Archived: Homelea Residential Care Home

Updated 5 June 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

This inspection which took place on 3 and 4 February 2015 and was an unannounced.

The inspection team consisted of one inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service, in this case elderly and dementia care.

Before the inspection we looked at information provided by the local authority including contracts and purchasing (quality monitoring team). We reviewed records held by the CQC including notifications. A notification is information about important events which the provider is required by law to tell us about. We also looked at information we hold about the service including previous reports, safeguarding notifications and investigations, complaints and information received from members of the public.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Not everyone was able to tell us about their experiences living at Homelea due to their dementia. To gain further feedback we carried out observations including a Short Observational Framework for Inspection (SOFI). SOFI is a tool used to observe care in communal areas to capture the experiences of people who have dementia and are unable to tell us about their experiences and the care they receive. SOFI observations take place over a designated period of time to gain feedback about people’s first hand experiences, staff interactions and how people spend their time.

We spoke with five people using the service, three relatives, nine staff, including the appointee manager, care staff, kitchen, domestic, maintenance staff and the registered provider. We also met with nurses from the district nursing team who visit the service regularly.

We looked at care documentation for four people and daily records, risk assessments and associated daily food, fluid and activity charts. All Medicine Administration Records (MAR) charts and medicine records were checked. We read diary entries and handover information completed by staff, policies and procedures, complaints, accidents, incidents, quality assurance records and staff meeting minutes. Recruitment files were seen for three staff and records of all staff training and supervision.

Updated 5 June 2015

Homelea is a residential home in Eastbourne, providing care for people with dementia. Homelea provides local authority and privately funded long term care and periods of respite. People’s care needs varied, some had complex dementia care needs that included behaviours that challenged. Other people’s needs were less complex and required care and support associated with mild dementia and memory loss. Most people were independently mobile and able to walk unaided or with the use of walking frames. The service is registered to provide care for up to 27 people. At the time of the inspection there were 22 people living at the service.

At the last inspection 28 August 2014 we asked the provider to make improvements for care and welfare of people who use the service, cleanliness and Infection control, management of medicines, assessing and monitoring the quality of service provision and records. The provider sent us an action plan stating they would have addressed all of these concerns by November 2014. At this inspection we found that some actions had been taken. However, further improvements were required to ensure all systems were fully embedded. You can see what action we told the provider to take at the back of the full version of the report.

This was an unannounced inspection which took place on 3 and 4 February 2015.

Homelea had a registered manager who had left the service three weeks before the inspection. An appointee manager immediately took over the general running of the service supported by the provider and had commenced the application process to become 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.

General maintenance and on-going redecoration of the service had not taken place in a timely manner. When the maintenance employee had been unavailable, interim measures had not taken place to ensure the continued improvement to the environment. This meant that areas of the building were poorly maintained and did not provide a positive living environment for people. Appropriate equipment maintenance and servicing had taken place including water safety checks.

Staff treated people with kindness and respect. Staff spoke with people in a dignified way and knew how people liked to receive care. Staff communicated in a positive manner, providing support when people became anxious or distressed. People who were able to communicate or who became distressed received immediate response from staff. However, during our observation, we saw that people who sat quietly went for long periods of time without any interaction. Due to a lack of opportunities to pursue hobbies, interests, activities or access things to do many people sat in the lounge impassively throughout the day or went to sleep.

Complaints received had not been appropriately documented to show that the provider had taken actions in line with the organisation’s complaints policy. It was unclear when complaints investigations had been completed and closed.

Risk assessments had been completed for people’s needs. This included behaviours that may challenge and was completed to give staff consistency in their response. Risk assessment information did not always correspond with the latest care planning information but was in the process of being reviewed and updated.

Policies were in place to support staff with medicines, safeguarding and whistleblowing. Medicines were managed safely and infection control in place to ensure cleanliness and hygiene throughout the building was maintained.

There was an organisational recruitment policy and procedure to follow when recruiting new staff to ensure that only staff who had the right skills and competencies to work were employed. However, references had not been clearly recorded in staff files.

All staff had completed safeguarding adults at risk training and were aware how to raise concerns. Further training had included Mental Capacity Act (MCA) and staff showed they had an understanding of Deprivation of Liberty Safeguards (DoLS). Capacity assessments were completed for people to ensure their rights were protected. Staffing levels were monitored by the manager and provider, with feedback from staff on whether levels were appropriate. This was flexible with extra staffing available if required. Staff told us they worked extra shifts if needed to ensure staffing levels were maintained.

People’s nutrition was being monitored effectively to ensure that people received appropriate meals. People received support at meal times. Peoples weights had been checked monthly and referrals for additional support and guidance had been made when people lost weight.

New staff received a period of induction. There was a training schedule in place for all staff. Staff felt that they received appropriate training to meet people’s needs. Staff felt they had clear direction with the new manager with supervision and appraisals taking place. Staff felt supported and were aware of their roles and responsibilities to ensure people received appropriate care.

The manager and provider had been reviewing previous auditing and monitoring of the service, with the use of an independent consultant and had identified areas which still needed to be improved. The new manager, supported by the provider, was in the process of reviewing how audits were completed to ensure they provided information and a clear analysis of findings. The manager had implemented a number of immediate changes to improve the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which now correspond with the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.