Archived: Holbeche House Care Home

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

Holbeche House Care Home provides accommodation for up to 49 people who require nursing or personal care. The home is split into two units. The general nursing unit, ‘Holbeche’ and a unit for people living with dementia which was referred to as ‘Littleton House’. At the time of the inspection there were 44 people living at the home.

There was a 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.

People told us they felt safe in the home and were supported by staff who had receiving training in how to recognise signs of abuse. Staff were aware of the risks to people on a daily basis and knew the procedures to follow if they any concerns or if someone had suffered an accident.

People were supported by sufficient numbers of staff who had been safely recruited. Medication records demonstrated that people received their medicines as prescribed by their doctor.

Staff received induction training and regular support from management which provided them with the skills, information and confidence to meet people’s needs safely and effectively.

People’s human rights were respected by staff because staff applied the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards in their work.

Staff supported people with their preferred diet and the registered manager had identified areas for improvement in the dining room experience for people. People were supported to maintain good health and had access to a variety of healthcare professionals which helped promote their health and wellbeing.

People were supported by staff who were kind and caring and who treated them with dignity and respect. People were supported to make their own decisions and were supported by staff who knew them well.

People were involved in the planning of their care and staff were aware of people’s needs, preferences and interests. The home was split into two units and there was an inconsistency in how people were responded to by some staff across the units. There was a lack of activities available for people to participate in or items of interest available to occupy people. People were aware of how to make complaints and where complaints had been raised, they were investigated and action taken where appropriate.

People were complimentary about the registered manager and the changes she had introduced. People, relatives and staff all considered the quality of service to be good. Efforts were made to support and develop staff in order to improve the delivery of care.

There were a number of quality audits in place to identify any areas of improvement that were required within the service. Where areas where identified, action plans were put in place to address any issues.

We checked to see that people's health and well-being was being promoted by the care home.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with four people using the service, two visitors, six members of staff, and the acting manager and area manager. We also looked at five records relating to people's care and other records related to the running of the service.

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

Is the service safe?

People told us they felt safe at the home although we heard some concerns about the availability of staff. One person told us staff responded in a reasonably time. Another told us, 'Sometimes there are not enough girls, they work very hard'. A relative told us, 'There are not enough staff' and, 'Changes need to be made' but was encouraged by the response of the new manager in providing reassurance as to what they were doing about the views of relatives.

The manager and staff told us that a number of staff had left the home recently and this had impacted on the ability of staff to provide effective and consistent care. The manager told us what steps they had taken to minimise the impact of reducing staffing levels, for example agency staff that were employed were as far as possible the same staff. They also told us that they were actively recruiting new staff. From our observations and looking at the staff rotas we saw that the provider was working to maintain staffing levels so that people's needs were met and they were safe.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. People's records did not always describe how their safety should be promoted. For example ensuring monitoring systems were in place to alert staff when someone maybe at increased risk of falls.

The manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do so. At the time of our inspection the manager had made some applications and they, and senior staff were able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

People all had an individual care plan which set out their care needs. People's relatives told us they had not been involved in the assessment of the health and care needs for people they represented and had not contributed to developing their care plan. People told us that the care and support they received was as they wanted it to be. We saw that assessments included people's specific health care needs although we did see that information in some care plans was not always accurate. Staff we spoke with did understand how to meet people's needs appropriately.

People told us that staff ensured they saw external healthcare professionals as needed to promote their healthcare.

We saw that staff knew people's individual care needs and wishes although planning for people's individual needs was not always accurate.

Is the service caring?

We saw on the day of the inspection that people were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

Staff we spoke with were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided showed that people's individual wishes for care and support were taken into account and respected. People we spoke we told us that, 'The girls are nice' and, 'The people that look after me are alright'. We did hear concerns from relatives about some people's care that the manager was to investigate.

Is the service responsive?

People told us, that they were satisfied with their day to day routines although we saw limited activities on the day of our inspection. The manager and staff told us this was an area that needed improvement. A relative commented that, 'They do dancing, singing, used to do baking and have fun days such as the Black Country day'.

People knew how to make a complaint if they were unhappy. Some relatives told us that concerns they had raised had not been responded to. This meant that some relatives felt their complaints were not taken seriously.

We did see that the manager was putting forums in place to gain the views of people and their relatives. We heard that the manager had changed residents and relative's meetings to an evening time so as to assist their attendance. Staff we spoke with also told us they felt the manager was listening to them one telling us the manager, 'Listens to our views'.

We have asked the provider to tell us what improvements that will make in relation to responding to people's complaints.

Is the service well-led?

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed. We saw this had helped the new manager, who had been in post a short while, to identify areas that required improvement and tell us how they intended to put right any shortfalls they had found.

Information from the analysis of accidents and incidents had not always been used to identify changes and improvements to minimise the risk of them happening again.

People's personal care records, and other records kept in the home, were not always accurate and complete.

We have asked the provider to tell us what improvements that will make in relation to improving people's personal care records.

We found that the service had made improvements in order to manage the risks associated with the unsafe use and management of medicines.

We found that arrangements continued to put people at risk of not receiving their medicines in a safe manner as prescribed.

We found that improvements had been made and people received care that met their needs. We saw staff deliver care in a timely manner. One person said, 'They look after me.'

We found that arrangements were in place to identify shortfalls, and action was taken to make improvements. Records were detailed, complete, and reviewed regularly. We saw improvements in the recording of information that related to people's care.

We found that improvements had been made in the way people were offered choices One person said, 'I get a choice for what I want to eat.'

We continued to find that people were not receiving appropriate care in a timely manner. People's care records were not always accurate and updated regularly. This meant that improvements had not been made to ensure people received care that met their needs.

We found that improvements had been made in the way that staff reported safeguarding concerns and in the way that people's finances were being managed.

We found that improvements had been made in supporting staff with regular supervision and training. One staff said, 'It is better now than before.'

We found that the registered provider and the registered manager had failed to make necessary improvements following our previous inspection, where we identified concerns. We found evidence to show that concerns had not been addressed appropriately to ensure better outcomes for people.

We found that records were inaccurate, incomplete, and unclear which continued to pose a risk of people not receiving the care they needed.