CQC report explained · a residential care home
What the CQC found at Homewood
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- People and relatives said they felt safe. Staff understood safeguarding, staffing levels were sufficient, risks were monitored and medicines were administered and recorded safely.
- Effective?
- Requires improvement
- Staff training and support had improved, and people received healthcare support. However, care plans did not always include clear goals and steps, and parts of the building needed repair.
- Caring?
- Good
- This question was not inspected during this focused inspection. The report says its rating was carried over from the previous inspection, but it does not state that rating here.
- Responsive?
- Good
- This question was not inspected during this focused inspection. The report says its rating was carried over from the previous inspection, but it does not state that rating here.
- Well-led?
- Requires improvement
- Management systems had improved, but audits still missed some record-keeping, cleaning and maintenance problems. Staff also said they needed more detailed training in communication and supporting emotional distress.
What inspectors found, February 2023
Rated Requires Improvement; inspectors found people were safe and treated kindly, but effectiveness and management still needed improvement.
This was an unannounced, focused inspection on 6 and 9 January 2023. One inspector and an Expert by Experience spoke with all six people living there, four relatives and six staff. They reviewed care, medicine, recruitment and management records.
The home was rated Good for Safe. People said they felt safe, staff understood safeguarding, there were enough staff and medicines were managed safely. The home had also reduced the use of restraint and emergency medicine when people were distressed.
The home was rated Requires Improvement for Effective and Well-led. Care plans did not always set out clear personal goals, some parts of the building needed repair, and quality checks missed cleaning, maintenance and record-keeping problems. The overall rating remained Requires Improvement, although Safe improved from Requires Improvement and Well-led improved from Inadequate at the previous inspection.
Safety and safeguarding
People and relatives said they felt safe. Staff knew how to recognise and report abuse, and incidents were investigated and reviewed.
“People and their relatives told us they felt safe.” from the report
Choice and independence
People were supported to make everyday choices, take part in cooking and household tasks, and develop their independence. Staff aimed to use the least restrictive approach.
“People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests;” from the report
Kind and respectful care
People and families described staff as kind and supportive. Inspectors saw staff respecting dignity and helping people understand healthcare information.
“People and their families told us staff were kind and supportive.” from the report
Reduced use of restraint
Staff had improved their understanding of distress and used strategies to avoid restraint. No emergency medicine had been recorded for distress during the previous year.
“The past year had seen no recorded incidents where people had needed emergency medication to help them when distressed.” from the report
Personal goals were not always clear
needs fixingCare plans needed more detail about people's goals and aspirations, including the steps staff should take to help people achieve them.
“Plans had been developed to focus more on people's strengths, however the registered manager identified this was work that needed further development to clearly include goals and aspirations” from the report
Repairs and decoration
minorSome paintwork and flooring needed repair. The provider had included redecoration in a planned programme of work.
“Paintwork was chipped or otherwise in need of repair and some flooring damaged.” from the report
Quality checks missed problems
needs fixingAudits did not identify some dated risk assessments, missed cleaning and a dirty or possibly damaged kitchen extractor fan. These issues were dealt with during the inspection.
“However, we found some areas of record keeping such as dates on risk assessments and missed cleaning from the cleaning schedules.” from the report
Further staff training needed
needs fixingStaff training had improved, but staff said they needed more detailed support with communication tools and helping people manage emotional distress.
“However, there were still gaps and staff told us they felt they would benefit from more in-depth training particularly around further development of communication tools” from the report
- 01What clear personal goals and aspirations are now recorded for my relative, and what steps will staff take to support them?
- 02Have the damaged flooring and chipped paintwork been repaired, and how do you check that the home remains in good condition?
- 03How do you make sure risk assessments are dated correctly and cleaning schedules are completed?
- 04What further training have staff received on communication tools and supporting people during emotional distress?
This was a planned focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings were used when calculating the overall rating. This explanation was written from the published report of 8 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2021
Overall Requires Improvement; inspectors found safeguarding, staff training and management shortfalls, with leadership rated Inadequate.
Inspectors visited on 28 October and 1 November 2021 without giving notice. They spoke with all six people living in the home, two relatives and six staff. They reviewed care plans, medicines records, staff files and management records.
They found people were not always protected from abuse. Four incidents involving people hitting each other had not been reported to the local authority or CQC. Risk assessments, fire arrangements and guidance for supporting distressed behaviour were not always clear or complete.
Staff knew people well and there were enough staff, but not everyone had suitable training in autism, learning disability, communication and positive behaviour support. People were not always supported to develop independence, and communication and sensory needs had not always been assessed.
The overall rating fell from Good to Requires Improvement, compared with the previous inspection published in July 2019. Safe and Effective were rated Requires Improvement, while Well-led was rated Inadequate because management checks had not found or fixed important problems.
Enough familiar staff
There were enough staff to meet people's needs, and staff generally knew people well.
“There were enough consistent staff who knew people well.” from the report
Medicines support
Inspectors saw trained staff give medicines carefully. Guidance was available for medicines given when needed.
“Medicines were received, stored, administered and disposed of safely.” from the report
Healthcare access
People had access to healthcare professionals and were supported to live healthier lives.
“People had access to health care and were encouraged to lead healthy lives.” from the report
Positive relationships
Most people were generally happy with the support and liked the managers and staff. Relatives said their views were listened to.
“Relatives told us they were pleased with the communication with the managers and staff and felt confident their views were listened too.” from the report
Safeguarding and incident reporting
seriousFour incidents involving people hitting each other were not reported to the local authority or CQC. Guidance after repeated self-injury was also not recorded clearly enough.
“People were not always safe from abuse. Systems and processes to protect people from the risk of abuse were not operating effectively.” from the report
Staff training
seriousSome staff had not completed training about autism or supporting people with a learning disability. Positive Behaviour Support training had started but was not yet fully shared with the staff team.
“The provider failed to ensure staff received appropriate training and support to enable them to meet people's needs.” from the report
Incomplete risk information
needs fixingSome risks linked to activities, mobility equipment and fire evacuation were not properly assessed, tested or recorded. This meant staff might not have had all the information needed to keep people safe.
“Risk assessments did not always contain adequate information to provide staff with information to mitigate risks.” from the report
Communication and independence
needs fixingPeople's communication and sensory needs were not always assessed. Care was described as task focused, with staff sometimes doing things for people instead of supporting their independence.
“The support was task focused and staff did things for people rather than encourage their independence.” from the report
Weak management checks
seriousThe home's systems did not reliably identify problems or make sure improvements lasted. Some records used unclear or disrespectful language and important care information had not all transferred to the electronic system.
“The provider had failed to establish adequate systems and processes to assess and improve the quality and safety of the service provided or to assess and monitor risks.” from the report
- 01Have all staff now completed training in autism, learning disability, communication and Positive Behaviour Support, and how has their understanding been checked?
- 02How are safeguarding incidents, including conflict between people and repeated self-injury, now recorded, reported and reviewed?
- 03Have all care plans and risk assessments been fully transferred to the electronic system, including guidance for mobility equipment, activities and distressed behaviour?
- 04What evidence can you show that communication and sensory needs are assessed and that people are being supported to do more for themselves?
- 05How are fire safety checks and night-time evacuation arrangements tested and recorded?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and previous ratings for uninspected areas were carried forward. This explanation was written from the published report of 24 December 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Homewood
4 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- February 2023Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2021Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Inadequate
- August 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- February 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- June 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 21 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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