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Inspection carried out on 15 December 2020

During an inspection looking at part of the service

Holbrook Hall is registered to accommodate 36 people. There were 27 people using the service at the time of our inspection. Each person had their own bedroom and access to a variety of communal areas and outside spaces.

We found the following examples of good practice.

¿The home was visibly clean and tidy.

¿People and visitors were informed of safe infection control procedures via posters and information leaflets that had been placed around the home.

¿The registered manager was aware of all current guidance provided both locally and nationally on how to reduce the risk of the spread of the infection at the home.

¿Access to the home was restricted. No new admissions to the home were currently permitted. Plans to admit people safely were in place. This will include a mandatory 14- day isolation period to reduce the risk of spreading the virus to others.

¿Regular testing was completed of staff and people living at the home.

¿Visitors were currently prohibited from entering the home; however, an assessment of how to enable visitors to see relatives had been completed. A booking system was in place. Visitors could book a 45 minute slot and they did not access the home at any time. They met and spoke with their relatives through a Perspex screen, using a microphone in a COVID-19 secure environment.

¿After each visit the area was thoroughly cleaned ready for the next visitor.

¿Staff supported people to maintain contact with family and friends in other ways. This included the use of technology, such as Skype as well as regular phone calls.

¿Personal Protective Equipment (PPE) and hand sanitising stations were readily available throughout the home. Training on the safe 'Donning and Doffing' of this PPE had been completed by all staff.

¿Clear, designated isolation areas were in place that could be closed off to the rest of the home for people who had a positive COVID-19 test. .

¿ A designated staffing team was assigned to the isolation areas with their own entrance and exit points to limit contact with others.

¿Staffing hours had been increased to ensure people were kept safe during the COVID-19 outbreak.

¿Agency staff had been used to cover some of these shifts. Robust procedures were in place to ensure the agency staff were suitable to work at the home. This included a negative COVID-19 test, a criminal record check and all mandatory training was completed and up to date.

¿The performance of agency staff was also monitored via regular observations and them being paired with an experienced member of the permanent staff.

Further information is in the detailed findings below.

Inspection carried out on 14 August 2019

During a routine inspection

About the service

Holbrook Hall is a residential care home that was providing personal care for up to 36 people with a range of needs. At the time of the inspection there were 31 people living in the home.

People’s experience of using this service and what we found

People who lived at the home continued to receive good care and told us they felt safe. Staff knew how to manage risks effectively and identify signs and symptoms of abuse and who to report concerns to. Accidents and incidents had been reported and medical attention sought where required. Improvements were required to ensure post falls observations were documented. Improvements had been made to medicines management. However further improvements were required to medicines administration practices. We made a recommendation about this. People were protected through robust recruitment procedures and told us there were enough staff to response to their needs. People lived in well maintained and clean environment and were protected from the risk of infections.

Care plans contained personalised information on people’s health and communication needs plus their likes and dislikes. However, improvements were required to ensure all care plans provided to staff were up to date and reviews completed to show changes to people’s needs. We have made a recommendation about this. People were provided with activities of their choice and supported to keep active in the community. People were able to make complaints concerning their care. People were supported to share their end of life wishes and care preferences.

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. People were asked to consent to care. Staff had received training and were knowledgeable about the principles of the Mental Capacity Act 2005.

People were supported by staff who were trained and had the skills to provide effective care. Staff felt very supported by the registered manager and management team. People’s nutritional needs were assessed and met. Staff worked with community health professionals to ensure people received effective care.

People told us staff treated them with dignity and were respectful. Our observations supported these views. One person told us, “The staff are excellent, friendly and helpful. One cannot fault them, they are more or less friends.” We saw lots of positive interactions between people and staff, no one was rushed, and activities were person-centred. One person told us, “The staff are very good, they do their best, they do care and treat you like a human being.”

The service was well-led. People, their relatives and staff spoke positively about the registered manager and management team. There was a positive culture throughout the service which focused on providing care that was individualised and promoted independence.

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 09 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 6 September 2016

During a routine inspection

Holbrook Hall provides a residential service for 36 older people. The service was last inspected in February 2014, when it was compliant in all areas inspected. We inspected the service on 6 and 7 September 2016, the first day of inspection was unannounced.

There was 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.

Improvements were required to how medicines were managed. Temperatures in medicine storage areas were not always within safe limits and controlled drugs were not always stored and administered safely.

Risks were not always managed effectively and we felt the recording of increased risk required improvement. Changes to the mobility needs of people were not always recorded accurately in care plans; and risk assessments were not always updated promptly. This meant that staff were not always aware of the changing needs and associated risks of people.

However, people told us they felt safe living at Holbrook Hall; they praised the service and the staff team. Pre-employment checks were completed for all staff to check their suitability, before they began caring for people. There was sufficient, suitably qualified staff available to care for people. Equipment was maintained and serviced regularly; and health and safety records were well organised and easy to navigate.

Staff had the skills and knowledge to care for people effectively. People were involved in planning their care and making decisions about their daily life. Care plans were informative and included the comments and preferences of people. People were supported to access local health and community services, where needed.

People were cared for by staff who were kind and compassionate. Staff were focused on providing a good quality, person-centred care experience for people. Staff supported people to maintain their dignity and independence and make their own decisions. There was a friendly, homely atmosphere in the home where people felt respected.

There was a varied activity programme based on the individual interests of people and people were free to join in or spend time on their own. There were plenty of communal rooms for people to spend time with friends, visitors or on their own. The management team proactively sought feedback from people and their families, and they responded positively to ideas and suggestions.

The quality assurance systems in place had not picked up the areas that we identified as requiring improvement. However, the management team were receptive to feedback and were keen to improve the care experience for people who used the service. People and staff felt supported by the management team and there was a positive culture within the home.

Inspection carried out on 11 February 2014

During a routine inspection

We spoke with ten people who used the service, three visitor, four staff and three visiting professionals.

We asked if people were consulted about their care. We were told that staff always asked them if they needed help. One person told us. �I am able to do most things for myself staff leave me to my own devices.� Staff spoken with understood about consent and we looked at three people's support plans that showed suitable arrangements were in place to ascertain people's ability to consent.

We asked people if they received the care and support they needed in a way that kept them safe. People told us they were aware of their plans and that they were involved in their reviews. Staff spoken with were aware of people's needs and how best to support them. We saw that support plans were reviewed regularly and changes made to meet people's changing needs.

People told us that they enjoyed the food and they received plenty of choice and where they needed supplements they received those. We observed the midday meal and saw people received choice and variety and where people were at risk of losing weight they received fortified drinks.

We toured the building and saw it was well maintained and a person told us. �It is like a five star hotel here.�

We asked people if they knew how to complain and we were told that when they arrived the manager explained the process. We saw records that showed that the manager took action when complaints were made.

Inspection carried out on 3 December 2012

During a routine inspection

We spoke with 11 people using this service, three family members and two visitors. We also spoke to four staff members and a visiting professional.

We found that people were fully involved in discussions about their needs and care. One person said that Holbrook Hall �can�t be faulted, I wouldn�t want to go anywhere else.� People told us that they were always treated with respect.

We observed and heard a good level of communication and contact between staff and people using the service. We saw that the care and daily routines were centred around people's individual needs and preferences.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping.

Inspection carried out on 30 June 2011

During a routine inspection

Everyone we spoke with was very happy with the standards of the care service. People told us that they liked using the service, that it was 'homely' and that staff were 'caring', 'very helpful' and 'kind'. One person said 'it's lovely here, they do everything for you'. Relatives told us that they were 'really, really pleased' with the service and that support was 'excellent'.

People enjoyed their food and the activities that the service provided. One person said the food was 'very good' and another that there was 'always something to do'.

Visitng professionals told us the service had 'high standards' and that they had 'no concerns' about the care. They told us that the service responded well to professional advice and guidance.

People told us the premises were clean and tidy and there was 'never any smell'.

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