Archived: Holmfield Court

Holmfield Court is a residential care home providing personal care to 21 people aged 65 and over, most of whom were living with dementia. The service can support up to 25 people.

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

We found multiple concerns at this inspection. The impact of the concerns was that people did not receive safe care and treatment. People’s needs were not fully met, and people were not always treated with dignity and respect.

Following the inspection, the provider has made the decision to close the service. Where a service is rated inadequate overall it would usually be placed into special measures. This is a process which ensures the service is monitored closely. Because the provider has made the decision to close the service on this occasion it will not be placed into special measures.

The provider had failed to protect people from avoidable harm. Risks in the environment had not been managed and staff followed poor infection control processes. In addition, staff and the manager did not recognise or respond appropriately to abuse.

People’s care needs were not routinely reviewed following accidents and visits from healthcare professionals. Therefore, staff were not aware of and did not apply all the control measures in place to reduce risks to people.

Staff were directed to complete tasks, rather than focus on people’s wellbeing and holistic needs. People were not supported to avoid social isolation and engaged in little or no activity. One person told us, “I just accept things. Things are not desperately unhappy or happy.”

The management of the service was ineffective; roles and responsibilities were unclear. The manager told us they were unhappy with the provider’s quality systems; however, we saw no evidence to demonstrate this had been raised or that any action had been taken to address their concerns.

People were not supported to have maximum choice and control of their lives and staff did not treat them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this 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 15 January 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvements had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified seven breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 at this inspection. The breaches relate to person-centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse or improper treatment, premises and equipment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

Following the inspection, the provider has made the decision to close the service.

At the last inspection in July 2017, we identified two breaches of regulation. These were regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 Safe care and treatment. This was because robust systems were not in place regarding medicines management, safety procedures and the environment. The second breach related to regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 Good governance. This was because the provider had failed to assess, monitor and improve the quality and safety of the service.

We asked the provider to complete an action plan to show what they would do and by when to improve the key question; 'Is the service safe?' and 'Is the service well led?' to a rating of at least good. At this inspection, we saw some areas of improvement. However, the service remained in breach of regulation 17 and we identified three further breaches of regulation.

Holmfield Court 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.

Holmfield Court is situated in the Roundhay area of Leeds, within walking distance of shops and local amenities and close to a main transport system into the city centre. The service is registered to provide accommodation for up to 25 people. It specialises in providing accommodation and care to older people, some of whom are living with dementia.

There was a registered manager in post. 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.

The governance of the service was not robust and had not ensured the necessary improvements at the service. The quality monitoring systems in place had not identified the concerns we found.

The service was not clean. Cleaning schedules were in place but these did not cover all areas of the service. This meant areas missed included furniture, carpets, clothing and bedding. There were no cleaning schedules in place for people’s mobility equipment. Poor standards of cleanliness at the service were not identified by the management team.

Some of the issues relating to cleanliness also impacted on people’s dignity. This included clothing which was heavy soiled which was found in one person’s bedroom. Used continence pads were not always removed in a timely manner and there were malodours linked to the age of some of the furniture in the home.

People who required support with their food and fluid intake were not always supported in a consistent and effective manner. Staff did not always complete documents regarding people’s nutritional and hydrations needs. We saw the mealtime experience for people was chaotic and disorganised. The registered manager told us this aspect of the service was not monitored.

The provider had failed to ensure staff had proper guidance within care plans and risk assessments on how to meet people’s needs. Care records and risk assessments were not always updated following a change in people's needs.

All of the people using the service had a diagnosis of dementia. The provider could not demonstrate that they had utilised available best practice guidance to ensure the best care outcomes for people. The premises of the service had not been adapted to meet the needs of people living with dementia.

Activity staff and care staff had not completed training on how to plan and facilitate activities for people living with dementia. We have made a recommendation about this.

People's medicines were administered safely. Topical creams were not always stored at the recommended temperature. We spoke with the registered manager who told us they would take action to address this.

People who used the service were asked for their views and opinions on the service.

Care staff did not demonstrate a working knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards. We have made a recommendation about this.

Staff were recruited safely and received appropriate support. Inductions were completed before staff started work and training was refreshed annually.

People accessed advocacy services and were supported to practice their religious beliefs. People and their relatives were complimentary about the service and said they would recommend it.

You can see what action we told the provider to take at the back of the full version of the report.

This comprehensive inspection took place on 25 July 2017 and was unannounced. At the last inspection in June 2016 the service was found to require improvement to be safe, effective and responsive. At this inspection we found further improvement was required. There is full detail of the action taken within the main part of the report.

There was 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.

There were systems in place to look at the quality of the service provided. Although action was taken where some shortfalls were identified, there was a failure to adequately assess the safety of the service and take appropriate remedial action. Quality assurance systems had not identified all shortfalls.

The registered manager had good knowledge of the service and there was a clear ethos of care.

The systems in place to make sure that people were supported to take medicines safely were not sufficiently robust. Required improvements had not been made since the last inspection. There was a lack of information for staff to support people safely in an emergency. There was no fire risk assessment in place to identify and mitigate risks. Some aspects of the environment had not been made safe.

People told us they felt safe at the service. Risks to people in relation to their needs had been assessed and plans put in place to keep risks to a minimum. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns.

There were sufficient numbers of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background. Staff were supported by a comprehensive training programme and supervisions to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided, taking into account people’s likes and dislikes.

People told us that staff were caring and that their privacy and dignity were respected. Care plans showed that individual preferences were taken into account. Care plans gave clear directions to staff about the support people required to have their needs met. People were supported to maintain their health and had access to health services if needed.

People’s needs were regularly reviewed and appropriate changes were made to the support people received. People had opportunities to make comments about the service and how it could be improved.

The home is situated in the Roundhay area of Leeds within walking distance of shops and local amenities and close to a main transport system into the city centre. There is parking at the front of the home. The home is registered to provide accommodation for up to 25 people. It specialises in providing care to people living with dementia.

At the time of this inspection the manager was registered with the Care Quality Commission. 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 people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Adequate recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work. Staff received the training and support required to meet people’s needs. We were told staff who did not have a disclosure and barring service (DBS) check were not left unsupervised. However, we saw a member of staff who did not have a DBS carrying out occasional care tasks whilst they were on their own.

Some staff had received training in Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff ensured people were supported to make decisions about their care and where they were not able to do so, their relatives or people who knew them well were consulted. However, further staff training and reviewing of MCA and DoLS was required.

People enjoyed the different activities and we saw people were engaged with these during our inspection.

People who used the service told us they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. We found the administration of medicines was generally safe, however, the registered manager told us they would look at improving the recording of creams and the administration of early morning medicines.

Staff had information about people’s likes, dislikes, their lives and interests. However, some of the care plans lacked some detail. New care plans were been introduced. People’s mealtime experience was good. People received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

Staff had a good knowledge and understanding of people’s needs and worked together as a team. Throughout our inspection, people were treated with kindness and compassion. Staff had a good rapport with people.

The registered manager was visible working with the team, monitoring and supporting the staff to ensure people received the care and support they needed. People spoke positively about the registered manager. Effective systems were in place which ensured people received safe, quality care. Complaints were welcomed and were investigated and responded to appropriately.

On the day of inspection the current CQC rating for Holmfield Court was not on display, and the registered manager told us they did not know this was a requirement.

We found a breach in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Staff we spoke with told us that they encouraged people to be as independent as possible and make their own decisions where possible. One relative told us, “The care quality is very good here; care is individualised.” One person told us, “It’s very nice here. The staff are all very kind.”

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were cared for in a clean, hygienic environment.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The home had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

A relative told us people received good care. They said, “The care is good. Other visitors also think the same. Staff are polite, patient and check everything out.” Staff told us people received appropriate care and support.

People we spoke with said they were comfortable in their environment and could choose to spend time in communal areas or time in their room. Some areas had been recently decorated but other areas needed decorating because paintwork and general décor was grubby. People who used the service only accessed one bath and didn’t have the option of a shower.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Staff we spoke with said people who used the service were made aware of the complaint’s procedure and how to raise informal complaints or concerns. Staff said good systems were in place to make sure people were listened to.