About the service:

The Homestead (Crowthorne) Limited is a care home which provides personal care and support for up to 23 older people living with dementia.

The registered manager of the home had left the service at the beginning of 2019, however was still registered with the Care Quality Commission (CQC). A new manager was appointed but left on 18 March 2019 just before our inspection. We were assisted by the Nominated Individual (NI) for the service, who is also the registered provider of the service. The registered manager and registered provider are ‘Registered Persons’. Registered Persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s experience of using this service:

¿People did not receive a service that provided them with safe, effective and high-quality care.

¿Risks to people's safety and well-being were not managed effectively and this placed people at risk of harm.

¿Infection control was not always managed in an effective way.

¿Incidents and accidents were not managed safely to prevent a reoccurrence.

¿People's needs and preferences were not always assessed or person-centred plans developed to guide staff on how to meet people's needs.

¿Staff did not always complete training in meeting people's needs and this meant people were at risk of inappropriate care and treatment.

¿People were not always treated respectfully or in a way that promoted their privacy and dignity.

¿Staff were not always deployed effectively.

¿The service was not well-led and the governance system was not effective and did not identify the risks to the health, safety and well-being of people or drive continuous improvements.

¿Complaints had not always been managed appropriately.

¿Appropriate referrals were not made to the local authority in a timely way.

¿We were not always notified, as required by law, of notifiable safety incidents.

¿Medicines management was not always safe.

¿People and their relatives told us staff were caring.

There is more information about this in the full report.

Rating at last inspection:

Good (Published on 19 July 2018).

Why we inspected:

This was a responsive inspection due to information we received of risk and concern regarding the safety and welfare of people living in the home.

Enforcement:

We have told the provider to take immediate action to address some of the concerns we found. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the ter

The Homestead (Crowthorne) Limited is a care home without nursing which is registered to provide a service for up to 23 older people many of whom have some form of dementia. There were 17 people living in the service on the day of the visit. All accommodation is provided within a three story building situated within private housing and close to local amenities.

This unannounced inspection took place on 21 June 2018. At this inspection we found the service was Good overall.

Why the service is rated Good overall:

There is a registered manager running the service. 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’s safety was contributed to by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect people and who to alert if they had any concerns. General operational risks and risks to individuals were identified and appropriate action was taken to eradicate or reduce them.

There were enough staff on duty at all times to meet people’s diverse and individual needs safely. The service now had a stable staff team. The provider had robust recruitment procedures. People were given their medicines safely, at the right times and in the right amounts by trained and competent staff.

The service remained mostly effective. Staff were well-trained and able to meet people’s health and well-being needs. They were able to respond effectively to people’s current and changing needs. The service sought advice from and worked with health and other professionals to ensure they met people’s needs. However, the design of the service was not dementia friendly and we could not be confident that people had choice with how they were assisted with their personal care needs.

In all other respects people were encouraged 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 practise.

The service continued to be caring and responsive. The attentive and knowledgeable staff team provided care with kindness and respect. Individualised care planning ensured people’s equality and diversity was respected. People were provided with a range of activities, according to their needs, abilities, health and preferences. Care plans were reviewed by management regularly. Care plans contained up to date information and records demonstrated that risk assessments were usually reviewed within stated timescales.

The registered manager was well regarded and respected. The quality of care the service provided continued to be reviewed and improved, as necessary.

This was an unannounced inspection which took place on 12 April 2016.

The Homestead (Crowthorne) Limited is registered to provide care (without nursing) for up to 23 people. There were 19 people resident on the day of the visit, one person was in hospital. The service has one double room which is only used for two people in the event of a couple or friends wishing to share. The house offers accommodation over three floors. The first and second floors are accessed via a lift. The shared areas within the service offer adequate space and suit the needs and wishes of people who live in the home.

There is a registered manager running the service. 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, visitors to the service and staff were kept as safe as possible by a staff and management team who took safety seriously. They were trained in the safeguarding of vulnerable adults and health and safety. The manager and staff were able to describe their responsibilities and methods for keeping people safe from all forms of abuse and harm.

People received safe care because there were enough staff who were effectively deployed at all times. The management team followed a robust recruitment procedure to ensure, as far as possible, that staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by properly trained staff.

People’s human and civil rights were protected. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provides a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm. The staff team took any necessary action to uphold people’s rights and the registered manager made the appropriate DoLS referrals to the Local Authority.

People’s health and well-being needs were met by well supported and trained staff. People were helped to acquire healthcare from appropriate professionals, as necessary. Staff were trained in all relevant areas, so that they could meet the variety and diversity of needs presented by the people in their care.

The service provided person centred care which recognised and met people’s individual needs. Staff built strong relationships with people and were knowledgeable about and knew how to meet people’s needs. Staff respected people’s views and opinions and encouraged them to make decisions and choices. People were treated with kindness, dignity and respect at all times.

People benefitted from a well-managed service. Meeting people’s needs was the priority for the staff team. The registered manager was described by staff as very supportive and approachable. The service had ways of making sure they maintained and improved the quality of care provided. Improvements had been made as a result of quality checks and listening to the views of people, other professionals, people’s relatives and the staff team.

At an inspection on 16 December 2013 we found the provider did not have effective systems in place to reduce the risk and spread of infection.

At our inspection on 6 March 2014 we found the provider had introduced cleaning logs and spot checks to ensure cleaning was completed, recorded and checked. New dispensers for toilet tissue and paper towel ensured appropriate materials were available to maintain good hygiene. These actions ensured that appropriate measures were in place to protect people who use the service and others from the risk of cross contamination and spread of infection.

We spoke with five people who use the service and a relative of someone who uses the service. Some of the people who use the service were not able to verbally communicate with us due to their health issues. We observed care and support provided to people to inform us of the standard of care and support people experienced.

We observed staff asked people for permission before supporting them to attend to personal needs. Where people were unable to verbally consent, care workers explained other factors they used to understand people’s preferences, such as gestures and expressions. One care worker told us “We know our residents and adapt to them.” Staff understood people’s capacity to make decisions and when it was appropriate to make best interest decisions.

People’s care needs were assessed and care provision was planned to meet them. Staff were aware of people’s health conditions and assessed risks to ensure people were cared for safely. One relative told us “I am happy with everything here. Staff are always on top of things and people have lots to do.”

We observed staff were aware when people required support to maintain a healthy diet. People we spoke with confirmed they had sufficient amounts of food and could ask for changes to the planned menu to meet their preferences. Appropriate records ensured staff were aware of the actions to take to maintain people’s dietary health.

We found the home to be clean. One relative told us “It’s a clean and happy home.” However, we found cleaning logs were not completed in accordance with the service’s cleaning schedules. One toilet did not contain tissue and another was lacking in paper towels. This meant people were not protected from the risk of infection.

Staff told us the manager was supportive. We saw training schedules were up to date, and staff told us they felt suitably trained to care for people safely. Staff attended supervision and appraisal meetings that provided opportunities to discuss training, development needs and opportunities.

A relative of a person who uses the service told us staff “look after my loved one well.” We observed staff were respectful of people’s wishes, and involved people in conversations about their care and general daily activities.

We saw staff provided care in accordance with people’s personal care plans. Consideration was made of people’s independence, balancing risk with continued actions, and seeking ways to ensure they could continue to do the activities they wished without harm. One relative told us “there are no restrictions on visiting. It’s a lovely home.” A member of staff said they provided “a personal service. We don’t treat everyone the same.”

We saw the provider had a suitable safeguarding policy in place, and addressed safeguarding issues appropriately to ensure vulnerable people were protected from the risk of abuse.

There were effective recruitment and selection processes in place. We looked at six recruitment files. Appropriate checks were undertaken before staff began work. The records showed evidence of the relevant checks such as Disclosure and Barring Service (DBS) enquiries, and references had been undertaken before staff began work.

The manager conducted regular quality audits to ensure systems and procedures set up to provide safe and quality care for people were followed, and were appropriate to people's and the service's needs. They sought the opinions of people who use the service, their relatives and staff to influence care provision.