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Archived: Holmesley Nursing Home Requires improvement

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Reports


Inspection carried out on 5 November 2018

During a routine inspection

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 carried out on 18 & 19 February 2016

During a routine inspection

Holmesley Nursing Home is registered to provide accommodation for 52 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.

This inspection took place on 18 and 19 February 2016 and was unannounced. There were 50 people living at the home at the time of the inspection.

We last inspected this service on the 29 April 2014 and found that the service was meeting the requirements of the regulations we inspected at that time.

There was a manager at the service who was registered with CQC. 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 supported by staff who knew them well and positive relationships had been formed. Staff were kind, caring and patient. They treated people with respect and promoted people’s dignity. One person said, “All carers are exceptionally kind, especially the overseas staff. I couldn’t fault them.” Another said, “The staff are wonderful…they cheer me up…” End of life care was provided by staff who were skilled and competent and ensured effective pain and symptom management. A palliative care specialist said, “…everyone (staff) wants to do the best for patients...trying to improve their experience…they (staff) add extra touches, which shows a caring attitude.”

People using the service, their relatives and visiting professionals said they felt the service was safe. Comments included, “I wouldn’t be anywhere else…” (Person using the service); “This is the best home in the area…” (Relative) and “…it is a well organised nursing home” (professional). People were supported in a way that ensured their safety and welfare. Risks to people’s health and wellbeing had been identified and staff understood how to keep people safe. Sufficient numbers of well trained and supported staff had been safely recruited to meet people's assessed needs.

There were safe systems in place for receiving, administering, storing and disposing of medicines. People received their medicines as prescribed. People's dietary needs and preferences had been assessed and catered for. People were supported to have enough food and drink to meet their needs. Everyone spoke highly of the quality and variety of food available and mealtimes were unrushed. People were supported to maintain their health. They received treatment and support from a variety of external health professionals. The service worked well with other professionals. Health and social care professionals expressed their confidence in the service.

People were protected by good practice in relation to decision making. The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been appropriately made when needed.

There was a varied activities programme in place and people participated in activities of their choosing. Families and friends were made to feel welcome and people were able to receive their visitors at any time.

People were able to express their views and opinions. If they made suggestions for improvements these were listened to and implemented where possible. People knew how to raise a concern or complaint and were confident that their concerns would be listened to and acted upon.

The service was well led and promoted a culture that cared for and valued people, including staff. People, their relatives and external professionals said the home was well run and they expressed confidence in the registered manager and staff team. There were effective systems in place to monitor the quality of the service. There were arrangements in place to obtain people's views of the service. The registered manager a clear view about how to continue to develop and improve the quality of the service, over the next 12 months.

Inspection carried out on 29 April 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People who lived at the home told us they were well looked after and were happy. One person we spoke with said "It's very good here; all staff are good and very helpful.� Another person confirmed that they were "well cared for�. One family member we spoke with confirmed that they were �very satisfied with the way [my relative] is cared for and looked after. We are always kept well informed of how [they] are or of any problems�.

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to safely manage medicines.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice had been identified and people were protected.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

We found that people's consent had been obtained for care and treatment provided to them by the service.

People�s health and care needs had been assessed with them or their representative, and those who wished to, and had been able to, had been involved in writing their plans of care.

Is the service caring?

We spoke with five people who lived at Holmesley. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; �They are all so kind and patient".

When speaking with staff it was clear that they genuinely cared for the people they supported. They told us about people�s individual health and social care needs and how these needs had been met in an individual way.

People�s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people�s wishes.

Is the service responsive?

We spoke with five people who live at Holmesley and five family members. People we spoke with were satisfied with the care and support they received.We saw from records that planned care and treatment had been provided in line with people�s individual care plans. Aspects of people's needs or care had been linked to risk assessments. Specialist health needs had been identified where required and appropriate health care professionals had been consulted and involved in providing care. People said that their care plans were up to date and reflected their current needs.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People who live at the home, their relatives, friends and visitors had completed a satisfaction survey in February 2014. Where shortfalls or concerns were raised these were taken on board and responded to appropriately.

Inspection carried out on 22 April 2013

During a routine inspection

We followed up an improvement action from our previous inspection in October 2012. We saw improvements in the way records were managed, reviewed and presented. Information was up to date and provided details of how people should be supported and cared for.

We talked with ten people who lived at the home, twelve staff including the providers, a health professional and seven relatives and visitors. We looked at the care records of six people living at Holmesley including records relating to their nursing support.

51 people were living in the home at the time of our inspection. We saw people responded positively to visitors who came into the home either to visit or provide entertainment. We observed a range of activities organised by the activity co-ordinators.

The people we spoke with and their visitors made positive comments about the home and about their care treatment and support. We saw how people�s care and welfare was provided with dignity and respect in line with their care plan and their changing needs. One person told us, �The staff are very good, I only need to ask and they help�; whilst another said, �It�s very nice here, a lovely home�.

People�s safety and wellbeing were protected by staff with appropriate skills and experience to meet the needs of people living in the home. People�s complaints were managed in line with the providers� policy and people living in the home told us they had their concerns listened to.

Inspection carried out on 1 October 2012

During a routine inspection

We talked with six people who lived at the home, eight staff and three relatives. Some people had communication difficulties; this meant they could not specifically tell us what it was like to live there. People told us the home was a pleasant place to live, one person said "the staff are good here, they look after me well". People told us they felt safe in the home and knew how to raise concerns although one visitor said their comments were not always responded to. People enjoyed the food, had plenty of choice and had their nutritional needs met. One person said �The food is excellent, lots to eat and drink�, another said "I enjoy the food, there�s plenty of choice". We found people with swallowing difficulties were well supported by staff to eat safely.

People we spoke with confirmed staff sought their verbal agreement before providing care and treatment. However, most people were not asked to sign their care plans to indicate they agreed with them. We found people were given the correct medication on time with good checks in place. There were effective recruitment processes in place to ensure all staff employed to work at the home had the appropriate skills and qualifications.

The home had good quality monitoring systems in place to ensure people's care and treatment needs were well managed. We identified record keeping as an area for improvement as we found some care and staff records were not as detailed and accurate as they should be.

Reports under our old system of regulation (including those from before CQC was created)