Holmewood Residential Care Home

Updated 10 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 2 inspectors and 1 Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Holmewood Residential Care Home is a ‘care home’ without nursing care. People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with CQC to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 20 July and ended on 16 August 2023. We visited the service on 20 July, 2 August and 7 August 2023.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

This inspection was carried out by conducting site visits and speaking to staff remotely. We spoke with 13 people who used the service and 8 relatives/ friends of people living at the service about their experiences of the care provided. We spoke with 22 staff, including the nominated individual, provider representatives, registered manager, deputy manager, supervisors, care staff, chef, activities coordinator and maintenance worker. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 13 people’s care records. We looked at multiple medicines records. We reviewed 3 staff recruitment and supervision records. A range of records relating to the management of the service, including accidents and incidents, staff training, health and safety records, audits and a sample of the provider’s policies and procedures were also reviewed. We received feedback from 6 health professionals that worked alongside the service.

Updated 10 February 2024

About the service

Holmewood Residential Care Home is a residential care home providing personal care to up to 26 people. The service provides support to older people. At the time of our inspection there were 22 people receiving personal care at the service. Holmewood Residential Care Home accommodates people in one adapted building.

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

People were at significant risk of harm as safety was not prioritised by the provider. People were not safeguarded against the risk of abuse. We requested GP visits for 4 people we were concerned had experienced and were at risk of neglect. Health and safety risks, such as risks linked to equipment and the environment were not always identified or managed.

People experienced poor symptom management and pain as a result of how medicines were managed. Medicines systems did not support their safe use. People were at risk due to poor infection prevention and control practices within the home, including PPE not being stored and disposed of safely and hygienically.

The provider did not ensure there were sufficient numbers of staff with the right skills to keep people safe. People’s requests for assistance from staff via the call bell system were not always answered or reassurance provided. Some people had stopped pressing their call bells due to this. Safe recruitment processes were not followed to ensure staff were suitable for working in the home.

People did not experience effective care. Staff did not always have the knowledge, skills or experience to provide people’s care. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support good practice.

People were at risk of not receiving enough or appropriate nutrition and hydration. People were given meals that were not appropriate to their specific nutritional needs. The service did not always work effectively with health and other professionals. The lack of an effective working relationship with the local GP surgery meant people’s health needs were at risk.

The service was not suitable for the needs of the people living at the home. The premises were not designed with people’s specialist needs in mind, including dementia.

People did not receive kind, compassionate care. On occasions, people were crying as they had not received assistance they needed. People were not treated with dignity or respect. People’s continence products and supplies were left in public areas of home.

People’s care was not person-centred. People were at risk of social isolation as they had few opportunities for stimulation and to speak with others, including staff members. The service was not inclusive, people’s communication needs were not considered or accommodated. People were not consulted in involved in making decisions about activities planned at the home.

People were at risk due to significant shortfalls with the governance and oversight of the service. Processes were not established to monitor quality and safety across the service. The registered manager was not accepting of the issues we found on inspection and did not always understand the risk to people. A culture had been established at the service of organisational and institutionalised care, where people did not experience good outcomes.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (1 December 2022). This service has been rated requires improvement or inadequate for the last 2 consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider review and update their visiting policy and review the specialist types of care provided at the service. At this inspection we found improvements had been made to visiting. However, the provider had failed to review the specialisms provided at the service.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, dignity and respect, need for consent, safe care and treatment, safeguarding, meeting nutritional and hydration needs, premises and equipment, good governance, staffing and fit and proper persons employed. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.