We carried out a review of the data available to us about The Holt on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Holt, you can give feedback on this service.
We found the following examples of good practice:
Visitors were only permitted by prior appointment but due to the nature of the small, personalised service the home were able to ensure people regularly kept in contact with their family and friends in a safe way. Each visit was risk assessed and all parties were aware of the guidelines for safe and enjoyable visiting.
People and staff have been regularly tested to ensure they have not contracted Covid-19. Strict measures were in place to ensure people and staff would be isolated immediately if they had any symptoms of the virus, or if they had tested positive. Contingency and admission plans were clear and included external accommodation for staff if necessary. People and staff had received their first Coronavirus vaccination.
People had coped well during the pandemic due to a positive staff group who knew people’s needs well. There was a good range of activities to suit individual interests. People had been able to go out for socially distanced walks in the nearby countryside, enjoy BBQs and birthdays and themed parties had been arranged to keep people occupied and keep their spirits up. Staff had made home made ‘takeaway’ meals and brought in their dogs which people had enjoyed.
Safe procedures have been followed by staff to minimise the risk of transmitting Covid-19. They had good stocks of all personal protective equipment (PPE). There were supplies of PPE available around the home. Staff were seen using appropriate PPE. Staff had received training on donning and doffing and on the coronavirus pandemic from various sources including e-learning and from in-house training sessions. These included regular refreshers and questionnaires to ensure staff knew what to do.
People were supported to understand what the pandemic meant for them using communications they could understand, such as easy read. Staff explained the television news for people and ensured people knew who was supporting them and why they were using masks.
The home was clean and hygienic and easily enabled zoning and space to allow social distancing and safe breaks for staff. Detailed cleaning schedules were in place for all areas of the home. All touch points were cleaned frequently including high touch points. Deep cleaning of all areas was carried out regularly. The home was well-ventilated and new cleaning products had been sourced for effectiveness.
The registered manager and providers acknowledged the staff team had been through a very difficult time and supported staff. The provider had sent personalised thank you cards to all staff. Staff across the provider group celebrated peoples’ achievements and shared positive stories using a workplace Facebook page. Staff and managers had good communication with with the provider through regular meetings and question and answer sessions and updates. Staff felt valued and appreciated and had received special treats as a thank you for their hard work.
The Holt Residential Home provides care and accommodation for up to two people. On the day of our inspection there were two people living at the service. The home provides residential care for people with a learning disability.
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.
There was a registered manager in post, however they were currently not available. In their absence, there was an acting manager working in the service. 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 checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharge if needed, people’s independence and links with their community.
At the last inspection on the 17 March 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
At this inspection we found the service remained Good.
Why the service is rated Good:
People were not all able to fully verbalise their views therefore they were not able to tell us verbally about their experience of living there. We spent short periods of time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. However, one person when asked if they were happy living in The Holt said ‘Yes’ they were.
People remained safe at the service. People were protected from abuse as staff understood what action they needed to take if they suspected anyone was being abused, mistreated or neglected. Staff were recruited safely and checks carried out with the Disclosure and Barring Service (DBS) ensured they were suitable to work with vulnerable adults. There were sufficient numbers of staff to meet people’s needs and help to keep them safe.
People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Staff assessed and understood risks associated with people’s care and lifestyle. Risks were managed effectively to keep people safe whilst maintaining people’s rights and independence.
People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook regular training and competency checks to test their knowledge and to help ensure their skills in relation to medicines were up to date and in line with best practice.
People were supported by staff who had received training to meet their needs effectively. Staff meetings, one to one supervision of staff practice, and appraisals of performance were undertaken. Staff completed the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the equality and diversity and the human right needs of people.
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's health was monitored by the staff and they had access to a variety of healthcare professionals. The acting manager worked closely with external health and social care professionals to help ensure a coordinate approach to people’s care.
People’s care and support was based on legislation and best practice guidelines; helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought as much as possible. Care records were person centred and held full details on how people liked their needs to be met; taking into account people’s preferences and wishes. Overall, people’s individual equality and diversity preferences were known and respected. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.
People were treated with kindness and compassion by the staff who valued them. Staff had built strong relationships with people who lived there. Staff respected people’s privacy. People, or their representatives, were involved in decisions about the care and support people received.
The service remained responsive to people's individual needs and provided personalised care and support. People’s communication needs were known by staff. Staff had received training in how to support people with different communication needs. The provider had taken account of the Accessible Information Standard (AIS). The AIS is a requirement to help ensure people with a disability or sensory loss are given information they can understand, and the communication support they need.
Staff adapted their communication methods dependent upon people’s needs, for example using simple questions. Information for people with cognitive difficulties and information about the service was available in an easy read version for those people who needed it.
People could make choices about their day to day lives. The provider had a complaints policy in place and it was available in an easy read version. Staff knew people well and used this to gauge how people were feeling.
The service continued to be well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff told us the acting manager was approachable and made themselves available. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.
People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.
The Holt provides accommodation with personal care for up to two people with learning and physical disabilities. Two people lived at the service when we visited. One had started living at the home in early 2015, having moved from another home run by the provider. The other person had only been with the service for four months.
The home is a house located on the outskirts of Exminster; a small village located close to the city of Exeter in Devon. The home had been adapted from a family home and includes two one-bedroomed units, which provided self-contained accommodation for each person living in the home, including separate bedrooms, bathrooms, sitting and dining areas. Between the two units was an office area which staff used during the day and night, when not with the people living at the home.
The home has a manager, who had been registered with the Care Quality Commission since 2015. 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.
People were treated with dignity and respect and their preferences were taken into account when delivering their care. Staff respected people’s choices and acted in accordance with each person’s wishes and preferences. - Staff understood their responsibilities in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, relatives as well as health and social care professionals were consulted and involved in decision making about people in their 'best interest’.
Detailed risk assessments were in place for each person with actions identified to reduce risks as much as possible. People received their medicines safely and on time.
Staff supported people to become more independent and develop their skills. This included increasing people’s ability to undertake personal care tasks, household skills as well as interpersonal and social skills.
Staff had a good knowledge of people’s communication, care and health needs. Staff received training when they started working at The Holt. There were regular updates of training considered to be mandatory for staff. Staff were also provided training in specialist areas including epilepsy, autism, Asperger’s Syndrome and positive behaviour management. Staff received regular supervision and an annual appraisal. Staff were supported to develop their skills through undertaking nationally recognised qualifications in care.
People’s care records were held on a computerised system. The records provided detailed information about how to support each person. Care plans had been developed with the person, and those close to them. Staff used different communication methods to ensure people were able to be involved.
Staff encouraged people to eat a well-balanced diet and make healthy eating choices which had helped them to lose weight. People were also supported to do exercise which had increased their well-being. Staff worked with healthcare professionals including the person’s GP, specialist medical staff and members of the local learning disability team. Health and social care professionals paid compliments to the home about the care provided.
Staff had completed safeguarding training and knew how to recognise signs of potential abuse. Staff knew how to report any concerns they had.
The provider had a written complaints policy and procedure. One complaint had been received in the last year; this had been investigated and responded to appropriately. . Relatives said they would speak to the registered manager about any problems and were confident the problem would be resolved. Accidents and incidents were reported and included analysis of how to reduce the risks of a recurrence.
The culture at the service was reflected in the organisations values of person centred care which promoted independence. Staff worked proactively with families and professionals to help the people they supported. The provider had quality monitoring arrangements in place. These included audits of care records and medicines management and regular health and safety checks. They made continuous improvements in response to their findings.