Holyrood House

Updated 3 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

Holyrood House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Holyrood House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who used the service and 3 relatives about their experience of the care provided. We spoke with 7 members of staff including the nominated individual, the registered manager, senior care workers and care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We carried out a visual inspection of the home to assess the living environment and observed interactions between staff and people who lived at the home. We reviewed a range of records. This included 3 people's care records, and multiple medication records. We reviewed a variety of records relating to the management of the service, including audits, policies and procedures.

Updated 3 May 2023

About the service

Holyrood House is a residential care home providing personal care to 25 people aged 65 and over at the time of the inspection. The service can support up to 29 people. Accommodation is provided in one adapted building, with bedrooms and communal facilities spread over two floors.

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

People did not always receive a safe and well led service. People were exposed to the risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs, as well as environmental risks. Lessons had not been learnt where accidents had occurred.

Medicines management put people at risk of harm. We could not be assured people received their medicines as directed. People who received time specific medicines did not receive these in line with the prescriber's instructions. Stock checks were not always consistently completed.

The providers systems to monitor the quality and safety of the service were not effective in identifying improvement or driving quality at the service. The inspection identified shortfalls in relation to the management of medicines, staff training and risk mitigation. The providers systems had failed to identify and address these concerns.

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 (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 18 December 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the management of risk, and infection control. A decision was made for us to inspect and examine those risks. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. Following the inspection, the provider implemented additional documentation to support the safe management of medicines. 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 Holyrood House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staff training and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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.