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Archived: Holmesley Nursing Home Requires improvement

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Inspection Summary


Overall summary & rating

Requires improvement

Updated 11 January 2019

This unannounced inspection took place on 5 and 9 November 2018. The service was last inspected in February 2016. The overall rating was good and the key question for Caring was rated as outstanding.

At this inspection, we found the key questions of Safe and Well Led were now rated Requires Improvement. This was because staffing levels had not always been maintained to ensure people’s needs were met in a timely way. Fire safety checks had not been always been completed. The key question of Caring is rated good at this inspection. This was because of the mixed feedback we received about staff’s approach at times.

Holmesley Nursing Home 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, and both were looked at during this inspection.

Holmesley Nursing Home is registered to provide accommodation for 55 people who require nursing and personal care. The service is intended for older people, who may be living with a physical disability, mental health needs or a dementia type illness. At the time of the inspection there were 53 people living at the service. The service provides accommodation over two floors, with access provided by a passenger lift. Many bedrooms have en-suite facilities and patios leading to the mature and well planted gardens.

The service had a registered manager in post. 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.’

Staffing levels did not always ensure people’s needs were being met in a timely way. Conversations with people and our observations confirmed staff were stretched and busy which led to a delay in some people`s support needs being met. This was being addressed by the provider who had agreed to increase the staff team. We have recommended the provider keep staffing levels and the deployment of staff at the service under review.

Improvements were made during and after the inspection to ensure that medicines were stored at the correct temperature. People received their medicines as prescribed from trained and competent staff.

The registered manager had begun to implement a new system to monitor that regular safety checks were being completed. Some fire safety checks had not been completed as necessary.

The majority of people said staff were kind, caring, friendly and thoughtful. However, some people had less positive experiences and said staff could be “short” with them when busy or short of staff. We received a mixed response from people about how staff promoted their privacy. We have made a recommendation to ensure staff attitude and approach improves.

Quality assurance systems were in place. However, the processes in place had failed to identify the shortfalls found at this inspection. We have made a recommendation to ensure the provider has a clear process for setting and achieving improvement plans.

People felt safe at the service. Comments included, “I am very happy here”; “They (staff) help me…” and “I like it here and feel safe”. They were protected from abuse and their safety was maintained because staff had a good understanding of the risks associated with the people in their care. Risk assessments were in place and provided guidance.

Staff were appropriately recruited, trained and supervised to provide care and support to people who used the service.

People had access to relevant health care professionals. Health professionals provided positive feedback about the service and the good working relation developed. A varied and nutritious diet was offered to people which reflected their needs and preferences.

Staff protected people’s rights by follo

Inspection areas

Safe

Requires improvement

Updated 11 January 2019

This key question has changed from Good to Requires Improvement.

Staffing levels did not always ensure people�s needs were being met in a timely way. This was being addressed by the provider who had agreed to increase the staff team.

Improvements were being made to ensure medicines were stored at the correct temperature.

Fire safety checks had not been always been completed.

Risks to people�s safety and welfare were assessed and measures were in place to reduce risks. Incidents and accidents were investigated and appropriate action taken where necessary.

The service was clean throughout and free from offensive odours.

Effective

Good

Updated 11 January 2019

The service remains Good

Caring

Good

Updated 11 January 2019

This key question has changed from Outstanding to Good

The majority of people thought staff were kind, caring and friendly. We received mixed feedback from some people about staff�s approach at times relating to privacy and attitude.

Positive relationships had been developed between staff and people who used the service. Staff knew people well and were aware of what was important to them.

Staff responded appropriately when people became anxious or distressed and promoted people�s dignity.

People were encouraged to be as independent as possible. People were supported to maintain contact with families and friends and to develop new friendships.

Responsive

Good

Updated 11 January 2019

The service remains Good

Well-led

Requires improvement

Updated 11 January 2019

The key question has changed from Good to Requires Improvement

The provider did not have effective quality assurance systems in place to monitor the quality and safety of the service.

A registered manager was in post and people expressed confidence in them. The management and leadership of the service were described as very supportive.

People�s views were sought about the service and they were encouraged to help improve the service.