Holmewood Residential Care Home

Holmewood Residential Care Home is a residential care home providing personal care to up to 26 people. The service provides support to older people. At the time of our inspection there were 22 people receiving personal care at the service. Holmewood Residential Care Home accommodates people in one adapted building.

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

People were at significant risk of harm as safety was not prioritised by the provider. People were not safeguarded against the risk of abuse. We requested GP visits for 4 people we were concerned had experienced and were at risk of neglect. Health and safety risks, such as risks linked to equipment and the environment were not always identified or managed.

People experienced poor symptom management and pain as a result of how medicines were managed. Medicines systems did not support their safe use. People were at risk due to poor infection prevention and control practices within the home, including PPE not being stored and disposed of safely and hygienically.

The provider did not ensure there were sufficient numbers of staff with the right skills to keep people safe. People’s requests for assistance from staff via the call bell system were not always answered or reassurance provided. Some people had stopped pressing their call bells due to this. Safe recruitment processes were not followed to ensure staff were suitable for working in the home.

People did not experience effective care. Staff did not always have the knowledge, skills or experience to provide people’s care. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support good practice.

People were at risk of not receiving enough or appropriate nutrition and hydration. People were given meals that were not appropriate to their specific nutritional needs. The service did not always work effectively with health and other professionals. The lack of an effective working relationship with the local GP surgery meant people’s health needs were at risk.

The service was not suitable for the needs of the people living at the home. The premises were not designed with people’s specialist needs in mind, including dementia.

People did not receive kind, compassionate care. On occasions, people were crying as they had not received assistance they needed. People were not treated with dignity or respect. People’s continence products and supplies were left in public areas of home.

People’s care was not person-centred. People were at risk of social isolation as they had few opportunities for stimulation and to speak with others, including staff members. The service was not inclusive, people’s communication needs were not considered or accommodated. People were not consulted in involved in making decisions about activities planned at the home.

People were at risk due to significant shortfalls with the governance and oversight of the service. Processes were not established to monitor quality and safety across the service. The registered manager was not accepting of the issues we found on inspection and did not always understand the risk to people. A culture had been established at the service of organisational and institutionalised care, where people did not experience good outcomes.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (1 December 2022). This service has been rated requires improvement or inadequate for the last 2 consecutive inspections.

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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider review and update their visiting policy and review the specialist types of care provided at the service. At this inspection we found improvements had been made to visiting. However, the provider had failed to review the specialisms provided at the service.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, dignity and respect, need for consent, safe care and treatment, safeguarding, meeting nutritional and hydration needs, premises and equipment, good governance, staffing and fit and proper persons employed. Please see the action we have told the provider to take at the end of this report. 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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Holmewood Residential Care Home is a residential care home providing personal care to up to 26 people. The service provides support to older people. At the time of our inspection there were 25 people using the service. Holmewood Residential Care Home accommodates people in one adapted building.

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

People were at risk of harm because of widespread shortfalls in safety across the service. Staff had not always received the appropriate training or had their competence assessed prior to providing people with specialist care tasks. There were not always enough staff available to provide people with safe and timely support. Feedback from people and staff was that people did not always receive their care when they needed it. The provider had not always carried out appropriate checks to ensure staff were safely recruited.

People were at risk as health and safety issues had not always been identified or addressed. Risks to people were not always well managed as they had not always been identified or robustly assessed.

Systems were not always in place to ensure people received their medicines safely and as prescribed.

People were supported against the risk of infection. Arrangements were in place to enable visitors to visit family members and friends living at the service. We have made a recommendation about the provider’s visiting policy.

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 at risk of not receiving high quality care as the provider did not have effective systems in place to assess, monitor and improve the service. Changes with the provider’s management structure had led to a lack of oversight of the service. The provider had identified some areas where changes were needed prior to our inspection, however, they had not identified the extent of issues we found. The registered manager and provider started to make improvements following our inspection, these had yet to be embedded and sustained. We have made a recommendation about the specialisms the provider wishes to offer at the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 13 February 2019).

Why we inspected

We received concerns in relation to health and safety, staffing levels and people’s quality of care at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 Holmewood Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed and good governance. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had good procedures for preventing visitors from catching or spreading infection. In line with guidance, all but essential visiting had been suspended due to the national lockdown. The registered manager had previously arranged some safe visiting at the front door, using a clear barrier and suitable personal protective equipment for visitors.

People understood the reasons for isolating. Arrangements were in place to encourage people to keep a safe distance in lounges and in the dining room. People could self-isolate in their en suite bedrooms.

The provider had followed safe procedures when people were admitted to the home. People had to have two negative COVID-19 test results before admission and on admission were supported to self-isolate as required.

The staff and the people who lived in the home had been tested routinely and staff were testing people when we inspected. All of the people in the home had received the vaccine. Staff had also received the Covid -19 vaccine. Any staff testing positive for the virus would self-isolate at home. One staff member continued to shield at home.

The home was clean and hygienic. The staff had been advised by the local authority and had made their cleaning systems more robust to ensure good levels of hygiene. Revised cleaning schedules were in place to ensure good infection prevention and control measures. Staff had received recent training and understood how to use and dispose of personal protective equipment.

The home had been supported by the local authority and they confirmed that the staff team had followed their advice and guidance. Arrangements had been put in place to ensure the staff could work safely. The registered manager was completing a contingency plan if there were to be an outbreak. No one in the home had tested positive for the virus and were in good spirits when we inspected.

People’s experience of using this service:

People told us they were very happy with the care provided, especially the caring nature of the staff team and the homely feel that had been created. One person summed this view up by telling us, “It’s home from home here, you can do what you like. I couldn’t wish for better, the staff are very kind. I kept falling and getting poorly but since I came here I haven’t had one fall, they’ve seen to that. My health is good now as staff are on the ball.”

People felt safe living in Holmewood and with the staff who supported them. Staff knew them well and were focussed on promoting their independence and well-being. Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.

Staffing levels were suitable for people’s needs. There was a stable staff team who had the skills and knowledge to meet people's needs. The home’s programme of training and staff supervision had improved which ensured staff were up to date with the latest guidance and information for their roles.

People received the support they required to maintain good health. Medicines records were accurate and supported the safe administration of medicines.

Meals were of a good quality and nutritional value and people told us the meals were very good and home-cooked.

The home worked in partnership with external healthcare professionals. Healthcare professionals gave positive feedback on the care and of the monitoring of peoples changing health needs. A relative told us that the end of life care of their loved one had been exemplary.

People were involved in planning their own support and the activities they wanted to take part in. There was a programme of activities for people to take part in and people were also supported to follow individual interests and hobbies.

The home had undergone improvements to the environment; and to care planning and staff induction and training since the last inspection. The registered manager and owner had developed an improvement plan for the home which included the next phase of improvements, such as continuing to replace furniture and carpets and developing a dementia-friendly garden space.

The home was clean and well maintained; checks were carried out on the premises and on the quality of the service. Good measures were in place to prevent the spread of infections. Concerns and complaints were managed appropriately and staff and people in the home felt able to speak to the manager and owner of the home.

More information is in the Detailed Findings below.

Rating at last inspection: Requires Improvement (report published 18 January 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had been rated as Requires Improvement and we asked the provider to submit an improvement plan. On this inspection we saw improvements had been made since our last inspection and we have now rated the service as Good.

Follow up: We will continue to monitor as part of the re-inspection programme for a Good service. If any concerning information is received we may inspect sooner.

There was a registered manager in post on the day of our inspection visit. 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.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were around risk assessments and ongoing assessments when people’s needs changed; staff induction, training and development; and the quality assurance systems to check the quality of the service.

We found assessments of people’s support needs did not always contain all the information needed to meet their current needs.

We found that the provider and the service did not have effective quality assurance systems in place. For example, for ensuring that the care given in the home was up to date best practice. Staff carrying out audits did not have the appropriate qualifications and skills to analyse and understand the significance and impact. The service was not always effectively seeking and acting on feedback from relevant persons, including people in the home, to improve the service.

People made informed choices and were enabled to be involved in decisions. Some of the records in people’s care plans were not clear on the support they needed to make decisions.

We made a recommendation about how people’s capacity was assessed and recorded.

We found some infection control measures were not in place and the home was not following national best practice guidance in this area. We have made a recommendation about improving infection control in the home.

Staff received basic training required to undertake their roles. Staff were given supervision and attended staff meetings. Staff received informal induction when they began working in the home.

We have made a recommendation about introducing a more formal structured programme, with more detailed training on the issues for people living with dementia.

Systems were in place for the safe storage, administration and disposal of medicines. Records showed people received their medicines as prescribed and in their preferred manner.

We made a recommendation about developing care plans to manage ‘as and when’ medicines.

There was a programme of entertainments in the home and people went out on day trips. People’s preferences to meet their social and recreational needs was not always recorded. Some people spent all their time in their bedrooms and they maybe at risk of being socially isolated.

We made a recommendation about seeking people's views on day to day activities and then ensuring these are in place with appropriate staff support.

People were supported by sufficient numbers of staff who knew them well. Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.

The environment was well maintained and the atmosphere was relaxed and homely.

Staff worked with external professionals to promote people's physical and mental well-being. People were well supported to have a dignified end of life and a pain free death.

People were supported to have a balanced diet that met their and health needs and told us of the good quality and range of the meals provided. Their visitors were made welcome in the home and people were able to maintain relationships that were important to them.

Safeguarding procedures were in place and staff had received training in safeguarding vulnerable adults. Staff knew how to recognise abuse and told us they would report any concerns.

Staff told us they felt they were listened to and valued by the registered manager and provider. There was good teamwork between the staff.

Staff and people who used the service said the registered manager was supportive and approachable. There was a complaints policy and complaints had been responded to and resolved appropriately.

Further information is in the detailed findings below. You can see what action we told the provider to take at the back of the full version of the report.

"The staff are excellent' Nothing is too much for them."

"I think I made a good choice coming here because everyone is very pleasant."

"I am given plenty of support but I can be as independent as I want."

The home was clean, tidy and fresh on the day that we visited. It was well furnished, freshly decorated and all of the equipment was up to date and well maintained.

The home was appropriately staffed with skilled and experienced team members. We spoke to the staff on duty and they were enthusiastic, well trained and knew the people who lived in the home very well.

No one in the home had any complaints about the care or services. People knew how to make a complaint but said that they have never had to do this. There was a minor change needed to the home complaints policy and the provider agreed to do this.

There was efficient record keeping systems in place. There were some minor changes needed and again the provider was happy to improve the way records were managed.