Archived: Holy Name Care Home

Holy Name Care Home is a care home that can provide personal and nursing care for up to 64 people, some of whom may be living with Dementia. At the time of the inspection, the service was providing care and support to 36 people.

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

People and their relatives told us they felt the service was safe. People felt satisfied with the care they received. However, they were not always consulted for their feedback and suggestions.

The registered manager and provider did not operate effective systems to effectively monitor safety and improve the quality of care provided to people who used the service.

We found people were at increased risk of harm. There were issues relating to people’s safety and the management of medicines. People who were at risk of pressure area damage did not always receive positional changes in line with their individual support needs. Risks to people’s nutrition and hydration needs were not monitored appropriately. Records relating to positional changes and meeting people’s nutrition and hydration needs were not always completed by staff. There was no oversight or analysis of accidents and incidents by the registered manager or provider to improve the safety of people using the service.

The environment, which accommodated people who were living with Dementia, was not designed and decorated in line with best practice guidance. We made a recommendation about considering best practice guidance to inform the environment for people living with Dementia.

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 Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 22 August 2019).

Why we inspected

We received concerns in relation to the support provided to meet people’s nursing care needs and pressure area care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 Holy Name Care Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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.

Holy Name Care Home is a residential home that can provide personal and nursing care to 64 people. At the time of the inspection, the service was providing support to 25 people who require residential care, 15 people with nursing care needs, nine people living with dementia and three people admitted for an intermediate care service. Intermediate care was commissioned to prevent hospital admissions and to help early discharge from hospital.

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

There were improvements in the quality monitoring systems, which ensured records were accurate and audits took place. However, although there was no impact on people who used the service, we have made a recommendation about the environment audit and the timeliness of addressing issues.

There were improvements in the way medicines were managed. People received their medicines as prescribed and there were safe systems of ordering, recording and storing medicines.

There were improvements in the way care plans were written and they contained good information to guide staff in how to support people.

The provider had safe systems in place to protect people. These included safeguarding people from the risk of harm and abuse, assessing and managing risk, recruitment checks, adequate staffing numbers and infection control measures.

People told us staff were caring, treated them well and respected their privacy and dignity. 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 were able to remain at Holy Name Care Home for end of life care if they wished.

People’s health and nutritional needs were met. Staff involved healthcare professionals when required; this included dieticians if people were at risk of losing weight.

Staff had access to induction, training, supervision and support so they felt confident when supporting people. Staff knew how to manage complaints and to learn from them to improve 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 30 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.

Holy Name Care Home is a purpose built home encompassing a church site and is situated in a residential area of North Hull; it is close to main bus routes into Hull city centre. The service is registered to provide personal and nursing care for a maximum of 64 people, some of whom may be living with dementia. The bedrooms are all for single occupancy and all have en suites which consist of a shower, sink and toilet. There is a large dining room, a number of open plan seating areas, two small conservatories, a hairdressing salon and courtyard gardens for people to use. The service has a separate area for people living with dementia called Penny Lane.

Holy Name 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 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.

At the last inspection in May 2017 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regulation 9, person-centred care, regulation 12, safe care and treatment, regulation 14, meeting nutritional and hydration needs and regulation 17, good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well-led to at least good.

At this inspection we found continued breaches in person-centred care, safe care and treatment and good governance, and that care had not been provided in a safe way for some people living at the service. Governance and quality monitoring was not robust. The provider had improved the monitoring of people’s nutritional and hydration needs to ensure this breach of regulation was resolved. The service has been rated requires improvement for the second time.

There remained some areas of concern regarding management and administration. One person may have been given medicine to help calm them when their behaviour was settled. Action was not taken to liaise with people’s GP’s to change the times of their eye drops to ensure they were not asleep. People’s medicine was not always in stock and there were gaps on medicine administration records. Further guidance for staff about ‘when required’ medicine and ‘variable dose medicine’ needed to be put in place for staff. Recording of a controlled medicine was found to be inaccurate. Supplementary charts to help staff assess people’s medicine needs were not always completed.

Some people’s care records were person-centred with their likes, dislikes and preferences for their care and support recorded and their risk assessments were detailed. However, other people’s care records still did not contained all the correct information to make sure their full and current needs could be met. Further work still needed to be undertaken in this area. Staff contacted health care professionals for help and advice to maintain people’s wellbeing. End of life care was provided at the service.

Quality assurance checks and audits had been improved in relation to maintaining people’s nutritional and hydration needs. However, other quality assurance checks and audits were not robust; they had failed to find the issues we found during our inspection. Further work was required in this area.

Staff protected people from harm and abuse and understood how to report concerns to the management team, local authority and to the Care Quality Commission. This helped to protect people. Infection control measures were in place.

Staff recruitment procedures were robust; gaps in potential staff’s employment history were investigated. Checks were undertaken to make sure people were suitable to work in the care industry, where issues were found these were discussed and a decision was taken if employment could be offered.

General maintenance was undertaken to make sure the service remained a pleasant place to live. Accidents and incidents were monitored and emergency plans were in place to help to protect people’s health and safety.

People’s mental capacity was assessed. We found care and support was provided in line with the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

Improved monitoring of people’s dietary and fluid needs had been implemented to ensure people’s needs were met.

Staffing levels were monitored to make sure there was enough skilled and experienced staff to meet people’s needs. Staff undertook training in a variety of subjects to maintain and develop their skills. Supervisions and appraisals were provided. Further training for staff was planned in relation to supporting people living with dementia.

The environment was maintained. Pictorial signage helped people to find their way around. Gardens provided an inviting outside space to people.

People were treated with dignity, respect and kindness by staff and the management team. There was a confidentiality policy in place for staff to follow. Care records were stored securely in line with current data protection legislation.

A complaints policy was in place to inform people how to raise issues. People were provided with information about advocacy services available to help them raise their views.

People told us they were satisfied with the service they received. People living at the service, relatives and staff’s views were sought and were acted upon. Links with the community were in place and fund raising occurred for different charities.

Holy Name Care Home is a purpose built home encompassing a church site and is situated in a residential area of North Hull; it is close to main bus routes into Hull city centre. The service is registered to provide personal and nursing care for a maximum of 64 people, some of whom may be living with dementia. The bedrooms are all for single occupancy and all have en suites which consist of a shower, sink and toilet. There is a large dining room, a number of open plan seating areas, two small conservatories, a hairdressing salon and courtyard gardens for people to use. The service has a separate area for people living with dementia called Penny Lane.

The service had a registered manager; they also managed the company’s other service in Beverley. This was a temporary arrangement whilst recruitment was underway for a new 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.

We found that people had not always received their medicines as prescribed. This was due to unclear guidance in one instance and in others, staff recorded people as asleep for specific medicines at night. Staff had not referred back to people’s GPs for advice regarding adjusting the times.

We found some people at risk regarding their food and fluid intake, and fluctuations in their weight were not monitored effectively. This meant people could lose large amounts of weight before this was identified and a plan put in place to address the loss. Menus provided people with choices and alternatives and people told us they liked the meals.

We found people had assessments of need completed but staff had not always recorded important information in care plans about how these were to be met. This meant staff may not have had full guidance on how to care for people in an individual way.

You can see what action we have asked the registered provider to take regarding these concerns at the back of the full version of the report.

Staff had received training in how to protect people from the risk of harm and abuse. There were also policies and procedures for additional guidance. Staff knew what to do if they had concerns, who to raise these with and which agencies to notify. Staff produced risk assessments for people to help minimise risk, whilst still ensuring people could make their own choices and decisions.

People who used the service were supported to make their own decisions and staff knew they had to gain consent prior to carrying out care tasks. When people were assessed as lacking capacity, meetings were held to discuss what decisions were to be made in their best interest. Some adjustments were required to the paperwork to make sure it was clear who was consulted in the decision-making.

People had access to community health professionals for advice and treatment. Staff knew when to consult these professionals.

Staff were recruited safely which ensured employment checks were in place prior to new staff starting work. There were sufficient staff employed to meet people’s needs but two people who used the service and some health professionals commented about the availability of staff. The registered manager told us they would speak with people who used the service about this and look at the deployment of staff at peak times to see if this could be addressed.

People told us staff had a kind and caring approach. We saw people’s privacy and dignity was respected and observed many positive interactions between staff and the people they cared for. Staff knew how to promote people’s independence and need to make their own decisions.

There was a selection of activities for people to participate in and people told us they enjoyed them. We have made a recommendation regarding sourcing additional activities to enhance those provided to people living with dementia.

Staff received training suitable for their role; a log was maintained of the training completed by staff so the registered manager could keep this under review and plan courses to meet shortfalls and updates when required. Staff told us they felt supported by the registered manager and deputy manager, and confirmed supervision meetings had re-started.

The environment was safe, clean and tidy and staff had access to protective equipment when required. They had completed training in infection prevention and control and knew the measures to take to manage any outbreaks of infection.

The environment had suitable equipment in place to meet people’s needs. Equipment items such as the lifts, hoists, wheelchairs, bedrails, hot water outlets, and electrical and fire-fighting appliances were serviced at regular intervals and checked daily to ensure they were safe and in working order. There was signage around the service to help orientate people living with dementia.

People who used the service and their relatives told us they felt able to raise concerns and complaints. There was a policy and procedure to guide staff in how to manage complaints.

The registered provider had a quality assurance system which included audits, checks and seeking people’s views. This had re-started following a gap during management changes. In the interim some audits had not been completed or had not been as thorough as they should have been. We have judged that this will be rectified now the full system is back in action. We will check this out at our next inspection.

We considered the findings of our inspection to answer questions we always ask:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe at Holy Name. We observed interactions between staff and people who used the service that were respectful and friendly. People were relaxed in the company of staff.

People received their medicines as prescribed by their doctor and told us they received medicines in a timely way.

The manager sets the staff rotas and they made sure there was sufficient numbers of staff with the right skills and experience to meet people's needs. They had recently reviewed and increased the number of staff at times during the day to provide more flexible staff deployment. We received some mixed comments from people about the staffing numbers. These included, 'There seems to be enough staff on, I always get the help I need and they find time to sit and talk when they can' and 'They are very busy at times and sometimes I have to wait when I ring the bell.'

We found the provider did not have clear systems in place to ensure the information they collected about incidents and accidents was analysed appropriately. This meant the information in audits was not always used to manage risks related to people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring risks to the health, welfare and safety of the people who use the service are properly assessed and managed.

Is the service effective?

People were included in decisions about their care and the support they wanted. We found people's care records overall reflected their preferences and choices.

We observed that there were good interactions between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives.

Care files we checked confirmed that initial assessments had been carried out by staff before people moved into the service. This was to ensure the service was able to effectively meet the needs of the people. Specialist mobility and equipment needs had been identified in care plans where required.

People were offered meals that were varied and nutritious. Comments from people included, 'We get lots of snacks' and 'I have a lot of dietary requests; the cook comes to see me most days to discuss the menu and my preferences, they are very good about that.' A range of snacks and drinks were readily available and offered to people to ensure individuals received enough to eat and drink. People were assessed for the risk of becoming malnourished.

Records and discussions showed staff had received training, direction and support which enabled them to be more skilled and confident when supporting people, especially in relation to their dementia and health care needs. Gaps in the training programme were addressed during the visit, with courses in essential and service specific training arranged.

People we spoke with were complimentary about the staff and said they were kind and caring. Comments about the staff included, 'Staff are kind to you', 'The staff are very kind and helpful' and 'The staff are pretty good. Nothing is too much trouble. I feel settled here.'

Is the service caring?

We found that staff were understanding of people's individual needs. People's preferences, routines, likes and dislikes had been recorded and care and support was provided in accordance with people's wishes and choices.

People were supported by kind and attentive staff. We saw that staff showed encouragement and patience when supporting people.

People who used the service told us they were happy living at Holy Name. Comments included, 'Care staff are friendly, always popping in and making sure I'm alright' and 'I've not been here long, but I do like the home. Staff and other residents are friendly.'

Is the service responsive?

Staff told us the care and support provided was flexible to the person's needs and adjustments could be made where required. Care staff said they informed the nursing staff if they felt any change in needs was required and the support was reviewed.

The provider had considered the specific needs of people with a dementia related condition when planning improvements to the environment. They had recently moved the dementia unit from the first floor of the service to the ground floor so people with dementia could independently and safely access the garden area. The provider had used external consultants for advice on improving the environment for people with dementia and had implemented some of their guidance about use of colour to aid orientation. Further work to provide individual memory boxes was underway.

People had access to a range of health and social care professionals such as GPs, a psychiatrist, dieticians, speech and language therapists, social workers, dentists and opticians. There was evidence the staff team sought appropriate advice, support and guidance both routinely and during emergency situations.

People who used the service were happy with their health care. One person said, 'They get the doctor when I'm poorly, they look after me very well, I am getting much better.'

Is the service well-led?

The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development. Regular meetings were held with the intermediate care team to facilitate and support effective joint working arrangements.

We identified gaps with the systems in place to monitor the quality of service provided. Whilst some information about the service was gathered each month there needed to be more robust reviews, analysis and records about this information. This meant that shortfalls in the service were not always identified and action plans not produced to address them in a timely way.

There was a system of sending out surveys to people who used the service and their relatives; this had not been extended to the staff. The manager told us the issues identified in surveys had been addressed but this had not been recorded.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

We re-visited the service to check the necessary improvements had been made. We found improvements had been made to the care plan records; people's needs in all areas had been properly assessed and detailed care plans were in place to direct staff on the care and support required.

People we spoke with told us they received the care and support they needed and they were happy with how staff delivered their care. Comments included: 'I'm very satisfied with the care here; I'm so relieved that I've settled and I'm happy' and 'The staff are lovely and kind, nothing is too much trouble for them.' A relative told us, 'Mum is well looked after.'

People told us they felt safe and one person said, "Staff always speak politely; they are very obliging and helpful.' We found people were protected from abuse; staff had training in safeguarding adults and demonstrated a better understanding of the reporting procedures.

People spoken with told us they were settled and comfortable at the service. We found improvements had been made to aspects of the maintenance systems to ensure people were better protected from the risks associated with unsafe premises.

People we spoke with told us they received the care and support they needed and they were very happy with how staff delivered their care. One person told us, 'Staff are very kind and are always there to help me.' A visitor said, 'We have been very satisfied with the care mum gets, she is very settled.' However we found not all people's needs were assessed and their care and treatment was not always planned effectively.

A visiting health professional told us that staff were now making appropriate referrals for routine and emergency support with health care issues.

People told us they felt safe and comments included, "Happy here" and "Staff are polite and respectful." However people were not fully protected from abuse as some staff had limited understanding about the types of incidents they should report and which external agencies they could report concerns to.

People spoken with told us they liked their home. They said it was warm and very comfortable. The premises were clean. The quality of d'cor and furnishings was of high standard. However we found some of the maintenance systems did not fully protect people from the risks associated with unsafe premises.

We spoke with people who used the service who told us they received a good standard of care. One person told us,"If I use the call bell it does not take long before someone comes to see me.' Another person told us, 'I am quite independent and I can go to the toilet myself if I need to'. A third person told us, 'Staff are very good here, they see to things quickly.'

Staff we spoke with were knowledgeable about the individual needs of people who used the service and gave consistent accounts of how they were supported. We saw several good examples of interactions between staff and people who used the service. We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We also looked at the management of medicines. We observed people being given their morning and lunchtime medicines. Staff carried out the task in the morning by visiting people in their bedrooms and then later we observed staff administering medicines in the dining area. On both occasions we saw staff carry out the task of administering medicines safely and spoke to people in a kind and respectful way. They patiently waited and stayed with the person to make sure that medicines were properly swallowed and correctly signed the medicine chart afterwards. We saw that medication was dispensed on an individual basis and people were seen to take their medication before staff left them.

We spoke to three people who used the service in the dining area who told us they were happy with the way their medication had been administered. One person who used the service told us, 'I have medication twice a day and they bring the medication to me.' Another person said, 'I have my medication after eight o clock in the morning during breakfast.' One other person said,"I have my medication with water."

People told us that care staff were, 'Very good, polite and courteous and that they consulted them about the care they received.' And 'I feel very safe here and the staff are very good at supporting me when I need my hospital appointments'. A visiting relative told us their family member, 'Only had to ask about anything and the staff would sort it out'.

We saw care plans that highlighted the monitoring and evaluations of support that was provided, together with evidence that people had contributed and been involved in aspects of this, to ensure their individual wishes and preferences were met.

We spoke with three staff who demonstrated knowledge about the different types of abuse and who told us how they would report any concerns.

The manager told us that, 'All staff have a supervision six times per year where training requirements are discussed. In addition to this an annual appraisal takes place to review staff performance and development needs."

We saw evidence of a complaints process and records which ensured concerns from people who used the service, relatives and the general public were captured and acted on.