Holme House Care Home

Holme House provides personal and nursing care for up to 68 people, some of whom were living with dementia. At the time of our inspection there were 49 people using the service. Holme House accommodates people over 2 separate floors.

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

People and relatives were involved in planning their care and needs were regularly assessed. Staff had completed relevant training required for their role. Staff had good knowledge of people’s care needs; professionals spoke positively about the team and the registered manager. The service was in the process of introducing a shopping and dining out experience on the top floor.

Activities coordinators had been recruited and activities in the service had improved. People’s documentation evidenced person centred care. Changes were being made to how people were cared for at the end of their lives. A robust complaints procedure was in place and the registered manager dealt with complaints effectively and learning was implemented.

Effective quality assurance measures in place. The service promoted a positive culture. People and relatives felt the staff team were approachable and friendly. The registered manager acted on feedback they regularly sought from people, relatives and staff.

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.

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 requires improvement (published 19 March 2021).

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Effective, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

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

Holme House Care Home accommodates up to 68 older people, including people living with dementia in one adapted building over three floors, each of which has separate adapted facilities. At the time of the inspection two floors were in use and 43 people were using the service.

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

The registered provider had effective systems of governance in place to maintain and improve the quality and safety of the service.

Staff were supported with role specific training and supervision, to ensure they had the knowledge and skills to support people.

People received their medicines as prescribed.

Feedback about whether there were enough staff to meet people’s needs was mixed. People’s needs were met in a timely manner during our inspection.

Safe systems of recruitment were followed to ensure staff were safe to work with vulnerable people.

The home was clean, with additional cleaning being completed during the COVID-19 pandemic. Measures were in place to ensure people were protected from the spread of infections. Staff had received recent training in infection prevention and control (IPC), including how to put on and take off their PPE in a safe way. An individual issue with PPE use was addressed by the manager. Regular observations were completed to ensure staff followed good practice guidance.

People told us they felt safe and staff we spoke with had a good understanding of how to safeguard adults from abuse.

Accidents and incidents were reviewed to ensure appropriate action had been taken and lessons had been learned to reduce the risk of a re-occurrence.

Staff were knowledgeable about people’s needs and people and relatives told us the staff were caring.

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.

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 06/05/2020) and there was one breach of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At this inspection the service remains rated requires improvement overall and safe and well led have improved to good.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 and 15 January 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same as requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holme House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Holme House Care Home accommodates up to 68 people in one adapted building over three floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia. At the time of this inspection 50 people were using the service.

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

At the last inspection in October 2018 we rated the service requires improvement. We found three breaches of regulation relating to consent, managing risk and good governance. At this inspection we found some improvements had been made, however issues with governance remained.

The registered provider did not have an effective system in place to improve the quality and safety of the service and accurate records were not always kept.

An effective overview of the amount people had to drink was not in place to ensure their needs were met. Most people told us they enjoyed their meals and we saw people received support with meals and drinks when required.

A fire evacuation drill had not been completed since May 2019 to ensure all staff knew what to do in the event of the need to evacuate the building. This was completed following our inspection.

Not all staff had received supervision necessary to perform their role effectively. Staff had undertaken training relevant to their roles and most staff told us they felt supported.

People told us they felt safe. Incidents were recorded, and action taken to keep people safe.

Medicines were generally managed safely.

We made a recommendation about ensuring medicines administration practice was up to date and followed NICE guidance.

Feedback from people and staff about sufficient staff being on duty was mixed. Adequate staff were deployed to meet people’s needs, however more staff on duty would enable people to lead more fulfilling lives.

We made a recommendation about staffing.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse had taken place.

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. Mental capacity assessments and best interest decisions were completed when decisions needed to be made, although consultation with the relevant person was not always evidenced.

People usually received support to access healthcare professionals and services.

People and their relatives told us staff were caring and supported them in a way that considered their dignity, privacy and diverse needs.

People were involved in planning their care and had access to some activities in line with their interests. Most people and their relatives told us they were in receipt of care that was responsive to their needs and preferences.

People told us they knew what to do if they had any concerns or complaints about the service and we saw complaints had been acted on when they arose.

Most people told us they thought the service was well led. Feedback from staff and relatives was mixed.

People who used the service, staff and relatives were asked for their views about the service and these were acted on on most occasions

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 12/02/2019) and their were three Breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of one regulation.

The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. The inspection was prompted in part due to concerns received about poor care, inadequate staffing levels, medicines management and safeguarding issues. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holme House Care Home on our website at www.cqc.org.uk.

Follow up

We have identified a breach in relation to good governance at this inspection. 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 and clinical commissioning group to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Following the last inspection, the registered provider sent us an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. At this inspection we checked to see whether improvements had been made and found the registered provider was not meeting the regulatory requirements relating to safe care and treatment, consent and good governance.

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

Holme House Care Home provides accommodation for up to 68 people with residential, nursing and dementia care needs. The home has three distinct units over three floors. At the time of our inspection 61 people were using the service.

A registered manager was in place. 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.

We found risks were not always assessed and measures not always put in place to reduce these risks. Incidents and accidents were recorded, however learning from these incidents was not always evident.

We found the systems for managing people’s medicines was not always safe because the administration of topical creams was not consistently recorded. Staff competency checks on the administration of medicines were up to date.

Emergency procedures were robust to protect people should the building need to be evacuated.

We found adequate numbers of staff were deployed to meet people’s assessed needs. Feedback from people, relatives and community professional about whether there were adequate numbers of staff deployed was mixed and some people said use of regular agency staff at night reduced consistency for people.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. Safe recruitment and selection processes were in place.

People were not always supported to have maximum choice and control of their lives because decision specific mental capacity assessments and best interest decisions were not always in place to ensure people’s rights were protected.

Staff told us they felt generally supported and they received some supervision, training and appraisal to meet their development needs. Staff had received an induction and role specific training, which ensured they had the knowledge and skills to support the people who lived at the home.

Most people told us they enjoyed their meals and meals were planned around their tastes and preferences. People were supported to eat a balanced diet and action was taken where people’s nutritional intake had declined.

People were supported to maintain their health and had access to healthcare professionals and services.

Positive relationships between staff and people who lived at Holme House were evident. Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs.

Some care records contained detailed information about how to support people, however other care records had not been updated to provide person centred support. End of life care plans were in place for some people using the service to record their preferences.

Some activities were provided for people in line with their tastes and interests.

Systems were in place to ensure complaints were explored and responded to and people told us staff were approachable.

The registered manager and registered provider had an overview of the service, however this system had not been effective in identifying and addressing the concerns we found on inspection.

People who used the service and their representatives were asked for their views about the service and they were usually acted on.

We found breaches of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Holme House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Holme House is a nursing home currently providing care for up to a maximum of 68 older people. The home has three distinct units Memory Lane, Oakwell Avenue and Redhouse Lane, providing care and support for people with nursing and residential needs including people who are living with dementia. On the days of our inspection 61 people were living at the home.

The service had a registered manager in place. 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.

Staff had received training in safeguarding people from the risk of harm or abuse and understood their responsibilities in reporting any concerns to a senior member of staff.

Information recorded in moving and handling records was detailed however, it was not always clear which hoist sling belonged to which person.

External contractors were used to service and maintain equipment. Internal checks were completed on the fire system. People had a Personal Emergency Evacuation Plan in place but these were not always an accurate reflection of their current needs and we were not able to establish from the records available that staff had completed a simulated fire drill.

Staff were recruited safely and we saw people’s needs were met in a timely manner.

The temperature at which some medicines were stored was not always appropriate but action was taken by the registered manager to address these concerns. The recording of creams was not robust; there was a lack of information available for staff to ensure they were applied correctly. We have made a recommendation regarding the management of creams.

The registered manager had implemented a system to review accidents and incidents. This provided an opportunity to address shortfalls and reduce future risk.

Policies referred to legislation but they did not always reference current good practice guidance.

New employees received induction but there was currently no facility at the home to support staff who had no previous care experience to access the Care Certificate. Staff received training and a programme was in place to provide further training for staff in regard to supporting people who were living with dementia. Not all staff had received regular supervision, the registered manager had begun to complete staffs’ annual appraisal.

Most people we spoke with told us the food was good. People were able to choose where they wanted to eat and were supported appropriately by staff. Where staff recorded people’s diet and fluid intake, improvements needed to be made to ensure the records were accurate and detailed.

People received support to access other healthcare professionals.

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 in the service supported this practice. We saw evidence mental capacity assessments had been completed and where appropriate, DoLS applications had been applied for.

People told us staff were caring and kind, staff treated them with dignity and respect. We saw kind caring interaction between staff and the people they supported. There was a range of activities provided at the home.

Care plans were stored securely but daily records were stored in unlocked cupboards. People’s care records were detailed and person centred, but care staff did not have access to them and two of the staff we spoke with told us they had not had opportunity to read them.

At the last inspection we recommended the service seek guidance from a reputable source, in regard to end of life care planning and record keeping, but this recommendation had not been implemented.

There was a system in place to ensure concerns and complaints were listened and responded to.

Feedback from people who lived at the home and staff was mainly positive. The registered manager had been in post since February 2017, they were supported by a deputy manager and two office based care co-ordinators. The registered provider visited the service on a weekly basis. A range of checks and audits were completed by the management team and an external consultant to monitor the performance of the service.

Meetings had been held with staff, people who lived at the home and their relatives to gain feedback about the quality of the service provided to people. The registered manager had recently sent a survey to people, the majority of respondents had given positive feedback.

This service had been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 regarding person centred care and good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Holme House is a nursing home currently providing care for up to a maximum of 68 older people. The home has three distinct units providing care and support for people with nursing and residential needs including people who are living with dementia. On the days of our inspection 52 people were living at the home.

The service had a manager in place but they were not yet registered with the Care Quality Commission. 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.

People told us they felt safe and staff understood their responsibility in reporting concerns about harm or abuse.

Not all aspects of people’s care and support had been robustly assessed. We found inconsistent information regarding the moving and handling needs of one person, we also found a lack of information in their care plan regarding the equipment they used. One person had had a number of falls but the care plan did not detail how staff were to help the person to get up from the floor.

On both days of our inspection, no fire extinguishers were available on the corridors of Memory Lane. Cleaning materials were stored in an unlocked kitchenette cupboard.

There were insufficient numbers of suitably deployed staff to meet people’s needs in a timely manner and people were left unsupervised.

Some aspects of staffs’ recording in regard to medicines administration needed to be improved.

Not all areas of the home were clean.

Staff received regular training but some staff said they would benefit from more specific training around supporting people who exhibited behaviour which challenged others.

The majority of the staff had competed training in the Mental Capacity Act 2005 (MCA) but care records did not evidence the decisions made where people lacked capacity had been taken in line with the requirements of the MCA 2005.

People told us they were not satisfied with the meals at Holme House and our observations of meal times raised concerns about the suitability of the food for some people and the skills and deployment of staff to meet people’s needs. People did not receive adequate support to eat their meals.

People and relatives said the care they received was acceptable but people said the care could sometimes be a bit inconsistent. Staff told us they did not have time to read people’s care plans and staff were not always aware of people’s needs.

We noticed that where people had limited ability to express themselves, staff made choices for them and did not always involve them in making decisions. People were not always supported in a way which maintained their dignity. We saw people using their fingers to eat scrambled eggs with beans and sponge with custard.

Records relating to the care people received as they entered the closing stages of their lives lacked evidence that people or their families had been supported with this aspect of their care. We have made a recommendation in regard to end of life care planning and record keeping.

People’s care plans were person centred but where people’s care needs had changed, their care planning records were not always updated to reflect those changes. People’s food diaries did not provide adequate detail of the food they were offered. Where care plans instructed staff to weigh people on a weekly basis, recent weights were not recorded.

Relatives told us the list of activities provided at the home was not an accurate reflection of the current programme. The manager told us they were recruiting for a second staff member to increase the provision of activities for people.

People told us they were not always satisfied with the response from the home’s management team in regard to concerns. We saw complaints, including verbal concerns were logged, but on this occasion we did not inspect the investigation records regarding individual complaints.

People did not feel the home was well led and staff felt unappreciated. A range of audits had been completed but these had been ineffective in addressing the issues we identified at our inspection.. Audits and action plans for the home had failed to highlight or the issues we have raised within this report. .

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

The inspectors, the expert by experience and the specialist adviser, also through observation and looking at records, used the information they were given to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found.

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

Is the service safe?

There were systems were in place to monitor the service. However, we found that some of these monitoring tools had not been completed with appropriate frequency.

We found the home to be clean with no offensive odours in communal areas.

We found some issues regarding staff training at the service, where training had either not been completed by staff or refresher training was overdue.

Is the service effective?

Not all staff had received up to date training and supervision. Feedback from staff was mixed in regard to how well they felt supported.

People's care records were not always assessed with their involvement or with the involvement of relatives and other healthcare professionals.

We found that people's care records were not always up to date and, at times, contained incorrect or inaccurate information.

Is the service caring?

People were supported by kind and attentive staff. We saw care assistants showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

People's preferences, interests, aspirations and diverse needs had not been recorded in all care records.

Is the service responsive?

The manager had taken steps to look into reasons why the service had experienced a high turnover of staff over the previous few months.

People did not partake in many activities at the home. On the day of our visit we observed people sitting in lounges watching television. We also observed people who used the service sitting in lounges with no interaction from staff members for a considerable length of time. People who lived at the home told us they would like more activities to partake in. We found pieces of artwork had been completed by people who used the service decorated the corridors, although some of this artwork was inappropriate for the client group. Artwork included small, blank canvasses with a piece of paper stuck to them with a year printed on them, printed pictures of teddy bears and beach balls and tissue paper and glitter string stuck to walls.

Is the service well led?

Audits at the home were not up to date. There was no formal analysis of accidents or incidents.

There was no documented evidence of the provider's management of the service.

Staff told us they were clear about their roles and responsibilities.

The people who used the service told us they were looked after well and felt safe with the care and treatment provided. Their comments included: "It's alright here", 'They are good to me' and 'It's nice to live here'.

We found that the service had appropriate systems in place to ensure consent was gained before staff proceeded with personal care.

We saw that there was an appropriate system in place for listening to and acting on people's comments and concerns.

We spent time observing the three lounges and dining areas during the day of our inspection. We looked at how people spent their time and how staff interacted with people. The interactions we saw between staff and people who used the service and visitors were respectful.

A relative told us they were involved in discussions and decisions about their relatives care needs and were kept informed about any changes. They said "the staff are great my relative is well looked after here." People who lived in the home and their relatives said the food was very good and the home was clean, warm and comfortable.