Holme Manor Care Home

We found the following examples of good practice.

Prior to our inspection, we received information of concern about infection prevention and control (IPC) practices at this service. The registered manager was accessing testing for people using the service and staff. Clear records showed safe processes were followed in response to any positive COVID tests, in line with government guidance. There were enough staff to provide continuity of support should there be a staff shortage. The registered manager spoke positively about the hard work, care and commitment provided by staff.

The home was clean and odour free. There were designated domestic staff and cleaning schedules were followed. We discussed replacing swing bins with pedal operated bins to ensure safer disposal of waste and ensuring cleaning schedules reflected the frequency of cleaning high touch areas. The registered manager agreed to address these points. The registered manager carried out regular checks of the environment and cleanliness and any shortfalls were being acted on.

There were enough stocks of personal protective equipment (PPE). We observed staff and management were using PPE correctly and there were procedures in place to support staff with its use. Staff had received training in the use of PPE and infection control. Signage was in place to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

The provider was facilitating safe visiting in line with government guidance. Indoor visiting was suspended during the COVID-19 outbreak other than for essential care givers and in exceptional circumstances. People continued to use telephone calls to maintain safe and meaningful contact with their family members. Visitor assessments were carried out to consider temperature checks, current health needs, lateral flow test results and COVID-19 symptoms and PPE and sanitisers were readily available. At the time of the inspection, admissions to the service were restricted; the manager was aware of current guidance.

IPC policies and procedures were kept under review. We found safe processes were in place and appropriate action had been taken during the outbreak. The local commissioner's IPC team was providing advice and support to management and staff.

People’s experience of using this service: People told us they felt safe at the service. Processes were in place to make sure all appropriate checks were carried out before staff started working at the service. There were enough staff available to provide care and support; we were told staffing arrangements were kept under review.

Arrangements were in place to promote the safety of the premises, this included maintenance, servicing and checking systems.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff had received training on safeguarding and protection matters. There were some good processes in place to manage people's medicines safely. Some improvements were made during our visit and the provider agreed to review medicines storage arrangements.

People's needs were being assessed, planned for and reviewed. Each person had a care plan which was designed to ensure their needs and choices were met. People were supported with their healthcare needs. Changes in people's health and well-being were monitored and responded to. Where necessary, people received appropriate medical attention.

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 at the service supported this practice.

People made positive comments about the caring attitude of staff. They said their privacy and dignity was respected. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff were respectful of people's choices and opinions.

There were opportunities for people to engage in a wide range of group and individual activities. Visiting arrangements were flexible, relatives and friends were made welcome at the service. There was a suitable standard of décor and furnishings to provide for people's comfort and wellbeing.

People said they were satisfied with the variety and quality of the meals provided at the service. Their individual needs and preferences were catered for. We found people’s mealtime experience could be better, we therefore made a recommendation for improvements.

People spoken with had an awareness of the service's complaints procedure and processes. They indicated they would be confident in raising concerns. Arrangements were in place to encourage people to express their views and be consulted about Holme Manor. They had opportunities to give feedback on their experience of the service and suggest improvements. A variety of checks on quality, systems and processes were completed regularly. These systems were being be further developed.

We found there were management and leadership arrangements in place to support the effective day to day running of the service. Progress was ongoing to ensure the management arrangements met legal requirements.

Rating at last inspection: At the last inspection service was rated Good (12 July 2016)

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will plan a follow up inspection as per our inspection programme. We will continue to monitor the service and if we receive any concerning information we may bring the inspection forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Holme Manor Care Home is registered to provide accommodation for up to thirty-two people who require personal care. The home is situated in the Rossendale valley in Lancashire. The home has 30 single bedrooms and one companion room on two levels which can be accessed via a passenger lift or stair lift. Bathroom and toilet facilities are close to the bedrooms and a lounge. A quiet lounge and dining room are also available. Enclosed garden areas are accessible to people living at the service.

At the time of this inspection there was a registered manager employed. 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. The registered manager was supported in their role by the home’s manager.

The service was last inspected on the 14 May 2014. We found it was meeting all legal requirements applicable at that time.

During this inspection, we found the service was meeting the current regulations.

People told us they felt safe living at the service and were happy with the care they received. Processes were in place to maintain a safe and appropriate environment and protect the safety of people using the service, staff and visitors. Training was in place for staff to ensure they were competent in recognising the signs of abuse and how to respond and ensure any safeguarding issues had been notified to the relevant authorities.

We saw evidence that fire audits were up to date and compliant. People using the service had personal risk assessments in place to inform emergency services of their responsiveness in the event of an emergency. A business continuity plan was also in place to ensure clear guidance to all staff in the event of an unforeseen event. Staff displayed a sound knowledge of processes to follow in the case of an emergency.

The service had sufficient numbers of staff to support the operation of the service and provide people with safe and personalised care. People told us they never felt rushed and staff were responsive to their needs. We noted the service offered a variety of training to its staff which ensured the staff team were skilled and experienced in safely and effectively supporting the people using the service.

We found the service’s recruitment systems protected people using the service by ensuring essential recruitment checks had been completed and appropriate steps had been taken to ensure the staff had the necessary training and knowledge to meet people’s needs. Disciplinary procedures were also in place to support the organisation in taking immediate action against staff in the event of any misconduct or failure to follow company policies and procedures.

The service had processes in place for appropriate and safe administration of medicines. Senior staff were adequately trained in medicines administration. Medicines were stored safely and in line with current guidance. People had been consulted about their dietary requirements and preferences and we saw choice was given at every mealtime. We saw appropriate referrals had been made to dietitians and instructions were strictly followed in cases where people had known dietary requirements.

All staff spoken with had an awareness of the Mental Capacity Act 2005 and had completed appropriate training. Appropriate referrals had been submitted to the local authority by the homes manager and a good audit trail was seen.

Care plans were in place which detailed ‘goals for support’. These were an effective way of ensuring the person maintained independence by providing a detailed plan covering essential information care staff needed to follow, which gave clear information about people's needs, wishes, feelings and health conditions. These were kept under regular review.

There was great emphasis placed on meaningful activities. People were involved in community projects and further activities were tailored around individual need to ensure participation from everybody.

Staff interacted and engaged well with people. Staff were caring and respectful in their approach and treated people as individuals. They promoted privacy and dignity and supported people to maintain control over their lives. People were given information about their care and the service to help them make informed decisions. Their opinions were routinely sought and acted on by means of questionnaires enabling them to influence the service they received. Feedback we received from people over the two days of inspection supported these observations.

Positive feedback was received from people using the service, visitors, staff and visiting health professionals about the management structure. People described the registered and home’s managers as caring and infusive. Staff felt well supported and felt they could approach either manager with any concerns and felt happy their concerns would be dealt with appropriately.

We also used the Short Observational Framework for Inspection (SOFI).

This is a summary of what we found:

Is the service safe?

Before people were admitted to the home arrangements were in place to make sure they would be safe in the environment and there was enough skilled and qualified staff to meet their needs.

We found people had been given a contract of residence outlining the terms and conditions of residency therefore protecting their legal rights.

The manager understood their obligation to apply the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions. An application for this safeguard was in progress and the correct procedures were being followed.

People told us they were treated very well by the staff. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments were completed and staff had been made aware of who may be at risk of falling, developing pressure ulcers or may not eat enough.

We observed people with advanced dementia showed no signs of distress around staff. Staff had been trained to understand dementia care needs.

The kitchen was clean and hygienic and people with medical problems such as swallowing disorder and diabetes were provided with a diet that met with their needs.

Staff were trained in emergency procedures such as fire and first aid. All staff had been trained in the safe moving and handling of people. Staff used safe ways of working, for example, when they used a hoist to assist them move people.

Care had been taken to make sure people were kept safe by good recruitment procedures being followed. Staff contractual arrangements prevented them from gaining financially from people they cared for.

Systems were in place to make sure the provider continually checked the service was safe. Guidance was being followed such as health and safety in the work place, infection control, fire regulations and control of hazardous substances. This reduced the risks to people and helped the service to continually improve.

Is the service caring?

We observed staff were attentive to people's needs. They provided care and support in a dignified manner. People told us they were happy with the care they received and the staff team. They said, 'I like it here. I get a bit anxious about things. I'm a worrier but the staff get me what I need and they are nice to be with.' And, 'I'm unsteady on my feet so I ring my bell and they will come and help me when I want to lie on my bed. They bath me every day. It's what I want and that's good for me.'

We saw staff treating people with respect and kindness while delivering appropriate levels of care and support. Where people required one to one support such as with eating this was given in a dignified manner. People were not rushed and staff chatted to them and encouraged people to eat.

Daily records showed staff responded to people's needs as required day and night. Staff gave a good account of, and showed an understanding of, the varying needs of different people we had discussed with them.

People were able to make choices regarding their lifestyle. They had the opportunity and scope to express their wishes for daily living and social activity, and this was respected. This supported people to be cared for in a way that did not inappropriately restrict their freedom.

Is the service responsive?

People were given plenty of opportunities to say what they wanted. People's assessment of needs and care plans were reviewed regularly and professional help and support was sought from health and social care professionals when needed.

Good practice was followed to make sure people admitted in an emergency situation were given the same consideration as a planned admission. A continuing assessment of need was ongoing, including mental capacity assessment to support continuing care needs being addressed appropriately.

Staff had relevant training to support them in their role. Training in topics such as end of life care and dementia was provided in response people's needs.

Arrangements were in place to deal with emergency situations such as fire evacuation.

People using the service and their relatives had the opportunity to complete a satisfaction survey. A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.

Is the service effective?

People told us they were happy with their care. They had their own preferred routines, likes and dislikes. One person told us, 'I like it here. I get a bit anxious about things. I'm a worrier but the staff get me what I need and they are nice to be with.' And, 'I just have to say what I want and the staff will get it. I'm happy with my life here.'

A relative told us, 'He came for a trial stay and never went back. Staff are very helpful. When it comes to his wellbeing, I would say they are very good. They keep me up to date with how he has been.'

People's health and well-being was monitored. Appropriate advice and support had been sought in response to changes in their condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care. Care and treatment given reflected relevant guidance such as the use of Malnutrition Universal Screening Tool (MUST).

Staff had been trained in dealing with health conditions people presented such as diabetes and dementia.

People told us they were consulted with and listened to. They had no restrictions or unnecessary rules imposed upon them such as what time they got up or went to bed. Staff were flexible in their work to accommodate individual needs and preferences.

Is the service well led?

People told us the management of the service was very good. They said, 'He is usually about. He calls in and chats to me. I only have to ask for something and it's done. The other day I mentioned the light in my room seemed dull. He changed the bulb straight away. He seems interested in how I am and what I want to do.'

Staff were clear about their responsibilities and duty of care and were able to raise their views and concerns and discuss work ethics at staff meetings. Staff were encouraged to develop their skills and knowledge. The staffing structure meant staff were given additional support from team leaders.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. We saw evidence the service knew when to consult with health and social care professionals when required. This meant any decision about people's care and support was made by the appropriate staff at the appropriate level.

The service had achieved the Investors In People (IIP) award. This is an external accredited award for providers who strive for excellence, which recognises achievement and values people.

We found suitable arrangements had been made to support staff. Supervisions had been arranged and appraisals had been organised. We also found that team meetings had taken place and staff had been informed and involved in updates about supervision arrangements.

We found improvements had been made to individual's care planning records. This meant that people living in the home continued to receive safe and appropriate care to meet their needs.

People living at the home made complimentary comments about the staff team. One person said, 'The staff are very polite, lovely'.

The care plans we reviewed highlighted people's needs and had been reviewed by the home manager. The provider may wish to note that although there were care plans in place these did not provide enough detail of how care staff would meet peoples individual needs.

People living at the home were protected by effective systems in place to maintain cleanliness throughout the home and to prevent any healthcare infections.

We spoke with five staff members who told us they felt supported by the home manager. However we found that staff were not always provided with appropriate supervision and appraisals.

We found there was an adequate complaints process in place to ensure that any comments and complaints were listened to and acted upon.