Background to this inspection
Updated
21 August 2019
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 Care Act 2014.
Inspection team
The inspection was undertaken by one inspector, an Expert by Experience and one specialist advisor on 17 July 2019. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert’s area of expertise was older people and dementia. The specialist advisor was a nursing professional. On the 18 July 2019 one inspector returned to the home to complete the inspection.
Service and service type
Holbeche 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). 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 of this information to plan our inspection.
During the inspection-
We spoke with seven people who used the service and 10 relatives about their experience of the care provided. We spoke with three nurses, the clinical lead, six care staff, the chef, the personal activity leader, the registered manager and regional manager. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We partially reviewed a range of documents and records including the care records for 20 people, 34 medicine records and three staff files and training records. We also looked at records that related to the management and quality assurance of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We requested training information, and quality assurance records.
Updated
21 August 2019
About the service
Holbeche House is a residential care home providing personal and nursing care for up to 49 older people, some of whom live with dementia. At the time of the inspection the service was supporting 42 people. The care home accommodates people in one adapted building which is split into two units. One unit supports people with nursing needs and the second unit supports people that live with dementia.
People’s experience of using this service and what we found
People did not receive their medicines as prescribed and management of medicines placed some people at risk of harm. Risks to people were not consistently well managed and left people at risk of harm. There was not enough staff to meet people’s holistic needs.
People told us they felt safe when supported by staff. Staff wore gloves and aprons to ensure they protected people from cross infection. Lessons were learned from any incident and accidents that had occurred in the service.
Staff had completed training in relation to the Mental Capacity Act but lacked the knowledge about which people had authorisations in place. The environment on one unit was not dementia friendly and homely and lacked signage to enable people to orientate themselves. 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. People accessed healthcare services to ensure they received ongoing healthcare support.
People were supported by staff who were caring, but the provider's systems and processes did not support them to consistently display their caring values. People were given some choices and were involved to make daily decisions around their care. People on occasion were not always treated with dignity.
People did not have meaningful activities to occupy them on a daily basis. People had care plans in place which provided staff with information about their needs and preferences and how they would like these to be met. However, these were not always updated following incidents that had occurred. Records did not reflect the daily support provided to people. A complaints procedure was in place and people and their relatives knew how to raise concerns and felt confident these would be addressed.
The systems and processes in place were not robust to enable the provider to identity where areas for improvement were needed. Where improvements were identified timely action was not taken to address these. The registered manager was described as approachable, open and transparent in the way they managed the service.
Rating at last inspection
The last rating for this service was good (published 8 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to the management of medicines and the overall governance of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk