Homelands Nursing Home provides accommodation, care and support, including nursing care for up to 50 people. This includes a separate unit, The Coach House, for up to 12 people living with dementia. There were 43 people living at the service at the time of this inspection, 33 in the main house and 10 in the Coach House.

At our last inspection we rated the service good. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The service met all relevant fundamental standards.

The service had a positive culture that was person-centred, open and inclusive. Staff were enthusiastic and keen to talk about their role. Recruitment practices were robust, and staff received training appropriate to their role and the needs of the people living at the service. People had individual plans of care and risk assessments. Care was person centred.

It is a requirement of the provider's registration that they have a registered manager in post. 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. The service had a registered manager in place. It was well led, and the registered manager was aware of their legal responsibilities.

Further information is in the detailed findings below.

We inspected Homelands Nursing Home on the 14 June 2016. We previously carried out a comprehensive inspection at Homelands Nursing Home on 29 May 2015. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in respect to cleanliness and maintenance of the service, people not being treated with dignity and respect and quality monitoring. The service received an overall rating of ‘requires improvement’ from the comprehensive inspection on 29 May 2015. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. However, a further area was identified in order to improve some practices in relation to activities and meeting people’s social and recreational needs.

The overall rating for Homelands Nursing Home has been revised to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

Homelands Nursing Home is registered to provide accommodation and care, including nursing care for up to 50 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues and dementia. The majority of people were accommodated in the main building. A short distance away, there was a separate unit, the Coach House, for up to 12 people living with dementia. On the day of our inspection there were 27 people living in the main building and 12 people in the Coach House, who required varying levels of support.

A registered manager was in post. 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 and associated Regulations about how the service is run.

The home had some arrangements in place to meet people’s social and recreational needs. However, we could not see that activities were routinely organised for people living within the Coach House. Feedback from staff and our own observations clearly indicated this need was not being addressed. We saw that the provider had recognised the lack of activities for people in the Coach House, and arrangements were being made to employ a further activities co-ordinator to rectify this. However, we have identified this as an area of practice that needs improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe, because the staff make sure you are safe”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and m

We inspected Homelands Nursing Home on 29 May 2015. This was an unannounced inspection. The service was registered to provide accommodation and care, including nursing care for up to 43 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues and dementia. The majority of people were accommodated in the main building. A short distance away, there was a separate unit, the Coach House, for up to 12 people living with dementia. On the day of our inspection there were 27 people living in the main building and 11 people in the Coach House, who required varying levels of support.

The main building was spacious, clean, bright and well maintained. However, we found the Coach House to be poorly maintained, with heavily stained carpets, peeling paintwork and an offensive and unpleasant odour. The manager told us they assessed and monitored the quality of service provision through regular audits, including health and safety and medication. However, as the neglected condition of the Coach House demonstrated, this monitoring process was evidently inconsistent and an area that we identified as requiring improvement.

A registered manager was in post and present on the day of the inspection. 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 received care from staff who were appropriately trained and confident to meet their individual needs, and they were supported to access health, social and medical care, as required. People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans we looked at were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made, including written references, Disclosure and Barring Service (DBS) checks, and evidence of identity.

Medicines were stored and administered safely and handled by staff who had received appropriate training to help ensure safe practice.

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

Staff received Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) training to make sure they knew how to protect people’s rights. The manager told us that to ensure the service acted in people’s best interests, they maintained regular contact with social workers, health professionals, relatives and advocates. Following individual assessments, the manager had made DoLS applications to the local Authority, for two people, and we saw that the appropriate authorisations were in place.

There was a formal complaints process. The provider recognised not all people could necessarily raise formal complaints, and their feedback was sought through regular involvement with their keyworker.

People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

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

The inspection team was made up of two inspectors. During the inspection we considered how people were cared for in both the main building at Homelands Nursing Home and in the Coach House. The service is comprised of two buildings. We considered our inspection findings to answer 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, discussions with people using the service, their relatives, visiting professionals, the staff supporting them and from looking at records.

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

Is the service safe?

Although there were enough staff on duty to meet the needs of the people living at the service, nursing levels had not been maintained to a level that allowed them to fulfil all their duties. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. On the day of our inspection an urgent application was being submitted and proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made to deprive someone of their liberty and how to submit one.

There was no system in place to make sure that the manager and staff learned from events such as accidents and incidents. This increased the risk of harm to people and failed to prevent such incidents in the future. A compliance action has been set in relation to this and the provider must tell us how they plan to improve in relation to learning from incidents and events that affect people’s safety.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. One person told us, “I’ve got a very bad leg and need assistance to get in my wheelchair. They use a frame to get me in my wheelchair. They know what they are doing”. A relative told us, “The nurses meet X’s (family member) needs in a very good way. They are always on top of things and keep us informed”. It was clear from our observations and from speaking with staff who worked in the main building that they had a good understanding of people’s care and support needs and that they knew them well.

People’s health and care needs were assessed, but some people who lived in The Coach House did not have care plans in place for identified needs. Therefore, there was a lack of information to support staff consistently to meet people’s needs. Staff in The Coach House understood the basic care needs of people. However, they did not demonstrate understanding or show consideration when providing care to people with dementia. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People were supported to be able to eat and drink sufficient amounts to meet their needs. When we spoke to people about their views on the meals provided, the majority of people expressed satisfaction. For example, one person told us, “They make sure everything is in position in the dining room so its runs smoothly. The meals are excellent. They are different every day”. Two people said that they were not happy with the meals provided. For example, one said, “The food is not good”. Some staff had completed training to ensure they were competent to manage the nutritional needs of people and a nurse that we spoke with demonstrated knowledge and understanding of the nutritional needs of people who lived in the main building.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and in the main, gave encouragement when supporting people. People that we spoke with confirmed this. One person told us, “The staff are very caring, very patient. Nothing is too much trouble for them”. Our observations confirmed this.

We noted that the lunch period in The Coach House was well paced and allowed people the time they needed to eat their meal. People were provided with protective aprons to ensure they did not dirty their clothes if they spilled any food. We observed good interactions between people and staff. Care staff who assisted people to eat their meal ensured the pace was dictated by the person. Encouragement was given where needed in a manner which enabled people to maintain their dignity and independence.

Is the service responsive?

Where staff had identified a concern about people's ability to swallow, a referral had been made to the speech and language therapy team (SALT). On the day of our inspection we observed staff in the main building following the guidance issued by the SALT team to reduce the risk of people choking. During our inspection we spoke with a member of the SALT team who was at the service. They expressed the opinion that the nurses who worked at the service took appropriate action to manage people’s nutritional needs. They stated, “I’d say they are pretty good. They make sensible decisions. They call when needed and appear to know the needs of people”.

During our inspection we also spoke with a visiting GP. They expressed the view that, “The nurses are capable, people are treated with dignity and communication with us is good”. This meant that people were supported to maintain and manage changes in their health.

Is the service well-led?

Since our last inspection we found that improvements had been made in relation to the supervision of staff and quality monitoring systems. This was also confirmed by people that we spoke with and by examining records. However, we found that gaps in care planning and injuries to people who lived at the service were not known by the manager. This impacted on the safety of service delivery to people.

People we spoke with told us they received information about their care and treatment and they were asked for their consent. People told us their decisions were respected, a person said "they might say what they think is best for me but I make my own decisions".

We found that people's individual needs were assessed and that care was planned and delivered to meet their needs. People we spoke with told us that they were satisfied with the care they received and a person's relative said "my relative is very happy here, I have no qualms about anything". We found that people's care was planned to ensure their safety and welfare, a person told us "staff help me to go down stairs - they have to be in charge of that to keep me safe"

People told us they felt 'safe' in the home and we saw that staff had completed training in safeguarding people from abuse.

People told us that they were satisfied with the standard of care they received from the provider's staff. One person said "they (staff) are very good and very helpful". Another person said "staff are lovely with personal care". We have asked the provider to make some improvements in the support they give to staff.

We found that people were asked about the quality of service they received and their feedback was responded to. However, we have asked the provider to make some improvements to their quality and safety monitoring system.

During our inspection we spoke with eight people who use the service and four family members. We also spoke with the manager and three staff members. We spent time observing the interaction between people and staff in the main building and in the Coach House. We found the interactions between staff and people who use the service to be positive, friendly and caring.

People told us they are happy with the care and support they receive. People told us that they were treated with respect and their privacy and dignity was maintained.

One person said, "Its a nice place to be. Staff treat me well and I have no concerns."

Another person said, "I’ve only been here a short time but everyone is so helpful, cheerful and friendly".

We spoke with with staff who told us that they are very happy working in a home which has a good atmosphere. They felt supported in their work and felt the management was open and supportive.