We inspected Homemead on 22 October 2018. The inspection was unannounced. We had previously carried out a comprehensive inspection in August 2017 where the overall rating was Requires Improvement.

Homemead is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Homemead provides accommodation and personal care for up to 26 older people with dementia. At the time of our inspection there were 23 people living in the home. The home is situated in its own grounds and has three floors, served by a lift.

At the previous inspection in August 2017 we found that the service was not meeting all the quality standards and was rated "Requires Improvement” in the key areas of safety and well-led. The inspection rated the service overall as “Requires Improvement”.

We asked the service to provide us with an action plan for improvement and we monitored improvement during this inspection. At this inspection we found that the provider and registered manager had made the necessary improvements to their service.

At the previous inspection we found that people were not always supported in a safe way when receiving their medicines. There were some occasions where people were not always given their medicines on all days and that the recording of medicines used was not always accurate.

During this inspection we found that the management of the recording of medicines had improved. We found that daily medication audits were completed and fed into a weekly audit, completed by one of the senior management team.

At the previous inspection we found that people were not always supported in a safe way at night due to the numbers of staff on duty. There were occasions when people had to be left unattended whilst staff were carrying out other duties.

During this inspection we found that the night staffing had improved because the provider had increased the numbers of staff on duty. This meant that people were more frequently monitored and have their needs met sooner.

At the previous inspection we found that the service had systems and procedures in place to help deliver high quality care. However, it did not always use its audits and information to make improvements or address issues that needed resolving.

During this inspection we found that the service had improved the way it used its quality assurance systems to help managers and staff understand what was important to people and how the service could develop and improve.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People who lived at the home were protected from the risk of abuse happening to them. People told us they felt safe and well cared for at the home and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing. Care staff could describe how they would report incidents of concern and records showed that training in safeguarding people had been updated.

Staff provided attentive care to people and risks to people’s health, safety and welfare were well managed. Risks had been assessed and where appropriate contributed to the person’s overall care plan.

Risk management plans clearly identified what the risk was and provided staff with instructions about how they needed to manage the risk to ensure people received safe care and support whilst enabling them to remain as independent as possible.

There were procedures and policies in place to control infection. We looked around the home and saw that all areas were clean and hygienic. Staff had re

We inspected Homemead on 29 and 30 August 2017. The inspection was unannounced. We had previously carried out a comprehensive inspection in November 2015 where the overall rating was Good.

Homemead provides accommodation and personal care for up to 26 older people with dementia. At the time of our inspection there were 25 people living in the home. The home is situated in its own grounds and has three floors, served by a lift.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People who lived at the home were protected from the risk of abuse happening to them. People told us they felt safe and well cared for at the home and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing. Comments included “They are all very kind” and “The staff are lovely.”

However, there was a risk to people that they may not always receive medicines in a safe way because of discrepancies in recording and reporting as well as a lack of clarity amongst staff of areas of responsibility towards aspects of medicines management.

Staff provided attentive care to people. However, we found that at times there were insufficient numbers of staff on duty and that reviews of staff ratios had not fully taken into account the needs of people or views of staff.

There were systems in place to audit and monitor the quality of the home. However, these were not used sufficiently well to enable the provider to evaluate and improve their practice.

Risks to people’s health, safety and welfare were well managed. Risks had been assessed and where appropriate a risk management plan had been put in place for aspects of people’s care and support. Risk management plans covered aspects of care such as, nutrition, choking, mobility, moving and handling, pressure care, physical and emotional health. These then formed part of the persons care plan.

Risk management plans clearly identified what the risk was and provided staff with instructions about how they needed to manage the risk to ensure people received safe care and support whilst enabling them to remain as independent as possible.

The premises were free from hazards and were clean. The outside areas had some debris, old leaves and general untidiness which could, if left unattended present a risk of slipping or other damage to people or visitors. The registered manager and operations director assured us that this would be quickly looked into.

There were procedures and policies in place to control infection. We looked around the home and saw that all areas were clean and hygienic. Staff had received infection control training and records confirmed this.

People spoken with were happy with the support provided by the staff working at Homemead. One person told us, “The staff are very helpful and do all they can.” A relative said, “I can’t fault them. They know exactly what to do and how to make [my relative] comfortable.”

There was a consistent team of staff working at the home who were appropriately trained. The provider had made improvements in reducing dependency on agency staff over the previous 12 months and all staff were now employees of the organisation.

The home ensured that wherever possible people were asked for their consent before care plans were agreed, medicines given or access to their rooms or personal information was requested. Records of signed consent forms were contained in people’s care records including Do Not Attempt Resuscitation (DNAR) forms where people had requested these.

We observed staff supporting people to choose and prepare their lunch as appropriate. The chef spoke passionately about how people were consulted about their m

During the inspection, we looked at how the service operated, spoke with people and care staff and looked at records in order to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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

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

Is the service safe?

People told us they felt safe and secure.

The staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

We saw that the home was clean and well maintained. All the people we spoke to told us that this was always the case.

We saw that there were sufficient staff on duty to meet people’s needs throughout the day. People received a consistent and safe level of support.

Recruitment procedures were rigorous and thorough.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager told us of any DoLS applications that had been made and was able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

People all had an individual care plan which set out their care needs. We saw that people had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. Assessments included needs for any equipment, mobility aids and specialist dietary requirements.

People had access to a range of health care professionals some of which visited the home. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented: "If you want something, you only have to ask and they will get it for you". A relative told us: "The care is excellent and I have never had any concerns. Sometimes they have had to sort out small issues like clothes, but they always sort them out".

Staff were aware of people’s preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is The Service Responsive?

People told us that they were able to participate in a range of activities both in the home and in the local community. The activities provided included ones people could enjoy as a group and others that meet their individual interests.

We saw that people were involved in reviewing their plans of care when their needs changed. One relative told us: "The staff keep you informed of everything and you can speak to them at any time".

Is the service well-led?

We saw that the service actively consulted people on their views of the service and acted on any concerns.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed. Prompt action had been taken to improve the service or put right any shortfalls they had found.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People’s personal care records, and other records kept in the home, were accurate and complete.

We observed staff throughout the visit to the home and saw that they involved people who use the service to make decisions regarding day to day activities. They demonstrated patience and care when assisting people and allowing time to listen to what people were trying to tell them.

We found that the home was clean and free from malodours. People were clean and appropriately dressed for the time of day and those people who required assistance with personal care were supported in a way that ensured their dignity and privacy.

Staff we spoke with confirmed that they had received safeguarding training and were aware of the different types of abuse that could happen to people and the procedures to follow. We looked at records in the home and these confirmed that procedures existed and that staff had received appropriate training.

The home was seen to be free from hazards and the layout was such that it afforded people free and unrestricted access to all parts of the home.

We observed appropriate positive interactions between staff members and people living at the home, and people were well supported within the home environment. We saw appropriate skills displayed by staff working with people.

We saw that there were thorough systems for making regular checks on all aspects of the service. These included checks on people's care, medication, activities, food, cleanliness, staff support and safety.

People who live at the home were not always able to tell us directly what they felt about specific topics. However, we received positive comments about the home, the food and the staff. One person told us that the home was ‘’lovely’’ and that she enjoyed the garden.

Relatives we spoke with were very positive about the attitude of staff and the care people received. One relative described staff as "lovely" and all relatives spoken to stated that they felt confident in raising any concerns and knowing they would be dealt with.

The people who live at Homemead could not always tell us clearly what they thought about the home. However, when we visited, we saw that they were relaxed and happy. We saw that they were able to move around the home freely and do what they wanted to do. People were able to have food and drinks when they wanted. We saw that the staff treated them with kindness and respect. Some of the things people told us were, ‘’I love this place, the people are so nice’’, ‘’I don’t think anything can be done better, it is all fine’’ and ‘’I like being able to stay in bed and not having to get up early in the morning’’.

Visitors told us that they were always welcome at the home. They said that they were kept informed about people’s wellbeing. They told us that they felt the staff were kind and caring and gave people everything they needed. We saw that visitors were able to support people if they wanted. We saw one visitor helping their relative to have lunch. Some of the things they said were, ‘’this place is great – my relative lacks for nothing and has all the medical care they could want’’ and ‘’this home has a great atmosphere’’.

The staff told us that they were well supported and happy working at the home. We saw that the staff were kind and considerate and listened to people. They were gentle and calm and showed genuine affection towards the people who live at Homemead. Some of the things the staff said were, ‘’there is genuine person centred care at Homemead’, ‘’we really care’’, ‘’we try to look after everyone really well’’, ‘’I cannot think of anything the home should do better’’, ‘’we all support each other, we have good training and regular meetings and we work as a team’’ and ‘’we always put the residents first’’.

We carried out an inspection of Homemead care home on 6 July and 7 July 2015. The inspection was unannounced. At the previous inspection of 27 May 2014 the home had met all the standards.

Homemead is a home for up to 26 older people, including people living with dementia. At the time of the inspection there were 20 people living in the home. The home has a registered manager. 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 were protected from the risk of abuse happening to them. People who were able to express their views told us they felt safe and well cared for at the service and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing. We saw that other people, although unable to express their opinions, were able to move freely around the home, speak with staff and receive support that made them feel reassured and safe.

Risk management plans were in place for people and clearly identified areas that presented possible risk to safety and wellbeing. There was guidance for staff on how they needed to manage the risk to ensure people received safe care and support whilst enabling them to remain as independent as possible.

People had an individual care plan which set out their care needs. We saw that people and their relatives had been involved in the assessment of their health and care needs and had contributed to developing their care plan. Assessments included needs for any equipment, mobility aids and specialist dietary requirements. People had access to a range of health care professionals some of which visited the home. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

There were enough staff on duty to care for people, with between four and five care staff with support from senior care staff and manager. Staff had been trained to use specialised equipment, such as hoists, safely.

People and relatives told us that they were happy with the care they received and felt their needs had been met. Care staff understood people’s care and support needs and knew people well.

The provider had a Service User Guide which emphasised the rights of people to be treated with dignity, to have privacy and to be able to exercise choice. This was also reflected in the home’s policies and procedures and formed the basis for staff training.

The provider ensured that people’s independence and choice was promoted, for example through meetings and communication with relatives. People told us that they had been involved in making decisions and there was good communication between staff and themselves.

We saw that people’s health, nutrition, fluids and weight were regularly monitored. The chef was closely involved in ensuring that people’s choices about meals were taken into consideration and there were well established links with GP services and pharmacist services offering a single point of access for people.

People told us that the staff were kind and caring towards them.

Care records were individual to each person and contained information about people’s life history, their likes and dislikes, cultural and religious preferences. Care records included details such as personal achievements, places visited and family relationships.

We listened to how staff spoke with people and found this was professional and relaxed, and included friendly chit-chat between staff and people who used the service. We saw how people who used the service responded positively to the interaction. Staff responded promptly when asked a question and took time to explain their actions.

People said they were able to get up and go to bed at a time that suits them and were able to enjoy activities and interests that suited them. The home also supported people to maintain relationships with family, relatives and friends.

The home’s philosophy placed importance on ensuring that people who live at the home continued to lead as normal a life as they were able. The activity team leader and staff spent time getting to know the individual, their background and life history.

In order to listen to and learn from people’s experiences the home had developed an approach that asked people about their life histories and also held three-monthly meetings with relatives. Relatives we spoke with told us that they found these meetings helpful.

The provider had an effective system to regularly assess and monitor the quality of service that people received. This was done through regular audits as well as regular visits by the Area Manager. Relatives were complimentary about the accessibility of the manager and the atmosphere in the home.

A copy of the complaint’s procedure was displayed near the main entrance. No complaints had been made to CQC or the local authority during the last year.

The manager and staff maintained a focus on keeping up to date with best practice through participation with groups such as the local authority provider forum and dementia care organisations.