This inspection was unannounced and took place on 11 and 15 August 2016.

Homelands is registered to provide care and support for up to 20 adults and older people living with mental illness or dementia. At the time of this inspection, there were 18 people living at the home, 10 of whom were older persons living with dementia and eight were adults living with Korsakoff’s syndrome or mental illness. Korsakoff’s syndrome is a brain disorder commonly associated with misuse of alcohol.

A registered manager was in post when we visited. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The registered manager had been appointed since our last visit and demonstrated what they had done to make the necessary improvements that were identified at the last inspection.

The registered manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Staff recognised the signs to look for if they suspected abuse had taken place; they knew how to report any incidents of abuse they may witness.

Any potential risks to individual people had been identified and appropriately managed.

People’s medicines had been administered and managed safely.

There were sufficient numbers of staff on duty with the necessary skills and experience to meet people’s needs.

Staff supported people to eat and drink if required. They ensured people at potential risk received adequate nutrition and hydration.

People were provided with support to access health care services in order to meet their needs.

Positive, caring relationships had been developed with staff to ensure people received the support they needed. They were encouraged to express their views and to be actively involved in making decisions about the support they received to maintain the lifestyle they have chosen.

The culture of the service was open, transparent and supportive. People and their relatives were encouraged to express their views and make suggestions so they may be used by the provider to make improvements.

At the time of our inspection there was no registered manager employed at Homelands. The organisation had informed us that the previous manager had left. However, the previous manager had not deregistered with CQC at the time of the inspection, therefore their name still remains on any reports until such time that this information is received. On arrival we were met by the deputy manager and a representative of the provider who was providing management support to the deputy manager.

During our visit we spoke with five of the 17 people who used the service. We spoke with both members of care staff who were on duty.

People told us that they were happy with the care and support provided. One person told us, "Staff are brilliant. They help me and give me advice".

Another person told us, "The food is good, we are looked after well. Not a bad place at all".

We looked at people's care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We looked at records that related to staff recruitment. They showed us that the provider had effective recruitment processes in place to ensure that people's care had been delivered by staff who were of good character and had the right skills.

Staff told us they liked working at Homelands. One staff member told us, "We are such a good team. We all help each other out".

We saw that feedback on the service was sought by the provider. This ensured that people who used the service benefited from a service that monitored the quality of care that people receive.

We spoke with two people who live at the home. Both were happy with the care and support provided. They also confirmed that they felt safe from harm whilst living at the home and felt able to raise concerns with staff if they needed. One person said that "Staff here look after us really well". Another told us that they had "no complaints at all.

We did not speak to people on this occasion as the purpose of this visit was to examine the provider’s response to previous concerns raised about this outcome.

We spoke to three people during our visit. People told us they were supported with their care needs and that staff consulted them. People also said the staff asked them about what they would like to do.

One person told us that he/she preferred to go out accompanied by staff and that this was arranged. This person also said he/she was able to choose what to do and where to go when outings were arranged. Two other people told us they understood that they needed support when going out.

People told us they felt safe at the home. Staff were described as helpful, caring and friendly.

We spoke to two people during our inspection visit. Both people said they were satisfied with the care and support they received. One person said support was provided when he/she went out and that he/she was aware of the safety reasons for this. Another person confirmed he/she has been able to exercise independence in going out and in domestic tasks such as laundry.

Comments made by people included the following: “The staff treat me well. They’re very good and caring.”

People said the staff offered support and one person said that staff were always available if they needed someone to talk to.

Choice was said to be available in how people spent their time, the activities available and in the food. We observed one person being offered a choice of meals for the midday meal.

We spoke briefly to two people but did not discuss the outcomes included in this report.

Two people told us at the previous inspection on 3 November 2011 that there not enough opportunities to go out and that their freedom to go out independently was restricted. One of these people understood that this was for reasons of his/her safety. Another person commented there were enough activities.

We received mixed views from people about the home. One person told us that he/she is very satisfied with the service adding that that the staff are helpful and speak to people in a respectful manner. This person commented, “The staff are excellent. They look after me ok. They do what they can for you.”

Two people said that they did not have enough opportunities to go out and that their freedom to go out independently was restricted. One of these people understood that this was for reasons of his/her safety. These two people also said that there was not enough to do, whereas another person said there were activities: “They always give us things to do and we go out with staff.”

We were told that there are enough staff and one person said, “Staff are around when you need them.”

We spoke briefly with 2 people living at the service who said that they were satisfied with the service they receive at the home.

People told us that they are treated with respect and dignity. Comments included the following:

• ‘The staff are very good.’

• ‘All the staff are willing to help. I’ve gone to them with problems and they always help. I know that what I tell them is confidential.’

People said that they are able to exercise choice in how they spend their time and that they have access to activities based on their individual needs. We were told by someone living at the home that the service has been supporting him/her to develop independent living skills. Comment was made that the range of activities for people could be improved, in particular the opportunities to go with staff to places of interest.

Privacy was said to be respected and people told us that they are able to lock their bedroom door when they go out.

People told us that the service provides the care and support they need. We were also told by people that they have read their own care plan and have signed an agreement to its contents.

The food was said to be ‘excellent’ and ‘very good.’ People confirmed that there is a choice at each meal time and that cooked breakfasts are provided on certain days.

People said that they feel safe at the home.

Sufficient numbers of staff were said to be on duty with 2 or 3 staff on duty in the daytime and 2 staff in the evening.

People said that they are able to give their views about the service by using a ‘comments’ box in the hall. We were told that the manager is approachable. One person said, ‘She will listen and give you all the time you need and support you in any way she can.’

This inspection was unannounced and took place on 5 and 6 November.

Homelands is registered to provide care and support for up to 20 adults and older people living with mental illness or dementia. At the time of this inspection, there were 14 people living at the home, five of whom were older persons living with dementia and nine were adults living with Korsakoff’s syndrome or mental illness. Korsakoff’s syndrome is a brain disorder commonly associated with misuse of alcohol.

A registered manager was not in post when we visited. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. This post has been vacant since 10 May 2014. Since then there has been three managers employed. The most recent manager was appointed approximately five weeks before our visit; they were present at this inspection. The provider has since notified us that this manager has left and another manager has been appointed. This has had an impact on the consistency and leadership of the service.

People said they felt safe at Homelands. We observed staff delivered care and support to people safely, with compassion and understanding.

Staff were able to identify signs of possible abuse and knew what to do if they witnessed them. However, not all staff had received up to date training in this area.

We observed that staffing levels ensured people’s immediate needs could be met safely. However, the feedback we had from people, staff and the manager was that the current staffing levels did not always ensure people had social stimulation and access to activities of interest. In addition there was no system to allow the provider or manager to assess the staffing levels required based on people’s needs.

Medicines were been stored, administered and managed safely.

People said the food was good and there was a choice. Where necessary, people were given appropriate support to eat.

Care records indicated risk assessments had been carried out but the information included in them was vague. Identified risks had not been transferred to care plans and records of care and treatment to be provided were not up to date or complete. Guidance for staff on how to mitigate risk was not clear or updated. This meant risks to people may not be effectively managed to reduce the likelihood of occurrence or recurrence.

Information held in care plans had not been kept updated to ensure it reflected people’s current needs. The details included in care plans to guide staff were not sufficiently clear or kept updated to ensure staff knew how to support people with their current needs. Although people said they were consulted in decisions about their care, there was not documentation of this to confirm how people or their representatives were involved.

A limited programme of activities had been provided. However, it was not clear how activities were provided for the needs of people who needed more staff support. This meant they were at risk of isolation and withdrawal.

Staff had not routinely received induction and supervision to ensure they had the necessary skills and knowledge required to carry out their work. Staff training records indicated training had not been kept up to date and some staff had received no training at all in some essential areas, such as understanding dementia, safeguarding and managing challenging behaviour such as aggression.

Staff had not received appropriate training to ensure they understood their role in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring that any restrictions to their freedom or liberty has been authorised by the local authority as being required to protect the person from harm. We did see examples of how best interest decisions had been made appropriately on behalf of people who did not have the capacity to consent to decisions about their care. However we found that appropriate mental capacity assessments had not been completed to determine people’s decision-making capacity before making a DoLS application for potential restriction of people’s liberty.

People and the staff had been asked for their views of the quality of the service. However, there was no evidence which demonstrated how comments and suggestions received had been considered and, where appropriate, implemented to improve the service.

A quality assurance system was not in place to monitor how the service had been provided and to identify and respond to shortfalls.

We have identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.