All inspections: Holmdale House - Care Quality Commission

We undertook this focused inspection on 24 February 2015 and it was unannounced. This was to check that the provider and registered manager had followed the requirements of the warning notices issued to them on 5 January 2015 and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Holmdale House on our website at www.cqc.org.uk

Following an inspection on 12 & 16 December 2014 we issued three warning notices telling the provider and registered manager they must improve the service provision in these areas by 26 January 2015. The warning notices related to medicines management, safeguarding people who used the service and the failure to ensure that people had their care and welfare needs met. We found the provider had not taken adequate action to meet the warning notices and become compliant with the regulations.

Holmdale House provides accommodation for up to 31 people who require support with their personal care. The home mainly provides support for older people and people living with dementia. There were 10 people living at the home at the time of our inspection.

The home had a registered manager in place. 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.

Medicines were not managed correctly. Where people were unable to say if they had pain there was no system or procedures to identify pain or ensure pain relief medicine was administered. Therefore people did not receive pain relief medicine when they require it. Medication audits had not identified the failure to administer topical creams as prescribed or the incorrect use of topical creams. Essential safety precautions were not followed in respect of the storage of oxygen. People were at risk due to these failings.

People were not protected from the risk of abuse and neglect. Staff did not recognise some aspects of their care practises as being abusive. People were at risk of developing injuries which may have been preventable and action was not taken promptly to ensure people received correct safe care.

Healthcare advice was not always sought or followed when required. Care records did not always show when medical advice had been sought or what the advice or guidance from medical practitioners had been. Care and support was not planned or delivered in a way that met people’s individual needs or responded to their changing needs.

People’s legal rights were not ensured. The principles of the Mental Capacity Act 2005 were not being followed and Deprivation of Liberty Safeguards (DoLS) not implemented effectively. People’s wishes in respect of how they should be cared for were either not known or ignored.

Staff did not receive the training they required to give them the necessary skills to meet people’s needs safely.

We found the provider had failed to take adequate action and are planning further enforcement action. You can find further information about this at the end of the report.

This inspection took place on 12 and 18 December 2014 and was unannounced. The service provides accommodation for up to 31 people, including people living with dementia. There were 30 people living at the service when we visited. This was the first inspection since the home was registered by the current provider in January 2014.

People did not receive their medicines at the correct times or in a safe way placing them at risk. Records of medicines administration did not show people had received all their medicines as prescribed and when they needed them. There were not always appropriately trained staff available who could administer medication.

Guidance on the prevention and control of infections was not followed and the risks of cross infection were not managed effectively. Staff had not received infection control training and there were no plans for this to be undertaken.

Action was not taken when people had a fall or where they were noted to have bruising or injuries of unknown cause. Emergency and fire safety arrangements were inadequate. Staff had not undertaken fire awareness training and new staff were unsure what action they should take should the fire alarms sound.

Recruitment procedures were not safe as appropriate checks were not always completed before staff started work. There was insufficient staff with the necessary skills, knowledge and experience to meet people’s needs. Staff had not completed other training necessary to enable them to provide safe, effective care.

People were satisfied with the care and support they received. People and relatives were positive about staff who they felt were kind and compassionate. They felt able to raise to raise concerns and complaints with the manager. However, concerns raised verbally were not recorded and patterns or trends could not be analysed to make improvements.

However we found not everyone had a care plan and others did not reflect people’s current needs. People may not be receiving care in a consistent manner. Choice was available for meals and people felt they were of good quality but people’s weights and nutritional intake were not monitored effectively.

The principles of the Mental Capacity Act 2005 were not being followed and Deprivation of Liberty Safeguards (DoLS) not implemented effectively.

People’s privacy and dignity was not always respected and staff did not always ensure this whilst providing personal care.

Quality assurance systems were not effective. Audits had not been completed and incidents and accidents were not investigated to ensure learning was used to prevent further occurrences.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Archived: Holmdale House

All Inspections

24 February 2015

During an inspection looking at part of the service

12 and 18 December 2014

During a routine inspection