The inspection took place on 17 January 2017 and was unannounced.

Homewood is registered to provide accommodation and care for up to six people with a learning disability, autism and other complex needs, including challenging behaviour. Some people had additional mental health needs. At the time of our inspection, the home was at full occupancy. Homewood is a large, detached, older-style property on the outskirts of Worthing town centre. It is close to public transport, a local park and the seafront. Communal areas at the service include two sitting rooms and a dining room. All rooms are of single occupancy and have en-suite facilities. Gardens surround the property.

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 2008 and associated Regulations about how the service is run.

Relatives felt their family members were safe living at Homewood and staff had completed training on safeguarding adults at risk. People’s risks were identified, assessed and managed appropriately by staff. Risk assessments contained detailed information about how staff should support people and to mitigate risks. Staffing levels were sufficient to meet people’s needs and robust recruitment processes ensured new staff were safe to work at Homewood. Medicines were managed safely.

Staff received regular supervisions and attended staff meetings. New staff followed the Care Certificate, a nationally recognised qualification. Staff completed training in a range of areas and the training plan and certificates obtained by staff confirmed this. People gave their consent to specific decisions and the staff worked in line with the requirements of the Mental Capacity Act 2005 and associated legislation under Deprivation of Liberty Safeguards. People were supported to have sufficient to eat and drink and were encouraged in a healthy lifestyle. People had access to a range of healthcare professionals and services. People showed us their bedrooms, which were personalised, comfortable and homely.

People were looked after by kind and caring staff who knew them well. Relatives spoke highly of the staff who supported their family members. People and their relatives were encouraged to express their views and to be involved in making decisions about their care, treatment and support. People were treated with dignity and respect and their privacy was promoted.

Care plans provided comprehensive information about people, and their support needs, in a person-centred way. Staff had clear guidance on how to look after people in line with their preferences and choices. Care plans were written in an accessible format. People took part in a range of activities that met their individual needs and preferences, including social activities and holidays. The provider had a complaints policy in place.

People and their relatives were asked for their views about the service and the care delivered through questionnaires and surveys. Residents’ meetings were held on a monthly basis. Staff were also asked for their feedback about working at the service. Results for all surveys were positive. Good management and leadership were evident throughout the service and the culture was one of openness and transparency. A range of audit systems measured and monitored the care delivered and the service overall.

Homewood is a privately owned care home for people needing personal care and accommodation. It provides care for up to six people with learning difficulties. We were informed that, at the time of our visit, six people were being accommodated.

This inspection was carried out by one inspector. We gathered evidence that helped answer our five questions; 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, the staff supporting them and from looking at records.

Is the service safe?

People were treated with respect and dignity by the staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were told there were no applications made under DoLS that were currently in force.

The manager confirmed they understood when an application should be made to deprive someone of their liberty. Relevant staff had been trained to understand how it should be implemented to ensure people's rights had been maintained. This meant that people would be safeguarded as required.

Is the service effective?

Where possible, people's health and care needs were assessed with them, and they were involved in writing their plans of care.

When necessary best interest decisions had been made to ensure the health and wellbeing of individuals who lacked capacity to make decisions for themselves.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Senior staff arrange meetings for people to talk about their views and experiences and to sort out any problems. One person told us, “We have meetings together. We can talk about things we want to. We can talk about living at the home. We can also talk privately with staff if we need to.”

Family members who completed satisfaction surveys reported they had no concerns about the care provided.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The activities provided have been in response to requests made by people who lived at the care home.

People's relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service well-led?

All staff received one to one supervision from the manager or from a member of staff in a more senior role. Staff we spoke with confirmed they felt well supported and well led by the manager.

During our visit we spoke with a senior manager of the service, the person in charge and members of staff. We spoke with three people who used the service. They all told us that the home involved them in their relatives care and they were regularly consulted. We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs.

People who lived in the home all told us "I like my room" and "I like my keyworker".

We looked at a selection of care records. We noted in two records that there was a lack of health monitoring to ensure that people's needs were being assessed and care planned appropriately.

We found although the service had some quality assurance systems in place, some were being developed. They did not protect people or others against the risk of unsafe care and treatment.

We viewed records relating to staff requirements and found that the provider was operating effective recruitment procedures.

We found the lack of consistent recording systems meant that there was a risk that information may not be kept up to date and people may not be protected against the risks of unsafe or inappropriate care and treatment.

We spoke to two people who used the service. One person said that the home was "Happy". We observed that the atmosphere was relaxed and that people appeared comfortable with staff. We found that people were involved in deciding what they wanted to do during the week. One person said "I do what I want".

An Operations Manager told us that the previous manager left the service last week. We saw that there were arrangements in place for the Operations Managers to cover the service whilst a new manager was recruited.

We found that there were robust systems to ensure that people were safeguarded from the risk of abuse and that the service responded appropriately to any allegation of abuse. Staff were trained in how to identify abuse and were aware of what action they needed to take.

We saw that staffing levels had been increased which meant that people at the home had the support they needed to meet their health and welfare needs.

Because the people using the service had complex needs they were not all able to tell us their experiences.

We observed that there were sufficient staff on duty to support the people in the home. We saw three people who all appeared relaxed and happy.

This inspection was a follow up to our visit on 16 July 2012 when we took enforcement action in relation to concerns about care practice. We found that improvements had been to the service. These included increased staffing levels and new procedures for safeguarding and recruitment which ensured that people at the home were kept safe.

Because the people using the service had complex needs they were not all able to tell us their experiences. We used a number of different methods to help us understand the experiences of people using the service. These included looking at records, talking to staff and observing care. The provider and manager were present during our visit, although the manager was only able to stay for part of the day.

When asked if they liked living at the home, two people said “yes.” We observed that people appeared relaxed and comfortable in their environment. Records showed that people’s liberty was sometimes restricted and appropriate safeguards were not always in place. Staff were observed to treat people with respect. However, the recruitment process was not robust and did not protect people at the home.

People told us that they like living at the home.

People said that they are satisfied with the support and help they get. One person said that he/she gets good support from his/her designated staff member. Reference was made to people receiving support for specific medical conditions. People said that they are satisfied with the help they receive with their medication.

There were mixed comments made about the food. One person said the food was ‘quite nice’ and 2 other people said that they ‘sometimes’ like the food. People confirmed that there is a choice of food.

People told us that they like the environment and that they have been able to decorate and personalise their rooms. One person said how much he/she likes the garden.

People told us that they are supported to take part in activities such as trips to the shops, theatre, cinema and on holidays. People confirmed that they are able to make choices in how they spend their time.

Staff were said to be provided in sufficient numbers to meet people’s needs although one person said the home is ‘sometimes a bit short of staff.’