Heather Holmes Care Home

Heather Holmes is a residential care home providing personal care for up to 12 people in one adapted building. It specialises in supporting people who have learning disabilities and or autism. At the time of our inspection, there were 10 people living at the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes.

The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. Ten people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

The provider's quality assurance systems and processes were not always as effective as they needed to be. They had not enabled the provider to ensure staff always maintained accurate and complete records of people's care or ensured a consistent approach to risk assessment.

The provider's risk assessment procedures required strengthening. The registered manager advised that care plans were in the process of migration to a new standardised process. However, consistency was needed when risk assessments were being evaluated and used by staff to keep people safe. Staff were clear how to identify and report abuse.

People's needs were assessed before they moved into the home. People were protected from the risk of infections; however, improvements were needed in relation to infection control practices.

The provider followed safe recruitment procedures. Staff received ongoing training and management support to enable them to work safely and effectively.

People had enough to eat and drink and any associated risks were managed with appropriate specialist input.

Staff worked effectively with community health and social care professionals to achieve positive outcomes for people and ensure their health needs were met.

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 interest. Policies and systems were in place; however, staff practice did not always follow policy in relation to the administration of Deprivation of Liberty safeguards (DoLS).

Staff knew the people they supported well and adopted a caring approach towards their work.

People were encouraged to express their views about the care provided, and these were listened to. People were treated with dignity and respect at all times.

People's care plans were individual to them, covered key aspects of their care needs and promoted a person-centred approach.

People had support to participate in a range of therapeutic, social and recreational activities.

People and their relatives understood how to raise any concerns or complaints with the provider.

The management team promoted effective engagement with people, their relatives and community professionals. Staff felt well-supported and valued

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 30 November 2016 (published 24th December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements.

Please see Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider is aware of the concerns and has a service wide action plan in place to mitigate the risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heather Holmes Care Home on our website at www.cqc.org.uk.

There was a registered manager in post at the time of our inspection. 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 felt safe in the home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job.

Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks. People were supported to take their medicines as prescribed and medicines were obtained, stored, administered and disposed of safely.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person and people were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to maintain good health and had access to healthcare services when they were needed.

People received care from compassionate and supportive staff and people and staff had positive relationships with each other. Staff understood the needs of the people they supported and used the information they had about people to engage them in meaningful conversations. People were supported to make their own choices and when they needed additional support best interest meetings with family involvement took place.

Care plans were written in a person centred manner and focussed on giving people choices and opportunities to receive their care how they liked it to be. They detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did. People were able to raise complaints and there was an easy read guide to support people through the process.

People and staff were confident in the management of the home and felt listened to. People were able to provide feedback and this was acted on and improvements were made. The service had audits and quality monitoring systems in place which ensured people received good quality care that enhanced their life. Policies and procedures were in place which reflected the care provided at the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service caring?

People were not able to communicate with us. We observed that they were relaxed with staff and they received care and support that met their individual needs. One person received one to one attention from a care worker and they laughed continuously during this time. People were cared for by kind and attentive staff. We observed people asking staff by their body language for staff to do things for them. Staff responded to the requests promptly and efficiently.

Is the service responsive?

Staff told us what they had done when a person became unwell. There was evidence that staff had taken appropriate actions to promote the person's health and well being. The service worked well with external professionals such as, community nurses to make sure people received good standards of care. When changes were made these were recorded in the support plans. This ensured that all staff were made aware of any changes in people's care needs.

Is the service safe?

People were treated with dignity and respect by staff. Staff had received appropriate training and received regular supervisions with the manager. These ensured that staff provided a safe environment and care to prevent people from accidents where ever possible. Any accidents or incidents that did occur were recorded and investigated by the manager. Improvements were put in place to prevent similar occurrences. The deputy manager had put robust checking systems in place to ensure that medicines were administered to people in a safe way.

Is the service effective?

People's health and care needs had been assessed and support plans were in place. There was evidence of people and or their relatives being involved with the development and regular reviews of support plans. Staff supported people in leading interesting and enriched lifestyles that met with their individual preferences. Staff also gently encouraged people to be as independent as possible.

Is the service well led?

The service had a quality assurance system in place that involved people who lived in the home, visitors and staff. Regular audits were carried out by the manager and senior managers on all aspects of the service. Records showed us that improvements had been made when they were identified through monitoring processes. Staff told us they were clear about their roles and responsibilities.

We found that works had been carried out to the issues we had identified as needing attention.

We found out although some work had been carried out, there was still a number of issues outstanding. We have informed the company these must be attended to. They have sent us an action plan to state that the issues will be completed by the end of November 2013.

A person told us that staff were good at their jobs. She said; 'staff are there to help if I need them'.

We spoke with the relatives of four people. They all told us that care was good, staff seemed to be well trained and they knew how to provide proper care.

One relative said; 'I have never had any concerns '.

This was a generally positive inspection. People we spoke with told us they were satisfied with the care provided. All their relatives we spoke with also said that care was good. The essential standards we inspected, except the premises standard, were found to have been met.

There were some suggestions made; to have more facilities and equipment for people such as a sensory room, tactile toys, swings and a sandpit as a number of people enjoy these activities; and to have more in-depth staff training on people's specific conditions. The manager stated she would follow up these issues. A relative also said that d'cor would be better if it was lighter to make it more homely. Also, it would increase the feeling of homeliness if pictures were displayed around the home.

We found issues to be largely attended to though there was laxity in attending to one issue. We will closely monitor this aspect in the next inspection.

We spent time in communal areas observing staff and people living in the home.

People spoken with told us they liked the staff. One person said; ' I like it here. Staff are nice''. All the people we spoke with confirmed that they were happy living in the home.

We spoke with four relatives and one advocate. They were all satisfied with the support supplied by staff. One relative said; 'My daughter has lived at the home for years. There has never been a problem. They always keep me informed'.

Our main concern was about maintenance arrangements. We found that issues identified in the last inspection had been followed up. However, other maintenance issues did not indicate that action had been taken. Current procedures do not produce swift arrangements to ensure good maintenance.

We received comments amount the vehicle used by the home. This was seen to be inappropriate for the needs of people living in the service. It had been identified as needing to be replaced by senior management. However the replacement had still not arrived.