Background to this inspection
Updated
24 September 2022
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
Two inspectors and an Expert by Experience completed the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It is also a supported living service. This service provides care and support to people living in two ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.
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. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with seven people who used the service and five relatives for their experience of the service. We also observed staff interaction with people to help us understand people’s experience. We spoke with the registered manager, a manager, two deputy managers and the provider. We sought feedback from staff and received feedback from eight support workers. We reviewed the care records of five people and four people’s medicine records. We reviewed four staff files and a variety of records relating to the management of the service, including policies and procedures, audits and checks.
After the inspection
We continued to seek clarification from the registered manager to validate evidence found, which was sent to us.
Updated
24 September 2022
About the service
Holmwood Gardens provides care at home and is a supported living service. People either live in the community in single or shared accommodation. There are also two supported living settings where people have individual or shared apartments with communal space. Staff provide onsite 24-hour care in both the supported living sites, and some people receive 24- hour care in the community. People receiving support are living with a learning disability and some people have physical needs and complex health conditions.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, 18 people were receiving the regulated activity of personal care.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted.
‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support: People received care and support that enabled them to have choice and control of their care. People’s independence was promoted.
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.
Right Care: People received care and support that was personalised. People were supported to achieve positive outcomes and led an active and fulfilling life.
Right Culture: Relationship difficulties amongst staff and the management team had had a negative impact on the culture of the service.
Medicines management did not follow best practice guidance. People’s support plans and risk assessments did not consistently reflect current care and support needs. Recruitment checks were not sufficiently robust. The provider’s systems and processes that assessed, monitored and improved quality and safety required improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 7 September 2018).
Why we inspected
The inspection was prompted in part due to concerns received about the behaviour of some staff, and an allegation of financial abuse. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. The registered manager took some immediate actions to make some improvements. Please see the Safe, Effective 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.
Enforcement
We have identified one breach in relation to the provider’s governance systems and processes at this inspection.
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.