Homelands Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation people not receiving person-centred care and safeguarding concerns due to potential medical restraint.

This service scored 32 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Care records were not person-centred and did not contain details of what was important to people. Care and support were not planned based upon people’s individuality and preferences, for example, moving and positioning care plans guided staff to refer to the moving and positioning policy rather than contain person-centred information about people. Some people displayed distress and anxiety when being supported indicating their support was not being delivered in a person-centred way. A visiting social care professional told us, “It would be good to see a more personalised care plan, this currently appears very medically led, which is not incorrect but does not give a sense of the person when reading it. However, as mentioned when talking to staff they appear to know the resident beyond their medical requirements.”

There were shortfalls in how staff and managers understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. People who resided in the Coach House lived with advancing dementia; their needs were not always understood by staff. Staff and managers did not always recognise where health or social care involvement could benefit people. Some people displayed emotions of anxieties, there had been few referrals to specialist teams such as the older people’s mental health team or dementia support team. This did not provide people with good outcomes and meaningful lives. Staff did not always take appropriate steps to support people when they displayed emotions of distress and anxiety. For example, a person was consistently administered a higher dose of calming medicine without staff attempting alternative interventions. Staff had not recorded the rationale for administering the medicine at the higher dose and had not referred the person to the prescriber for a review.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. People’s care records did not guide staff on their communication needs and preferences. However, a person who did not use words to communicate their needs had a pictorial board to express their wishes, we observed staff communicating well with them. The service did not meet the Accessible Information Standards (AIS), documents were not readily available in larger print or a format to suit people. Following our feedback, the provider sent us evidence they had created pictorial menus and activity schedules to enable people to understand their choices and make informed decisions. Staff had not received training on communications needs, a staff member told us, “No we haven't had any communication training but if we have any problems we will ask the registered nurses to give us some assistance if we need to communicate differently with the residents.”

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. There were few opportunities for people to be able to give direct feedback to the registered manager on a day by day basis. A relative told us, “I mention small concerns straight away and they are actioned right away and explained to me. My only niggle would be that I don’t see the manager engage with residents.” A person told us, “I know the manager I can speak to them. My [relative] comes every day and they would tell [registered manager] if I would need to speak to them." There was a suggestion box was in the foyer of the Manor House; however, it was situated on a shelf low to the floor and was not in the sight range or easily accessible to people. Complaints were logged and investigated by the registered manager. Most people and relatives told us their concerns were listened to, one relative commented, “We made a complaint about [person] being in their bedroom. They did listen and put them in the common room but then put them back in the bedroom. We complained to the head nurse but it isn’t sorted yet.” Another relative said, “I met the manager after complaining and had asked for a meeting. I didn’t find them very co-operative or helpful. I asked for an action plan going forward but it wasn’t forthcoming.”

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. The Coach House was not accessible for people living with dementia. There was no dementia friendly signage around the service to help people orientate themselves. Not everyone had their name or photographs on their bedroom doors to help them and others know whose personal space it was. The main door to the Coach House had an alarm which sounded after a very short period of time, the alarm was loud and heard by people in the lounge throughout the day. Following our feedback, the provider sent us evidence they had obtained dementia friendly signage and confirmed people’s names were now on their bedroom doors to enable people to identify spaces.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. People at risk of inequalities did not always experience positive outcomes. There were examples of missed opportunities of people receiving professional input, for example, specialist advice for people living with dementia and where people could benefit from equipment to support them. Although we identified some missed opportunities, health and social care visits were arranged in the service when people were unable to attend outpatient appointments, for example, opticians and dentists. A healthcare professional told us, “If a resident has a [health] issue the staff are very good at contacting our clinic for an appointment.”

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. People and/or their families were not always supported to plan for the future, staff did not always involve them in discussions about where they wished to spend the end of their lives and how their needs could be met in a holistic way. People’s end of life wishes were recorded on a document called ‘planning future care’, these were inconsistently completed. A visiting professional told us, “I’m unsure if staff training, specifically for end of life care is up to date.” We reviewed staff training records, there was no evidence staff had completed training on how to support people at the end of their lives. We did, however, review multiple cards from relatives thanking staff and management for the care provided whilst their loved ones were at the end of their lives.