Homelands Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulations in relation to the lack of assessing risks to people in respect of their health needs and the lack of obtaining people’s consent for decisions.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Preadmission assessments did not provide an overview of what and who was important for the person. Preadmission assessment forms contained basic information and an overview of health needs, there was little information gained about people’s preferences. Assessments were conducted over the phone by nursing staff, person-centred information was gathered from people’s relatives using a ‘this is me’ form and a ‘my life story’ form. We reviewed some of these documents which lacked detailed, one person’s form simply stated they were ‘antisocial’ there was no evidence of follow up about this statement or evidence that staff asked people themselves how they wished to be supported. A relative told us about their loved one’s experience and said, “[Person] was admitted during Covid from hospital. Relatives were not given much choice. The nursing home assessed their needs. We had a chat with the home, but no discussion that [person] was going to stay permanently.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always follow legislation and current evidence-based good practice and standards. The National Institute for Health and Care Excellence (NICE) guidance was not followed in respect of covert medicine administration (where a medicine is hidden in food or drink). NICE guidance sets out where advice should be sought from other professionals when making the decision to covertly administer medicines. For example, a pharmacist to plan what medicine can be safely given without the person knowing and whether the medicine can be crushed or safely taken with other medicines. Staff and management were not following CQC’s Right Support, Right Care, Right Culture (RSRCRC) guidance, this guidance sets out expectations where a service supports people with a learning disability. We discussed RSRCRC with the provider following our assessment, they provided assurance of new ways of working and offering different communication methods for any person they support with a learning disability. Staff and management utilised other nationally recognised tools such as the Waterlow, the Waterlow assessment tools identify people’s risk of sustaining pressure damage to their skin. These assessments were used appropriately and staff were supporting people well with pressure area care.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs with different services. People were not always well supported by an effective team. We observed people had different experiences in the Manor House and the Coach House. People living in the Manor House were supported by a team who appeared to know them well, people in the Coach House were not supported in the same way. The registered manager shared they had concerns about staff in the Coach House, however, they had not increased managerial oversight in the building. Visiting health and social care professionals provided mixed feedback about the service. Comments included, “My impression is that the Main (Manor) House has good nursing staff and provides supportive care. The Coach House seems less organised and the information I have received from staff there often differs. I think referrals from both are made in a timely manner but staff at the Coach House may not know why someone has been referred when I call or visit.” And, “We believe that the staff look after the residents effectively. Communication with members of the nursing team in general is good, but lack of continuity perhaps can contribute to variability in knowledge about individual residents. If they have concerns about a resident, they seek medical advice and review appropriately. In general, we believe guidance from ourselves is followed.”

Staff supported people with their dietary needs well. People’s nutritional needs were met, catering staff were aware of people’s individual requirements including allergies and intolerances. Where people experienced swallowing difficulties they were assessed by the Speech and Language Therapists (SaLT), advice was migrated to people’s care records and catering staff were informed. We observed, when needed, meals were prepared according to SaLT advice, for example, some people were assessed to receive a pureed diet. Catering staff pureed different food separately, such as, meat and vegetables so meals still looked appetising. People told us they enjoyed the food, comments included, “Food is fine, we have what we are given but if I make a comment they change it.” And, “The food is good, it's okay, they cut it up for me as I can only use one hand. I choose what I want a week in advance.” Staff monitored people’s weights and where needed made referrals to the dietitians, we reviewed a person who had been admitted to the service underweight, staff followed guidance and the person’s weight had healthily increased.

Staff and managers did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. People’s care records were regularly reviewed; however, reviews did not highlight where outcomes could be improved. Care delivery and staff practices were not always aligned to people’s care records which meant there were missed opportunities to improve people’s everyday lives. One person spent their days in a transfer wheelchair, we observed them fall asleep in the wheelchair with discomfort. Staff told us the person needed to be secured with a lap strap in case they ‘jumped’ from an armchair. Reviews and monitoring of the person did not highlight where this practice could be improved by referrals to health professionals and services to explore different options. We raised our concerns with staff who subsequently made a referral to wheelchair services. Following our feedback, the person was supported to sit in a recliner chair, we observed the person looked more comfortable with this option.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. We observed people in the Manor House being asked for consent and offered choices by staff. People in the Coach House were not given the same opportunities; staff did not always respect people’s right to decline support. Some people’s care records evidenced staff continued to provide personal care, continence care and support to move and position despite people displaying behaviours of distress or anxiety. Staff and managers did not work within the principles of the Mental Capacity Act 2005 (MCA), where staff had assessed people to lack mental capacity, MCA assessments were not completed to evidence robust decision making. Best interest decisions were made for people without their backgrounds and experience being considered and without consultation with Lasting Power of Attorneys and/or professionals where appropriate. CCTV was being used in the Coach House, we asked the registered manager how they have gained people’s consent for the use, they told us visitors were informed by the poster outside the premises and people using the service would not understand what CCTV was. Consent forms were not in place for the use of CCTV. We raised our concerns with the provider who arranged for MCAs to be reviewed and revisited their consent policy and arranged training for staff.