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The Holmes Care Limited Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 12 January 2018

The inspection was unannounced and took place on 19 October 2017. We then arranged to return on the 26 October 2017 to complete the inspection. Prior to the inspection the relatives of one person had raised concerns about care at the home and the inspection followed up on these concerns and we also discussed the information with partner agencies. We last inspected The Sycamores on 22 May 2017, looking at whether the service was safe, which we rated as good.

The home is registered to provide accommodation and personal care, and the treatment of disease, disorder or injury for a maximum of 84 people. There were 78 people living at the home on the day of the inspection. The home is split across three floors comprising a nursing unit, a unit for people living with dementia and a residential unit.

The registered manager left the home in March 2017 and a new manager was appointed. The new manager has applied to CQC to become the registered manager. 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 that people’s medicines were not always available and administered to them as prescribed to meet their health needs. Medicines for four people had been out of stock for a period of four days and action had not been taken to seek advice from a GP or make observations to assess the potential risk to the people concerned.

People told us that they felt safe and they were supported by staff who knew how to keep people safe from harm but they sometimes had to wait for support. Staffing arrangements need to ensure there were enough staff who were organised in the right way to meet people’s needs effectively.

Staff had a good understanding of protecting people from the risk of abuse and harm and knew their responsibility to report any concerns.

The principles of the MCA had not been consistently applied. Staff spoken to had limited knowledge of the MCA and how this impacted on the care provided to people. Systems for reviewing DoLS applications had not identified actions required.

Staff understood people’s individual care needs and had received training so they would be able to care for people living in the home. There were good links with health and social care professionals and staff sought and acted upon advice received, so people’s needs were met.

People’s nutritional needs were met. People were given a choice of meals, however they felt the quality of the food they received could be improved. The manager was working with staff to improve people’s dining experience.

People liked some of the staff who cared for them, however care was not provided in a person centred way. Care provided was task focussed and people were not always treated with dignity and respect.

People’s access to activities and support varied across the homes three units. We found improvements were needed to support people living with dementia. Relatives said they would like more dementia appropriate activities as there was little for their family members to do and our observations supported this.

Relatives told us communication was good and they were updated on any changes in their family member’s health. The manager had introduced new meetings and records which staff told us had improved communication within the staff group. People felt able to raise concerns; however they did not feel actions were always taken in response.

The provider had systems in place to check and improve the quality of the service but these had not been effective in identifying the concerns that we found at our inspection. Audits need to be developed further to ensure that actions had been applied in practice to improve standards of people’s care.

The new manager had made some improvements, for example, daily management meetings and a new handover process, but further action was required to ensure that changes were embedded and also further improvements made in a timely way.

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

Inspection areas

Safe

Requires improvement

Updated 12 January 2018

The service was not consistently safe.

People’s medicines were not always available and administered to them as prescribed to meet their health needs.

Staffing arrangements need to ensure there were enough staff who were organised in the right way to meet people’s needs effectively.

People told us that they felt safe and they were supported by staff who knew how to keep people safe from harm.

Effective

Requires improvement

Updated 12 January 2018

The service was not consistently effective.

The principles of the MCA had not been consistently applied. Care staff spoken to had limited knowledge of the MCA and how this impacted on the care provided to people. Systems for reviewing DoLS applications had not identified actions required. This showed there was a risk that people would potentially be deprived of their liberty when this was not lawful.

The mealtime experience of people needed improvement to enable people to enjoy their meals and support their wellbeing.

People were supported to access healthcare professionals and attend a range of medical appointments.

Caring

Requires improvement

Updated 12 January 2018

The service was not consistently caring.

People liked some of the staff who cared for them, however care was not provided in a person centred way. Care provided was task focussed and people were not always treated with dignity and respect.

Responsive

Requires improvement

Updated 12 January 2018

The service was not consistently responsive.

People did not always receive care that met their individual needs in a timely way and did not always receive support to engage in meaningful activities.

Relatives said communication was good and people said they felt able to raise concerns; however they did not feel actions were always taken in response.

Well-led

Requires improvement

Updated 12 January 2018

The service was not consistently well-led.

The provider had systems in place to check and improve the quality of the service but these had not been effective in identifying the concerns that we found at our inspection. Audits need to be developed further to ensure that actions had been applied in practice to improve standards of people’s care.

A new manager was in place and some improvements had been implemented but further action was required to ensure that changes were embedded and also further improvements made in a timely way.