Archived: Holmwood House Care Centre

Holmwood House Care Centre is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided. The care home accommodates up to 59 people in one adapted building and was full at the time of this inspection. The three double rooms had been converted into single rooms. Most of the home is on one level; however, there are 6 bedrooms on the first floor in the main house accessible by a dedicated lift” for residential and nursing, the other predominantly for people living with dementia. The home was on the outskirts of the market town of Swaffham and had a dominant position in the town with far reaching views across the garden. There was ample parking.

The service has a registered manager who is a registered nurse. There was also a deputy manager and a registered nurse working on each floor. 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.

Our overall finding for this service was positive but we did identify a number of areas for concern, which constituted a breach of Regulation 17 Good Governance. We have rated the key question for safe and well led as requires improvement because we found records did not always tell us what people’s current needs were. Records were not always updated in a timely way when people’s needs changed. The service was not always proactive in reviewing its records of accidents, incidents or hospital admissions to assess if they had taken all the action they could to lower or mitigate risks. We therefore could not see how lessons were learnt to improve people’s safety and in ensuring good outcomes for people. There was a lack of management oversight for these areas although we saw the manager worked very hard and was a good organiser and communicator.

There were enough staff to provide timely care to people using the service and most of the staff had been at the service a long time. This meant they were familiar with people’s needs and offered continuity of care. Staff had the necessary skills and told us they were well-supported and provided with lots of training opportunities. The service had a robust recruitment process, which helped to ensure that only suitable staff were employed.

Risks to people’s safety were mostly mitigated. The environment was fit for purpose and free from hazards. Some people were identified as high risk of falls. This was clearly documented and actions had been taken to reduce the risks such as regularly monitoring people. The service ensured people had the right equipment and some beds were on a low setting with bedrails and, or crash mats. The service where possible monitored and reduced risk and there were enough staff to keep people safe. However, record keeping in this area could be improved upon particularly in regards to how the service learnt from events and incidents.

People were supported to eat and drink enough for their needs. Where risks of dehydration or unplanned weight loss were identified there was some additional monitoring of people’s needs. Food and fluid charts seen did not give enough information to be of any real value. For example, where people were on supplements these were not included on the charts and they did not always show quantities consumed or if snacks had been offered. We saw in practice this did happen but not recorded.

People received their medicines as intended by staff that were suitably trained. There were audits in place to help identify if people had received their medicines as required although we identified one error not picked up by the audit. .

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found people’s rights were being upheld and staff supported people lawfully and in line with legislation around mental capacity and deprivation of liberties. Records keeping in this area could be improved.

Staff understood what constituted abuse and what actions they should take to safeguard people. They were confident in raising concerns and the registered manager made themselves available and was responsive to people’s concerns or that of their friends and relatives.

The environment was appropriate to need and was maintained to a high standard. The environment was stimulating and designed in consideration of people’s needs. There was access to outside space and sufficient private and communal space. Visitors were made welcome and could meet with their relatives in private.

Staff kept up to date with best practice and worked across the service to help ensure people received a seamless service. Staff worked in conjunction with other services and sought advice from other professionals as required. People’s health was promoted and we saw staff had the necessary understanding and skills in relation to people’s needs.

Staff were observed treating people well and with respect. Staff demonstrated patience and kindness and enhanced people’s well –being through frequent and positive interactions. People were supported to live well and stay independent. Where people could, they were encouraged to join in different activities and socialise with others to reduce social isolation.

People were consulted about their care needs and relatives felt involved with the planning and reviewing of their family member’s needs.

Care plans were not concise and did not always include relevant information or accurately demonstrate how a person’s needs or risks were managed. However, staff knew people’s needs well and provided good standards of care. Activities were organised around people’s individual needs and were both spontaneous and planned ahead to help ensure people remained active.

Complaints and feedback about the service was acted upon and the service was responsive to issues raised.

The service had an established, experienced registered manager who staff held in high regard. The service was for most part well planned and feedback received was positive. Risks were mostly mitigated but records were not as robust as they could be.

However, during our last inspection on 21 August 2013 the five members of staff we spoke with talked us through the infection control process. They told us that they had access to personal protective equipment (PPE) at all times. And during our visit we observed that there were supplies of PPE throughout the home. We observed that members of staff were all wearing uniforms and using the PPE where necessary during our visit.

During this review on 11 September 2013 we have found that the provider has made the necessary improvements needed to minimise the risk of cross contamination to people and visitors to the home.

Staff had access to detailed care plans to ensure that they provided people with safe, appropriate, individual treatment, support and care. A person who we spoke with told us they had, 'No complaints.' Another person said that they, 'Like it here. Staff are nice. (I) feel safe.'

All of the areas of the home that we saw during our tour of the premises were visibly clean. However, we found that improvements were needed regarding the safe storage of clinical waste prior to it being collected. This meant that people were not protected from the risk of infection spreading as there were not effective systems in place to reduce the risk.

Effective staff training was in place to make sure that people who used the service received safe support and care from suitable, skilled, and knowledgeable staff. We found evidence which demonstrated to us that staff were supervised on a regular basis and had appraisals once a year.

There was an effective system in place for people to make a complaint if they wished to do so.

Staff had access to detailed care plans to ensure that they provided people with safe, appropriate, individual support and care. A relative who we spoke with told us they would, "Give (Holmwood House) five stars for everything." They also went on to tell us that it was a, 'Marvellous home.'

People were protected from the risk of dehydration and poor nutrition because nutritional needs were assessed ensuring that any such risks were identified and eliminated.

People who lived in the home were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were effective staffing levels in place to ensure the safety and well-being of people who lived at the home.

We saw an effective quality assurance system was in place as the provider generated action plans using the results from surveys, incidents and audit to improve the quality of the service delivered.