The Holt Retirement Home

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

We observed positive interactions between people and the staff. People received person-centred support and staff knew people well.

People were supported to maintain important relationships with friends and family. Relatives could have face to face visits using the indoor conservatory area that had robust cleaning procedures in place. For people whose relatives couldn’t visit other options were available using technology such as phone calls and video calls.

All visitors had to wear appropriate personal protective equipment (PPE). In addition, complete NHS Track and Trace information, have a negative COVID-19 test result, have their temperature checked carry out hand hygiene prior to entering the home.

The home had ample supplies of appropriate PPE which was stored hygienically and kept safe. Staff were provided with appropriate areas to put on, take off and dispose of PPE safely.

The home was very clean and additional cleaning of all areas and frequent touch surfaces was in place such as handrails. These were carried out and recorded regularly by housekeeping staff. Additional deep cleaning was also carried out where required.

The registered manager had quality systems in place to check the home was providing safe care. There was robust communication systems in place to ensure staff received consistent updates in relation to infection control policy and practice.

Staff supported people’s social and emotional wellbeing. Meaningful activities were adapted and taking place in smaller groups. The home had used different methods including information technology to assist communication.

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

Rating at last inspection

The last rating for this service was good on (15 December 2018 )

Why we inspected

We undertook this targeted inspection following concerns raised from an anonymous whistle-blower regarding COVID-19 management and peoples personal care.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. The service was rated good at the last inspection.

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 found the following examples of good practice.

• The service operated a booking system for visitors. Staff screened relatives ahead of their visit and provided them accessible information about how to reduce the risk of the spread of infection during their visit.

• People were provided with their own sanitising hand gel to ensure they could continue to keep their hands clean where handwashing facilities were not within easy reach.

• The service had appointed a dedicated lead to ensure policies and procedures remained up to date and reflected the most current government guidance.

The Holt Retirement Home is a 'care home' situated in the village of Hutton Buscel. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service supports older people, some of whom may be living with dementia, and can accommodate up to 22 people. At the time of our inspection 20 people lived at the service.

The service is provided in one large building and people have access to communal spaces including a conservatory and a recently landscaped outdoor area.

A registered manager was in post who assisted us throughout the inspection. They had managed the service since 2015. 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.

At our last inspection we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Quality assurance checks completed by the registered manager and provider did not identify all the issues we highlighted during our inspection. For example, protocols for ‘as and when needed’ topical medicines not being consistently in place, bed rail checks had not been completed and the recording of reviews and activities required improvement. The management team were responsive and took actions to address the issues we raised.

Detailed risk assessments were completed and control measures to respond to and mitigate potential risks were clearly documented. There were sufficient staff, who worked well together, to safely meet the needs of people who used the service. Staff continued to be recruited safely. Health and safety checks on the building and equipment were completed to ensure people’s safety.

Overall, medicines management was safe. We found gaps in one person’s medication administration record and protocols for topical creams were not consistently in place. We have made a recommendation that the service ensure their medicines management is in line with best practice.

Staff undertook training to ensure they had sufficient skills and knowledge for their role. Staff had an annual appraisal of their performance and most staff had received a recent supervision. Staff described feeling supported in their role.

Assessments were completed before people moved into the home to ensure their needs could be met and to understand their like and dislikes. Staff sought people’s consent before providing care. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Applications to deprive people of their liberty were sought appropriately. The staff worked closely with professionals and sought their advice and input in the care provided. People's weight was monitored and choice of meals and snacks were available according to people's needs and preferences.

People who used the service, their relatives and professionals were positive about staff’s approach. Staff were calm and patient with people and promoted their privacy, dignity and independence. Information was available about advocacy services and advocates had aided some people in their decision making process.

People received person centred care from a staff team who understood and responded to their changing needs. Detailed care plans were in place which described people’s needs, the support required and contained information about their life history and personal circumstances. The service employed an activities coordinator who arranged a timetable of activities which included visits from performers and craft activities. Information was recorded about people’s end of life wishes. The provider had a complaints policy in place, however no formal complaints had been received within the last 12 months. People’s relatives were confident that any issues they raised would be listened to and addressed.

We received positive feedback about the management of the service with both the registered manager and provider described as approachable and visible. The management team worked closely with other agencies to ensure people received the care they required. People’s feedback on the running of the service was sought and a series of staff meetings were held to share important information about the service and to seek their views.

Further information is in the detailed findings below.

The Holt Retirement Home provides residential care for up to 22 people. The home specialises in caring for older people who are living with dementia, or a dementia related condition. On the day of the inspection there were 20 people living in the home. The service does not offer nursing care.

The home has 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.

Staff were able to tell us what they would do to ensure people were safe and people told us they felt safe at the home. The home had sufficient suitable staff to care for people safely. Staff received regular informal supervision and they were safely recruited. People were protected because staff handled medicines safely. The home was regularly cleaned and staff were trained in infection control.

Staff had received training to ensure that people received care appropriate for their needs. Staff were able to tell us about effective care practice and people had access to the health care professional support they needed.

Staff had received up to date training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff ensured that people were supported to make decisions about their care. People were cared for in line with current legislation and they were consulted about choices.

People’s needs in relation to food and drink were met. People enjoyed the meals and visitors told us how good the food was. We observed that the dining experience was pleasant and that people had choice and variety in their diet.

Health and social care professionals told us that the registered manager communicated with them well and were quick to ask and act on advice.

People were treated with kindness and compassion. We saw staff had a good rapport with people whilst treating them with dignity and respect. We saw people smiling and chatting with staff. Staff had a good knowledge and understanding of people’s needs and worked together as a team. Care plans provided information about people’s individual needs and preferences.

People were supported to live their lives the way they chose to and staff understood people’s interests and preferences. People were afforded opportunities to be involved in interesting and stimulating activities. Staff responded quickly to people’s changing needs. Needs were regularly monitored through staff updates and regular meetings.

People told us their complaints and concerns were handled quickly and courteously.

The registered manager worked with the team, monitoring and supporting the staff to ensure people received the care and support they needed. People told us they liked the registered manager, that they were approachable and listened to them.

The registered manager and staff told us that quality assurance systems were used to make improvements to the service. We sampled a range of safety audits and care plan audits and saw how these were used to make improvements to the service.

Our inspection team was made up of an inspector, and an inspection manager. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were appropriate management systems in place. This meant that the managers and staff could monitor and learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The provider knew how to request an assessment if this was required. Staff received safeguarding and Mental Capacity Act training. This meant people would be safeguarded as required.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included appropriate referrals to other health and social care professionals such as dentists, opticians, occupational therapy and dieticians.

People were protected from the risk of unsafe or unsuitable premises because the provider had taken appropriate measures to maintain the premises.

There were sufficient care staff to respond to people's health and welfare needs.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. This ensured that the outcomes for people would continue to improve.

The activities organiser was knowledgeable about methods she could use to engage people and to support people to continue their interests and hobbies.

Is the service caring?

We saw staff were kind and respectful when speaking with or supporting people.

People looked well cared for and we observed good care practices taking place. We observed the lunchtime experience and saw that staff were calm and unhurried and they spent time with people.

Is the service responsive?

People's needs were met in accordance with their wishes.

People using the service and families were provided with information about the home so they would understand the care, treatment and support choices available to them and who to speak to if they were upset or worried.

One family member said, "I can speak with the manager and discuss any issues; the home has improved beyond recognition in the past few months."

We saw evidence that people's experiences were taken into account in the way that activities were provided. For example, people were supported to access the garden. This meant that people had experiences that were stimulating and meaningful.

When we visited we saw a staff team that acted professionally and responded appropriately to people's care needs. People were being assisted promptly and we saw that the staff had time to spend socialising and engaging with people.

Is the service well-led?

Effective management systems were in place to promote people's safety and welfare. The owner and manager spoke about dementia care with real commitment and understanding and were committed to improving the quality of care.

The owner is an experienced business man who understands the financial aspects of social care provision and who has given assurance of financial viability.

The manager was familiar with the Care Quality Commission, its regulations and processes, and with her role and responsibilities. She was confident that the staff team can bring about real improvements. This was confirmed by staff who said they felt supported to do their jobs well. Comments we received included, 'I feel really valued and part of a team since the new people started here,' and 'I only came to work here for a short while but I can't imagine working anywhere else now.'

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.