Homeleigh Residential Care Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home is registered to accommodate up to five people who have mental health needs and may also have learning disabilities in one adapted building which have facilities including dining rooms and sitting areas. There were five people living at the home when we visited. The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We undertook this unannounced inspection on 30 August 2018. The service was last inspected in April 2016 and was rated Good. At this inspection we found three breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have rated the service requires improvement.

Risks to people were not always adequately managed to keep people safe. Risk assessments were not always carried out to identify risk of harm to people and management plans were not developed to minimise risks. Lessons were not learned from incidents or when things go wrong. People were not protected against the risk of abuse as safeguarding procedures were not followed. The registered manager did not raise alerts or investigate allegations of abuse in line with the provider’s safeguarding procedure.

People’s care and support were not always planned to meet their individual needs and preferences. Care records did not highlight support people needed with regards to their religious, sexual and cultural needs.

The quality of the service was not effectively monitored to drive improvement. The issues we identified during our inspection had not been picked up through audit systems.

There was 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.

There were enough staff available on every shift to meet people’s needs. Recruitment checks were undertaken before staff started working with people. People’s medicines were managed in a safe way including the administration, recording, storage, and disposal of unused medicines. The health and safety of the environment including infection control were well maintained.

People were supported 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 practice. People gave consent to the care and support they received. The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s freedom was promoted. Staff understood how to recognise signs of abuse and how to protect people from the risk of abuse.

Staff told us they felt supported in their roles through induction, supervision; and training. People’s needs were assessed before they came to use the service. People’s nutritional needs were met. The service liaised with relevant professionals to ensure people received appropriate support and care that met their needs. People had access to healthcare services to maintain good health. The service had suitable facilities for people. The registered manager told us they would work closely with other services to deliver end of life care if needed. No one required end of life care at the time of our visit.

People tol

This inspection took place on 25 February 2016 and was unannounced. At the last inspection on 10 December 2013 the provider met all the requirements for the regulations we inspected.

At this inspection the service was providing care, accommodation and rehabilitation services for five people who have mental health needs and may also have learning disabilities.

There was a registered manager in place. 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 using the service said they felt safe and that staff treated them well. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported. Staff were recruited safely

Medicines had been managed appropriately and equipment had been serviced on a regular basis to ensure that it remained safe for use. Risks to people were identified and monitored. There were enough staff to meet people’s needs and the provider conducted appropriate recruitment checks before staff started work.

Staff received adequate training and support to carry out their roles. They asked people for their consent before they provided care, and demonstrated a clear understanding of the Mental Capacity Act 2005(MCA) and the Deprivation of Liberty Safeguards (DoLS).

People and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people. People were supported to have a balanced diet. People had access to a range of healthcare professionals in order to maintain good health.

Regular residents and relatives meetings were held where people were able to talk to the manager about the home and the things that were important to them. People and their relatives knew about the home’s complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

People received support that was personalised, their wishes were respected and their needs were met. People were provided with information about the service when they joined. People were supported to be independent where possible. People’s support and care needs were identified, documented and reviewed on a regular basis.

Systems were in place to monitor and evaluate the quality and safety of the service. However they required some improvement as they had not identified the need for a business continuity plan to deal with foreseeable emergencies.

The provider took into account the views of people using the service, their relatives, and staff.Staff said there was a good atmosphere and open culture in the service and that both the registered manager and the deputy manager were supportive.

An adult social care inspector carried out this inspection. We spoke with the registered manager, the deputy manager, two people who use the service and one member of the care staff team. 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, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Staff were aware of the importance of consent and people were asked for their consent before care was provided. People's needs were assessed and risk assessments were carried out before care was provided. These were regularly reviewed so that staff were aware of the best way to provide support.

The manager and deputy manager were available on a daily basis to oversee the staff, and monitor that people were being safely supported, for example with personal care and when travelling out in the community. Health care professionals and social services were involved in people's care planning and in responding to people's concerns when needed. People's health needs were included in their care planning to ensure they were healthy. There were always a minimum of two staff available to support people throughout the day and one person at night to respond to night support needs.

There were arrangements in place to deal with emergencies and to make sure people were safe. Fire safety equipment and procedures were in place to ensure people would be kept safe in the event of a fire. The staff and manager were trained in protecting people from neglect or abuse and people told us they felt safe in their home.

At our inspection of December 2013 we found that the staff did not have adequate medication policies and guidance available to them regarding their responsibilities in managing people’s medication. At our inspection of 30 June 2014 we found that the provider had updated the medication policy and guidance for staff and staff were fully informed of their responsibilities. There were safe procedures in place to look after and administer medication and staff who were responsible for people's medication were trained for this task.

There were enough staff who were trained and experienced to provide support during the day and at night. Two people we spoke with told us they felt safe and secure at the home.

Is the service caring?

We spoke with three people who used the service and observed staff working with people. People told us that the staff and manager were very caring and supportive. We saw that staff always took the time to stop and speak with people and spoke with them in a manner they best understood, speaking slowly and using pictures to help people to understand. One person said, “the staff are always helpful and respectful and they make living here easy for me, and they are good at helping me to do things for myself and to make choices about doing things.”

Is the service effective?

We saw from four people’s records we looked at that people's needs were assessed and a care plan was drawn up to meet those needs. Two people told us they were happy with the plan provided. Regular reviews were made of the plan and people told us they were involved in the reviews of their care plans. There were suitable policies in place for example; consent to care, care planning and management of medication. One person told us, "the staff know how to support me well and I now travel by myself and I have got a job, which I love.”

People who used the service were consulted for their views on a regular basis, which involved them , their family or advocate and social services. Any changes they requested were included in a revised care plan.

Staff had been provided with adequate support, guidance and training to do their job. They were experienced in supporting people with learning disabilities and mental health support needs, and used effective systems to communicate with people.

Is the service responsive?

People we spoke with who used the service told us that the staff and the manager always listened to their concerns and do something to help sort out any problems they are experiencing. People were provided with a range of enjoyable activities and changes were made when necessary to try out new activities. People's support plans were reviewed and changed when necessary in response to changing needs, for example in helping people to become more independent in managing their medication and being involved in shopping and cooking. People told us they had lots of interesting activities and that the staff listened when they wanted to do something different.

Is the service well led?

The registered manager was involved in direct care and worked with all the staff almost every day. They felt this meant they could identify any issues quickly and address them if they arose. Staff we spoke with told us that they felt the home was very well managed and that they received direction and training to allow them to support people at the home.

People who used the service told us that they felt the manager was very good at managing the home and was always present to speak with them about any concerns.

There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed.

We spoke to the manager, staff and three people who used the service. People who used the service confirmed they were involved with consenting to their care. One person told us they were “able to decide what they wanted to do.” We observed people making decisions relating to their well-being during our inspection.

People's care records we looked at showed that external healthcare professionals along with people and the staff at Homeleigh were involved in planning and delivering people's care and welfare needs. We found risk assessments were thorough and ensured people were kept safe whilst maintaining their independence. People told us they were "happy with the care" they received and "felt supported by the staff."

We observed the medicine administration process and found that medicines were given in a timely manner. We saw that risk assessments in care records detailed any issues of people's non-compliance with medicines.

We found evidence that effective recruitment procedures were followed and people were cared for by staff who were fit and appropriately qualified to deliver safe and effective care. Staff told us they were "happy with the training they received."

Records for people and staff contained appropriate information and were detailed, accurate and stored securely.

We spoke with the manager, one other member of staff and one person using the service. People were involved in developing their care plans and we observed people going out independently into the community. One person told us they went out independently but staff supported them to go to appointments that were further away as they didn't know what buses to take. We observed people being encouraged to take part in daily living activities to support their independence such as doing their laundry and one person said, "It's my job to peel the veggies every day and I wash and dry up".

Care plans considered people's preferences, likes and dislikes and were reviewed at regular intervals to reflect any changes that took place. People's comments were recorded in their care records. Care records contained risk assessments that ensured people were kept safe whilst balancing their right to make choices and maintain their independence. For example, we saw risk assessments relating to people's mental health needs, self harm and vulnerability to exploitation.

The home was clean, warm and well maintained. Health and safety checks were taking place at regular intervals and maintenance issues were addressed promptly.

There were sufficient staffing levels to meet people's needs effectively.

There was an effective complaints management system in place and one person told us they were encouraged to talk about their concerns at the house meetings that were held.

People who used the service told us during our visit on 16 March 2012 that staff were friendly and approachable and that they did their jobs well. They told us they received the care and support they needed and that they felt comfortable and safe at Homeleigh Residential Care Home. They told us also that the regular community meetings were useful, as things got done as a result of them.