Holmside Residential Care Home

We found the following examples of good practice.

The service had good arrangements for facilitating relatives to visit people living at the home. People’s individual visiting needs were considered.

Individual risk assessments had been carried in relation to keeping people safe during the pandemic. The service had sought consent for actions, such as regular testing, or taken best interests decisions based on people’s particular needs.

Effective measures had been put in place to support social distancing in the home, including during mealtimes.

Holmside Residential Care Home provides accommodation and nursing or personal care for older people, some of who are living with dementia. The home has been significantly extended and provides ensuite rooms over two floors and a large, multifunctional communal space. The service is registered to support up to 39 people. At the time of the inspection 39 people were living at the home.

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

Systems around assessing, monitoring and minimising risk had been improved. People’s care records contained risk assessments and care plans reflected these risks. Staff were aware of safeguarding issues and how to report concerns. People were supported by staff who had been safely recruited and subject to checks. Medicines were managed in line with national guidance. The home was maintained in a clean and tidy manner. The registered manager and staff had worked hard to learn lessons from the previous inspection and improve outcomes for people living at the service.

People’s needs had been assessed and care was being delivered in a safe manner and with regard equality and diversity. Staff had access to a range of training and received regular supervisions and appraisals. People were supported to maintain a balanced diet and had ready access to drinks. They were supported to access health services to help maintain their wellbeing. The service was acting within the guidance of the Mental Capacity Act and people’s consent was obtained in an appropriate manner.

People and relatives told us staff were caring and supportive and we observed good relations between staff and people. People were supported to express their views and make choices. Staff had a good awareness of personal preferences and people as individuals.

People told us staff respected their privacy and dignity and helped promote their independence. The service had appointed a dignity champion to assist people and staff in this area.

Detail in people’s care records had improved since the previous inspection. Records now contained sufficient information to allow staff to deliver good quality care. There was some evidence that people’s communication needs had been considered, although we spoke with the registered manager about ways to further develop this. A range of activities were available and people were supported to maintain social contacts. Complaints had been dealt with appropriately. People’s end of life wishes had been considered and recorded.

Improvements in the quality monitoring and auditing process had been instigated to help improve and maintain the standard of care people received. Staff were clear about their roles. The service had a number of champions to ensure care delivery was up to date and person centred. Staff told us they were well supported by the registered manager and senior staff. The service worked co-operatively with outside agencies.

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 20 July 2018).

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.

Why we inspected.

This was a planned inspection based on the previous rating.

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.

Holmside Residential Care Home 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 home is registered to provide support for up to 39 people over two storey accommodation. Nursing care is not provided. At the time of the inspection there were 35 people using the service, including three people who were staying at the home on a short term basis.

The home had a registered manager who had been registered since May 2017. 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 were safe living at the home and we found safeguarding issues had been dealt with appropriately and referred to the local safeguarding vulnerable adults team. Maintenance of the premises had been undertaken and safety certificates were available. Three window restrictors were missing. These had been removed for maintenance and we were later told they had been replaced. Accidents and incidents were recorded and monitored. However, there was limited evidence to show these issues were looked at in terms of prevention and ‘lessons learned.’

A range of checks and risk assessments were in place at the home. At night time there were three staff on duty and the registered manager had assessed how quickly an evacuation to a safe zone in the home could be made. We found these estimates of time to be over optimistic and that risks associated with night time emergencies had not been fully considered. Risks associated with care delivery were not always fully considered and not effectively documented in care plans.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). People and staff members told us there were enough staff on duty at the home during the day. The registered manager used a dependency tool to help determine staffing levels.

Medicines at the home were managed appropriately. Medicines were safely stored and regular checks were made on stock levels and administration. We observed the home was maintained in a clean and tidy manner.

Staff had an understanding of issues related to equality and diversity and what it meant for people using the service. They told us they had access to a range of training and records confirmed this. They confirmed they had access to regular supervision and an annual appraisal.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We found the registered manager had a system in place to monitor and review DoLS applications. People were asked for their consent on a day to day basis. Where this was not possible there was some evidence of best interests decisions being made. Where relatives held lasting power of attorney or had been appointed deputies by the Court of Protection this was recorded in people’s file.

People were happy with the quality and range of meals and drinks provided at the home. Special diets were catered for and staff had knowledge of people’s individual dietary requirements. People’s health and wellbeing was monitored and there was regular access to general practitioners and other specialist health staff. Health professionals told us the home was proactive in monitoring people’s health.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. Staff demonstrated an understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity and were involved in care decisions, where appropriate.

Some care plans had good personal information about the individual and their particular likes and dislikes. Other care records did not always contain sufficient detail to assist staff in meeting people’s needs. Care plans did not always reflect the most recent professional advice. Reviews of care and risk assessments were extremely limited and failed to review significant events, such as changes in medication or recent falls.

A range of activities were available at the home and a recently appointed activities co-ordintaor was in post. Some people told us they would like to go out more. The registered manager told us there had been no recent formal complaints and people and relatives told us they had not raised any recent concerns.

The registered manager told us regular checks on people’s care and the environment of the home were undertaken. However, audits had failed to identify the issues we noted at this inspection. Audits and check by the provider were of very poor quality. Actions identified had been listed on a plan but timescales for completion were not always evident. Staff and visiting professionals praised the registered manager highly and her running of the home. Staff felt supported by the registered manager, who they said was approachable, responsive and ‘firm but fair.’ They told us they could raise issues or make suggestions.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to Safe care and treatment and Good governance. You can see what action we told the provider to take at the back of the full version of the report.