Holmfield Care

People’s experience of the service and what we found

We were assured people received care and support based on their needs. A positive person-centred culture was promoted within the service. People and staff thought highly of the service and management.

Medicines were managed safely. Medicines that required stricter controls were recorded correctly. The room temperature in the medicines room was warm, the registered manager confirmed they would address the room temperature to ensure people’s medicines were not impacted by the warm room temperature.

Care plans were person-centred and guided staff to meet people's needs. People's communication needs were met. People were able to take part in activities provided by the service.

Aspects of the home were tired and in need of refurbishment. We have made a recommendation about updating the environment and implementing a refurbishment schedule.

The provider had effective quality assurance systems in place to monitor the quality and safety of the service. Regular staff and residents' meetings were held, and feedback was also sought from people about the service.

Systems and processes were in place to protect people from the risk of infections and people were supported to receive visitors when they wanted.

The provider supported people appropriately with end-of-life care and liaised with the GP when people's end of life needs changed. Staff were recruited safely and there was enough staff on duty to meet people's needs in a timely way.

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. The policies and systems in the service supported this practice and were followed by the provider in line with the Mental Capacity Act.

Staff were provided with an induction and training relevant to the needs of people living at the service. People told us they enjoyed the meals on offer and choices were available. There was a calm atmosphere during mealtimes with staff respectfully asking people if they needed support before intervening.

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

Rating at last inspection

The last rating for this service was Good (published 6 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made a recommendation about the improvement and refurbishment of the environment.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Holmfield is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Located in Didsbury, South Manchester, Holmfield is registered with the CQC to accommodate up to 29 people. At the time of this inspection there were 21 people living in the home. The home is converted from two adjacent houses with a link between them. There are three adjoining lounges and a dining area.

The previous inspection took place in place in September 2016. At that time the home received an overall performance rating of ‘Requires Improvement.’ However, the issues we found at that time were low level and there were no regulatory breaches. At this inspection we found continued improvements had been made to attain an overall rating of ‘Good.'

People living at Holmfield told us they considered the home to be a safe place to live. This was underpinned by effective systems and procedures which sought to protect people from abuse.

Where people experienced an accident or untoward incident, such as a fall, these were reported and recorded in a timely manner and management took appropriate action to reduce the likelihood of such events occurring again in the future.

Where a particular risk had been identified, information was provided in people’s care records which sought to ensure care and support was delivered as safely as possible. Reviews of risk were also completed in a timely manner.

People’s medicines were ordered, administered, stored and disposed of safely. Staff responsible for the management of medicines were suitably trained and competent to do so.

Staffing levels at Holmfield were sufficient to meet people’s needs and the home benefited from a stable workforce.

All relevant health and safety and building maintenance checks had been completed and safety certificates were up to date. Equipment used for moving and handling people had been serviced and maintained in line with regulations and was deemed safe to operate.

People living at Holmfield are cared for by staff who were well trained and competent to carry out their roles. The home benefited from an in-house trainer and all new staff were required to complete the Care Certificate.

Staff supported people to have maximum choice and control of their lives and in the least restrictive way possible; the policies and systems in the service reflected? this practice.

People were well supported to eat and drink and to maintain a balanced diet. A senior care assistant had lead responsibility for nutrition and they worked well with the chef.

The outside space at Holmfield had been transformed to create a wonderful sensory garden that was now accessible to all.

Staff treated people with compassion and dignity and respected their privacy. We saw people were afforded time to express their needs and communication was at an appropriative level and was not rushed. Staff talked to people with kindness and encouragement and this clearly brought out the best in people.

Everyone living at Holmfield was allocated a keyworker. Their role was to get to know the person particularly well and to ensure their day-to-day needs were met. The keyworkers were full time members of staff who each had a maximum of three people they were responsible for. This meant they had the opportunity to get to know those people well.

Holmfield is a well managed home and people spoke highly of the management team and wider staff group.

This inspection took place over two days on 27 and 28 September 2016. The first day was unannounced, which meant the service did not know in advance we were coming. The second day was by arrangement.

The previous inspection took place in November 2013. At that inspection we found minor breaches of three regulations. These related to infection control, safety of the premises, and the Statement of Purpose not being updated. The provider submitted an action plan in February 2014 stating actions had already taken to remedy the breaches. At this inspection we checked and saw that those issues had been rectified.

Holmfield had a registered manager who had been in post for two years. 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. There were also two assistant managers and there was always at least one manager on site during office hours and at weekends.

People living in the home told us they felt safe and the building was designed to minimise the risk of falls. There had been no serious injuries so far during 2016. Falls were recorded and analysed with a view to improving safety.

People were protected against the risk of fire. Individual evacuation plans needed to be improved to give a summary of people’s mobility. This was done during the inspection. The building and equipment were serviced regularly. The home was clean and smelled fresh.

Staffing levels were adequate. Agency staff were never used. Recruitment methods were robust to ensure that suitable staff were employed, but there were a few points of detail to attend to. The registered manager used effective disciplinary procedures.

Staff were trained in safeguarding and knew what procedures to follow. There had been no safeguarding incidents within the past 12 months. Risk assessments were carried out. Medicines were managed safely.

People enjoyed the food. Daily pictorial menu sheets were produced. Meetings were held at which people could express their views about the food. There was a nutrition lead who together with the chef ensured that people got the food they needed and wanted.

People’s weight was monitored and action taken when required. People’s health needs were met.

Training was thorough for both new and established staff. A variety of training methods was deployed. There was regular supervision of staff, and annual appraisals took place.

The service was complying with the Mental Capacity Act 2005 and ensuring that consent to care interventions was obtained. The registered manager understood the legislation relating to the Deprivation of Liberty Safeguards (DoLS). Applications were made when needed. However, the registered manager had not notified the CQC about four DoLS authorisations. This was done immediately during the inspection.

The environment had some adaptations for people living with dementia.

People living in the home were happy with the care provided and with the staff. Families also expressed satisfaction with the home.

Staff were patient and thoughtful when helping people with physical tasks, and they showed empathy with their emotional needs. We observed kind and considerate interactions.

Staff maintained people’s dignity, and respected their privacy. Care records were kept confidentially.

Staff were well trained in end of life care. People’s preferences to stay in Holmfield at the end of life were adhered to where possible.

Effective assessments were carried out before people moved into Holmfield. Then detailed care plans were created. These were personalised and gave sufficient information to enable care to be delivered effectively. They were reviewed monthly and any changes recorded.

There was a keyworker system so that staff were especially aware of the people they were keyworkers for. People were given ‘personal time’ where the member of staff would spend time only with that person. Residents’ meetings were held regularly.

Different activities took place every day. We observed am engaging armchair exercises session which people were thoroughly enjoying. There were occasional trips out.

There was a policy on complaints. Minor complaints were dealt with informally. There had been one formal complaint in the last 12 months which had been dealt with promptly and sympathetically.

People living in the home and their families, and visiting professionals, told us they thought the home was well managed and the registered manager was approachable. The registered manager shared responsibility with two assistant managers. They had defined areas of responsibility but worked together well.

Staff expressed confidence in the management team and in each other. There were regular staff meetings where staff could contribute their views.

The service had an up to date Statement of Purpose. A range of audits were carried out. The registered manager’s line manager visited the home regularly and reported on their findings, so there was outside scrutiny of the management of the home.

There was an annual survey of families and the results were collated by the provider.

The staff and carers were observed to be unhurried and respectful with the people who lived in the home. Arrangements were made for people to practice their faith and faith representatives also visited the home. Visitors told us that they were made welcome and felt well involved in the care of the people they visited. The manager has introduced meetings for people who lived at Holmfield to try and improve the service users' involvement in the running of the home.

The care plans were completed by the assistant managers and the carers were involved in helping to update them. Staff were supported with training and the home was working towards gaining accreditation for The Gold Standard Framework for end of life care.

We found areas on non-compliance with a moderate impact on people using the service in relation to the safety and suitability of the premises, cleanliness and infection control. The statement of purpose needed updating to reflect the developments at Holmfield. The statement of purpose is a document that the provider must update and make available to the Commission. It should include the aims and objectives of the service provider in carrying out the regulated activity, the kinds of services provided, contact details of the service provider and any registered manager, the legal status of the service provider and details of the registered locations.

People who used the service said: "my number one carer makes sure I get what I need"; "I can relax especially at night when I lock my door I know I won't be disturbed'; "there always someone about"