Holyrood House

Updated 9 March 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was conducted by three inspectors, a pharmacist inspection manager and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed all the information we held about the service including information about important events which the service is required to tell us about by law. We requested feedback from other stakeholders. These included the local authority safeguarding team, commissioning team and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We spoke with nine people using the service and three relatives about their experience of the care provided. We observed care in the communal areas to help us understand the experience of people. We also gathered information from nine members of staff including the registered manager and received feedback from four healthcare professionals who had worked with the service.

We reviewed a range of records. This included seven people's care plans, risk assessments and associated information, and other records of care to follow up on specific issues. We also reviewed multiple medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records, accident and incidents, policies and procedures and further records of care.

Updated 9 March 2022

Holyrood House is a care home providing personal and nursing care to up to 85 people, some of whom were living with dementia. There were 61 people living in the home at the time of this inspection.

Holyrood House accommodates people in a purpose-built property. Each person had their own bedroom with en-suite facilities. There were indoor and outdoor communal areas.

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

Accidents and incidents were recorded and analysed. However, we identified some trends in relation to falls. We made a recommendation about staffing levels and equipment used to manage risk of falls.

Medicines were being given as prescribed and most records were accurate. However, we identified some improvements were required in the records related with people’s medication and these had not been identified by the provider during their medication audits. The registered manager developed an action plan to address the issues found.

People told us they received safe care. Risks to people’s care were managed appropriately and most risk assessments and care plans were detailed.

The provider was following current guidelines in relation to infection and prevention control, visiting and vaccination as a condition of deployment.

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 received support to maintain good nutrition and hydration and their healthcare needs were understood, met and relevant records kept. The service worked well with other healthcare professionals to meet people's needs.

There was a person-centred culture at the service. We observed positive interactions between people and staff. Staff enjoyed working for the provider and told us they felt well supported by a regular programme of training, assessment of competencies and supervision.

There were several quality assurance processes in place. The home had a quality action plan that identified areas for improvement and timescales. We received positive feedback about the registered manager being approachable.

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 25 April 2018)

Why we inspected

We received concerns in relation to the management of medicines, falls, moving and handling and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

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

Recommendations

We have made a recommendation for the provider to review information about people’s falls and ensure staffing levels were adequate and equipment used to manage people's risk of falls was effective.

Follow up

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