy or felt uncomfortable with any given situation.

People were provided with nutritious and wholesome food. People’s dietary needs were assessed and where needed heath care professionals were consulted. People’s dietary intake was recorded and their weight monitored.

Is the service well led?

The provider consulted with people about how the service was run and took account of their views. Relevant persons who had an interest in the care and attention people received had also been consulted and their opinions taken into account about how the service was run. Staff received training which equipped them to meet the needs of the people who used the service. The provider also gave staff the opportunity to gain further qualifications.

What people who used the service and those that matter to them said about the care and support they received.

People we spoke with told us they liked living at the service and found the care staff caring and kind. Comments included “Its lovely here I’ve no complaints”, “The care are marvellous they just can’t do enough for you” and “I like living here and I have a really nice room.” They also told us they could exercise choice in the daily lives. Comments included, “Yes I can come and go as please”, “I can get up when I want and can spend time in room which is important to me” and “I just do as please really.” People told us they enjoyed the food. Comments included “The food is lovely”, “the waitress bring our food it’s all really nice” and “The cook is marvellous we’ve never had a bad meal here.”

People confirmed that their care and treatment options were discussed with them and they were asked for their consent. One person said, “I gave my consent to be here. If I hadn’t liked it here I wouldn’t have asked to stay.”

People’s comments about their care were very positive. One person told us, "The care is very good,” and another person said," I can’t fault the care." A relative commented, “I am amazed at what they can do for my relative. I feel very fortunate we have been able to find such a caring home.”

People commented positively about the cleanliness of the service. Comments included, “It is absolutely clean,” and “The cleanliness is very good, I find it is very clean. “ A relative told us, “The cleanliness is excellent and there is no odour.“

There were effective recruitment and selection processes in place and people spoke positively about the staff that worked with them. People’s comments included, “The staff are all very good,” and “They are carrying out their duties properly.“ A relative told us, “The staff are really on the ball; the staff communicate very well.” A visiting healthcare professional told us, “The staff are all very helpful.”

People were clear about how to make a complaint. One person told us, “I would see the manager if I had a complaint but I haven’t had a complaint yet.” A visiting healthcare professional told us, “The relatives have never had any complaints about the care; I’ve never had anyone wanting to complain.”

People who used the service told us how they enjoyed living in Homefield House. One person said, “I do like it here. I read and I like sewing. I made some of my own dresses and knitting.” One relative told us, “They play dominoes and they do quizzes and play bingo, although my mother is not able to participate. My Mother liked quizzes – they have done music quizzes for her because she is partially sighted.” Another relative said, “We personalised her room with her. They Skype my mum (the person was assisted to make internet calls to relatives). They do gardening. A gardener comes and they grow seeds. A singer comes in and they do reminiscence. They play bingo and other games and someone comes to do chair exercises. They are doing a strawberry tea next week when all the relatives can come.”

People explained to us how much they appreciated the service in Homefield House and the care they received. One person said, “You get the caring and the knowledgeable nursing. I think it is an ideal place to come. As far as I am concerned the care is the best. I have some care needs that are quite specific to me and they do this no question.” A relative told us, “Mum always has her own clothes and they are clean and her bed is always clean. I can’t really fault it. It was recommended. I think the care is very good. They are on to it straight away if she has any infection. She looks so much better since she has been in here. She is happy and she is cared for. They really do care.”

People who used the service spoke with us positively about the staff that worked in Homefield House. One person told us, “The staff are very good they do the best they can for you.” A relative said, “Staff always seem very upbeat. They are lovely and they always come and talk to you.” Another relative told us, “I feel they are a happy band.”

People we spoke with explained that they were listened to and their concerns were acted on. One person told us, “Sometimes I have been to the residents meeting. They always include you. They do listen to you. I have no real complaint. I would go to the manager if I had any complaint.” A relative we spoke with said, “I have been to a resident and relatives meeting and they do listen. I have filled in a couple of surveys. If I have any questions I can go to the manager.”