Archived: Holmlea Care Home

Holmlea Care Home is a residential care home providing personal care to up to 40 people. At the time of the inspection there were 31 people in one adapted building which was organised across 4 wings. There were several communal areas, refurbished bathrooms and outside spaces.

Improvements had been made in some areas of the home and the care people received since our last inspection but the systems to monitor and continuously improve quality required further development. People were not always supported to have maximum choice and control of their lives. Staff didn’t always support them in the least restrictive way possible and in their best interests; the policies and systems in the service were not always implemented fully.

The systems in place to manage medicines were not always applied correctly. Outcomes from concerns raised were not always shared in a timely manner to ensure learning from them was embedded promptly. Individual preference and need was not always considered at mealtimes; however, at other times people did receive kind care which upheld their dignity.

There were now enough staff to support people safely and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and plans were in place for staff to follow which were regularly reviewed.

People were encouraged to be independent and staff understood their needs well. They were supported to maintain good health and for some people clear goals were set with other organisations. Creative activities were provided to engage people and keep them linked to their community.

There were meetings in place which encouraged people and staff to give their feedback. People and relatives knew how to raise a concern or make a complaint.

The environment was adapted to meet people’s needs. There was a refurbishment programme in place to continue to improve it.

More information is in the full report.

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 Requires Improvement (published 26 October 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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.

We have found evidence that the provider needs to continue to make improvement. You can see what action we have asked the provider to take at the end of this full report.

We inspected Holmlea Care Home on 21 September 2018. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Holmlea Care Home provides personal care and accommodation for up to 40 people in one single storey building across four wings. The service provides a permanent residence for people and short-term care beds are available for people to access. At the time of the inspection there were five community specialist beds that were funded by the NHS. These beds were used to provide step - up or step-down beds for people living in the community. The beds were to prevent people requiring hospital admission or support people following hospital discharge before returning home. People using the community specialist beds were supported by a multi-disciplinary team of staff including health care professionals. On the day of our visit a total of 35 people were using the service.

At the last inspection in December 2015, the service was rated ‘Good’ in all the key questions. At this inspection, we found the fundamental care standards were not being fully met, resulting in the rating for the service changing to ‘Requires Improvement.’

At the time of our inspection there was a registered manager in post and they were present during the day of the inspection. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons”. Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

People’s daily social needs were not always met. People did not always receive their meals in a timely way and some people did not receive sufficient support or have adaptations made available to them, to support them with eating. People’s dignity and preferences regarding how they received support were not always considered. Staff received an induction and ongoing training, but had not received regular opportunities to formally review their work and this was being addressed by the registered manager. Quality monitoring systems were in place to support the manager in driving improvement. However, they had not, at the time of the inspection identified the improvements that were needed at meal times and to the daily social opportunities available for people.

Staff were clear about what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. People received their medicine in a safe way and when they needed it. Recruitment checks were done before staff started working at the home to check they were suitable to support people.

Risks to people’s health and safety were assessed and care plans directed staff on how to reduce identified risks. Staff had the equipment needed to assist people safely and understood about people’s individual risks. The provider checked that equipment was regularly serviced to ensure it was safe to use. The checks in place for the prevention and control of infection were effective in reducing the risk of cross contamination.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the provider’s policies and systems in the service supported this practice. People’s capacity to consent to their care and treatment had been considered where required. Information about independent advocacy services was available.

The registered manager and staff team worked with health care professionals and people’s health was monitored to ensure any changing needs were met.

People received a choice of meals and their nutritional care needs had been assessed and planned for, but some staff’s understanding of this was limited; this had the potential impact of people not receiving meals that were suitable for them. The environment met people’s individual needs.

People’s right to maintain relationships with those that were important to them was respected and promoted. People’s right to confidentiality was respected. People and their representatives were involved in decisions relating to the planning of their care and were supported to raise any concerns they had.

People and their representatives were supported to express their views and opinions about the service provided and felt the home was managed well. There registered manager and provider understood their responsibilities around registration and worked in partnership with other agencies to meet people’s needs.

During this inspection we found two breaches of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with nine people using the service, three visitors, four external professionals, three staff and the management team. Below is a summary of what we found.

Is the service safe?

Our tour of the building identified that the premises were clean and tidy, there was soap and paper towels in toilets and staff used personal protective equipment properly.

Staff we spoke with were able to describe infection control procedures and told us there was always a plentiful supply of gloves and aprons for them to use. Training records we saw showed us infection control training had taken place in the previous twelve months. This meant staff received appropriate guidance in preventing the spread of infections.

Medicines were kept safely. We saw that the storage of medicines was satisfactory and a random stock check showed that medicines were within their expiry dates. We saw that the medication refrigerator temperatures and the storage room temperatures were recorded on a daily basis and were within safe limits. The management team told us there were plans to develop a new treatment room for medicine storage but this had not yet been completed. They were able to show us documentation to verify that the plans had been approved and funding made available and we were told the work was due to commence on 16 September 2014.

Is the service effective?

We saw that external health professionals were called in as required and one told us 'They follow our advice'. One professional described the progress made by one person since using the service as 'fantastic' and said 'They nurse people well'.

Is the service caring?

People we spoke with were generally complimentary about the care; one person and their relative both told us 'Staff are very good'. One person told us 'I like it here' and another said 'I feel happy here'. Our observation of people's care found that staff were caring and helpful and had friendly relationships with people.

Is the service responsive?

On the day of the inspection visit, there were no domestic staff available and essential cleaning duties were undertaken by care staff. This had the potential to adversely impact on the cleanliness of the home and in meeting people's care needs in a timely manner.

We saw that external health professionals were called in as required and one told us 'They follow our advice'. We discussed end of life care and pressure ulcer prevention with relevant professionals and they all told us that the service was good at providing the appropriate care.

We received mixed feedback about the number of care staff available from people we spoke with. Some people told us there were enough staff to help in a timely manner and others said they sometimes had to wait for assistance. Relatives and visitors also gave mixed feedback; most thought there were enough staff but one told us 'they are sometimes short of staff.' This meant there was the potential for people's needs not to be met.

Is the service well led?

The management team had addressed the majority of the issues found at our last inspection visit in January 2014. However, we found there were some records that were not up to date; for example, we found medication audits had not taken place according to the provider's procedures and some care documents had not been updated following a change in people's needs. This meant steps to ensure records were accurate and fit for purpose were not always taken in a timely manner.

During our visit people we spoke with told us they felt mostly satisfied with their care and support and the cleanliness of their own rooms and communal lounges. One person said, 'Staff are very kind, I'm well looked after.' Another person told us, 'I am happy living here and feel safe.' However, we found that people were not cared for in a clean and hygienic environment and were not fully protected from the risk of infection.

We found that people often experienced care, treatment and support that met their needs and protected their rights. They were asked for their consent to their care and consulted about their daily lives in the home. This included choice of clothing and meals, social activities, medicines arrangements, personal hygiene assistance and for morning rising and going to bed

However, we found people were not always protected against the risks of receiving inappropriate or unsafe care and the appropriate management of their medicines was not consistent.

We spoke at some length with three people who live at the care home. One person said that they liked living at the home, the staff were kind, but there were not enough of them. This person chose not to join in with the organised activities, partly because of the effort of getting to the lounge, and partly through personal preference. This person was also a smoker, and said that the smoking room was on the other side of the building, so not easy to get to. As a result they smoked outside the building, however there was little cover in bad weather. A second person said they were very happy at the home and had everything that they needed. A third person talked about being able to make choices and being asked by the staff rather than being told, or having decisions made for them.

Our observations of people at Homelea showed staff were talking with people in a respectful manner, and there was a level of calm throughout the care home. Our observations did not raise any questions or issues with regard to people's safety.