Holmwood Rest Home

Holmwood Rest Home is a residential care home registered to provide care and support to up to 16 people. The building had been adapted and care was provided over 2 floors with stairs and a stair lift as access. There were 7 people living at the home at the time of inspection.

People's experience of using this service and what we found

Significant improvements had been made to the governance systems within the home. Leadership was visible. The newly registered manager was clear on their role and responsibilities and had a good understanding of the regulations.

Policies and procedures were comprehensive and up to date. 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.

People were asked for their views, actions were taken and staff told us the structure and work processes had improved.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 January 2023). At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 17.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

Holmwood Rest Home is a residential care home registered to provide care and support to up to 16 people. The building had been adapted and care was provided over 2 floors with stairs and a stair lift as access. There were 10 people living at the home at the time of inspection.

People’s experience of using this service and what we found

Improvements had been made to the assessment of risk, medicines management and the protection of people’s rights.

Risks to people’s wellbeing and safety were assessed and clear instructions were in place for staff to work in safe ways. Environmental safety had improved, all utilities servicing and equipment checks had been carried out and organised.

People received their medicines as prescribed and medicines were stored safely. Infection prevention and control procedures were in place and working well.

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. People’s rights were respected, and the home was working in accordance with the principles of the Mental Capacity Act 2005. Consent was sought and staff had a better understanding of their responsibilities following extensive training.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 January 2023). At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 11 and Regulation 12.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 11 and Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

Holmwood Rest Home is a residential care home registered to provide care and support to up to 16 people. The building had been adapted and care was provided over two floors with stairs and a stair lift as access. There were 11 people living at the home at the time of inspection.

People’s experience of using this service and what we found

Governance systems were not established and therefore not operating effectively as they did not identify the shortfalls found within this inspection. The provider had made staff responsible for undertaking management duties within the home but had not given the staff time to complete them. The home did not actively seek feedback on the service they provide in order to improve outcomes for people. The registered manager did not submit statutory notifications to CQC about events that had taken place in the home as required by law. The registered manager did not have day to day management oversight of the home. There was no measurable system in place to have oversight of the home at provider level.

Risks to people were not always identified and properly assessed to protect them from avoidable harm. Environmental and equipment checks did not always take place to ensure a safe living environment. People received their medicines as prescribed, however, medicines were not always managed and stored safely. Safeguarding procedures were not robust, the home did not report certain events within the home to the local authority as necessary. Staff had received safeguarding training but were unsure of the correct procedures for raising concerns and whistleblowing outside of the home.

Accidents and incidents were recorded but the information was not used by the home to learn lessons and reduce the likelihood of them happening again. Recruitment processes were not always robust as staff did not always have the necessary checks needed to work with people. There were enough staff on duty but recruitment challenges and unplanned staff absence had a negative impact on the home.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Consent was not sought from people for their care and support and where there were concerns of a person’s capacity the necessary capacity assessments had not been carried out. The registered manager told us they were not sure of their responsibilities and staff did not have an awareness and knowledge of the Mental Capacity Act 2005. This meant that there were risks to people’s rights and freedom.

Staff supervision did not happen as planned. Staff received training; however, this was not effective as staff knowledge and the subjects offered were limited. There was a risk staff were working outside their scope of competence, for example, with wound care.

People and their relatives told us Holmwood Rest Home was a safe place to be. People told us staff were kind and they were happy living at the home. People had access to healthcare as required. There was enough to eat and drink, with choices and alternatives if needed. Staff told us they knew people well and were like family. People and their relatives told us they were kept informed and felt involved in their care and support.

People had enough to eat and drink and access to healthcare when needed. People, their relatives and staff told us the management of the home were kind and could be approached with any concerns. Staff told us they were confident the manager would follow up any concerns they had.

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 21 December 2017).

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to consent, risk management, medicines safety and the management oversight of the home at this inspection. We have made a recommendation about the provider’s recruitment process.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Holmwood Rest Home provides accommodation and personal care for up to 16 older people. There were 11 people living at the home at the time of inspection. The service is located in West Parley and is a detached dormer bungalow. The accommodation offers 14 bedrooms on the ground floor and two bedrooms on the first floor. There are two staircases to access the first floor, one with a stairlift. There is a communal lounge and dining area on the first floor. There is also a conservatory and an accessible garden.

Quality assurance measures were not always effective because they did not consistently identify gaps or trends in areas of support people received. The manager rectified gaps when we identified these, but improvements were needed to ensure that there was consistent oversight of the service.

The manager of the service did not have any external links or sources of good practice guidance. We made a recommendation about this.

Risk assessments were in place and identified the risks that people faced and provided guidance about how to manage these. Staff knew peoples individual risks well and their role in supporting people to manage these safely.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

There were enough staff available and people did not have to wait for support. People had support and care from staff who were familiar to them. Staff were consistent in their knowledge of people’s care needs and spoke confidently about the support people needed to meet these needs.

People were supported by staff who had been recruited safely, with appropriate pre-employment checks in place.

People received their medicines as prescribed and these were securely stored. Where there were gaps in information about what medicines people needed ‘as required’, the manager addressed these immediately.

The home had good links with health professionals and regular visits and discussions meant that people were able to access appropriate healthcare input promptly when required.

People were supported by staff who had the necessary training and skills to support them. Training was provided in a number of areas the service considered essential and other learning offered was relevant to the conditions that people faced.

Staff understood and supported people to make choices about their care. People's legal rights were protected because staff knew about and used appropriate legislation. The manager was in the process of ensuring that documentation was in place for people who required decisions to be made in their best interests.

People spoke positively about the food and had choices about what they ate and drank. The kitchen were aware about people’s dietary needs and catered to people’s preferences and special diets where needed.

Staff knew people well and interactions were relaxed and caring. People were comfortable with staff and we observed people being supported in a respectful way. People were encouraged to make choices about their support and staff were able to communicate with people in ways which were meaningful to them.

People were supported by staff who respected their privacy and dignity and told us that they were encouraged to be independent.

People were supported by staff who knew their likes, dislikes and preferences. Staff told us that they communicated well staff were confident about their roles and responsibilities.

People were able to engage with a range of activities including one to one time with staff. People told us that they had enough to do at the home and enjoyed the activities on offer.

Relatives spoke positively about the staff and management of the home. They told us that they were always welcomed and visited when they wished. Both relatives and people told us that they would be confident to complain if they needed to.

Feedback was gathered both formally and informally and used to drive improvements at the home.

This unannounced inspection took place on 23 June 2016. Holmwood Rest Home provides residential care for up to 16 older people. There were 14 people living in the home at the time of our visit, some of whom had memory problems.

The owner was also the registered manager. 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 by a manager who was responsible for the day to day management of the home as well as on-going improvements. The registered manager told us the manager would be applying to become a registered manager of the home.

There were systems in the home for recording accidents and incidents We saw that two people had several falls over a period of four months. We checked to see what actions had been taken. Peoples risk assessments had been updated and one person s risk of falls was increased in one month from a low risk of falls to moderate risk. There had not been amendments to the persons care plan to reflect the increase in risk. The manager told us they had discussed the person’s falls with a healthcare professional. There was no clear follow up in the persons care records. Therefore it was not clear that all possible measures were taken to minimise the risk of the person coming to harm as a result of a fall.

One person needed to live in the home to be cared for safely and they did not have the mental capacity to consent to this. A Deprivation of Liberty Safeguard (DoLs) had not been applied for. The management team did not fully understand when an application should be submitted and therefore were not working within the requirements of the Deprivation of Liberty Safeguards. This meant people were at risk of having their liberty restricted unlawfully. The manager completed the DoLs application during our inspection and told us they would review all people living in the home.

Medicines were stored and administered appropriately, the Medicine Administration Record (MAR) were stored in a ring binder and several sheets had come loose. They fell out when we picked the folder up which meant there was a risk of either losing a MAR or mixing them up.

There was a relaxed informal atmosphere in the home. The management team were visible and accessible and staff told us they were supportive. People and their relatives were positive about the staff and we saw staff were kind and considerate to people.

Food was freshly prepared in the home and we saw the food was served hot. People told us the food was very good.

People had access to healthcare when they needed it and the manager told us they had weekly support from GP’s. We saw people had appointments with a range of healthcare professionals.

People were asked to give feedback on the home in a survey. Responses were generally positive and comments received were acted upon.

Staff told us they had enough training and support to carry out their jobs. There were systems in place to provide staff with regular supervision.

People were offered a choice to join in an afternoon activity. Some people were supported to maintain independent activities such as going to the shop.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the documents and records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were treated with respect by the staff, their dignity upheld and their independence promoted.

CQC monitors the operation of Deprivation of Liberty Safeguards, which applies to care homes. While no applications had needed to be submitted we found that the registered manager was fully aware of the requirements. We saw that where risk assessments were carried out consideration was given to the least restrictive way to minimise risk. Staff had received relevant training in the Mental Capacity Act.

People were supported to be independent. Risk factors were identified, analysed and measures put in place to minimise the risk of harm.

Medication was managed safely and administered by competent staff.

Is the service effective?

People told us they were well cared for and their needs were met. From speaking with staff and observing how they supported people it was clear that they knew people well and understood their needs.

Care plans were individualised and contained guidance that enabled staff to provide effective and consistent care. Two care staff gave us examples of how they supported people to make choices in a way that was appropriate for them.

We saw that people were supported to pursue their own activities and interests. Risk was identified and analysed, and clear guidelines put in place to minimise the risk of harm.

People were cared for by staff who were trained and well supported to enable them to meet the needs of the people living at Holmwood Rest Home. We spoke with all three care staff on duty, the cleaner and the cook all of whom had received appropriate training. The records showed that new staff received a thorough induction in line with the sector standards.

The quality assurance systems in place meant that the provider was able to monitor the effectiveness of the service provided.

Is the service caring?

People were cared for by staff who were caring and attentive. People told us they were able to do what they wanted to do when they wanted. We saw that care staff supported people in way that was unhurried. One person said 'Can I praise it to the hilt? The staff are so kind'. Another person who had lived at the home for a short time also told us 'the staff are kind.'

People were safe and their care and welfare needs met because there were effective systems in place to ensure staff were competent to do their jobs.

Is the service responsive?

Individual needs were assessed before people moved into the home. Care plans and associated documentation showed that individual preferences and interests were recorded. We saw that staff checked with people how they would like support to be given, and that they were sensitive to people's changing needs.

We spoke with a visiting nurse who told us that the staff worked closely with the community nursing team to promote and maintain people's health.

Regular audits were completed, for example for medicines. We saw the results of a survey of the views of people using the service about the quality of care provided, which were positive.

Is the service well-led?

There was a clear management structure in place. The provider was registered as manager and was present during the inspection. They are referred to in this report as the registered manager. In addition there was a manager who was taking over some of the day to day operation of the home, referred to in this report as the manager. The manager was on a day off at the time of the inspection and we observed that the staff understood their roles. The registered manager and the manager had clearly defined areas of responsibility. For example, the registered manager dealt with ordering medicines and supervising staff and the manager reviewed care plans and carried out audits.

Staff only started work in the home after all appropriate recruitment checks had been completed. The manager told us they took people's safety very seriously.

People we spoke with told us that staff knew their personal preferences and provided care the way they wanted. For example, one person told us " staff know me really well."

We looked at the risk assessments for five people. We found that risk assessments were not completed well. This meant that people could not be sure their welfare was protected as staff did not have clear information.

All medicines we looked at that were not in a blister pack were dated when they were opened. One person told us, "Staff always make sure I have my medicine when I need it."

Recruitment practice had not ensured all checks were carried out before staff worked in the home.

There had been progress in ensuring all staff received the training they needed to meet people's needs.

People told us there were enough staff to provide their care and keep the home clean. They told us that the employment of dedicated cleaning staff had improved staffing in the home and ensured that care staff had enough time to provide their care and spend time with them. People told us that new staff were supported by more experienced staff to ensure they had time to learn about people's needs and how to meet them.

Although the feedback we received from people who lived in the home and their relatives was very positive, there were some shortfalls in the home's recruitment procedures. This meant that not all the pre-employment checks required by law had been completed by the home before some care workers had started work. Training arrangements did not ensure that each care worker received all the training they needed in a timely way or had their competency assessed.

We found the home was kept clean. There were designated staff hours for cleaning. A newly appointed cleaner was about to start work in the home. Cleaning tasks were planned through the day and week. The manager monitored the quality of cleaning.

The provider had resumed reviewing care plans monthly. This meant people's changing needs were recognised and adjustments in how their care was planned were made in a timely way. Short term care plans were put in place for temporary needs, such as a period of illness. If a person could display behaviours that required some form of special care or management, this was recognised in a care plan for that purpose.

The provider recognised that when they previously transferred some responsibilities to a manager, this had not been well managed. They were using learning from past experience in the imminent appointment of a new manager.

We also looked at how the service kept records. These showed evidence of being reviewed and updated and were made available as required. People who lived in the home gave examples of how they were involved in changes to how their care was organised or recorded.