Holmbury Dene (Respite)

At the time of the inspection there were four people living at the service and one person on respite. Holmbury Dene (Respite) 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. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

The service has a registered manager in post at the time of the inspection. This manager was newly registered with the Care Quality Commission. 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 were supported to remain safe at the service. Staff used the provider’s safeguarding policy and guidance to continue to protect people from harm and abuse. Staff completed training in safeguarding and had gained the knowledge to identify and report to the local authority an allegation of abuse.

Risks to people were identified. Staff reviewed people’s needs and risks associated with them. Risk management plans were developed which provided staff guidance on how to care for people in a safe way. The registered provider’s infection control policy was followed by staff. Staff maintained the cleanliness of the service which helped to reduce the risk of infection.

People were supported by enough staff each day. There were sufficient staff available to meet people’s individual needs. Safer recruitment procedures were followed to ensure suitable skilled staff were employed to work with people.

People’s medicines were managed safely. There was an established system in place for the administration, ordering, storage and disposal of people’s medicines.

Staff received support through training, induction, supervision and appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People consented to care and treatment before staff supported them.

Health, social care services and specialist support was sought when people’s needs changed. Healthcare professional’s recommendations and guidance for people was followed by staff.

Staff carried out people’s care and support in privacy while protecting their dignity. Staff knew people well and understood their individual needs and the support required to meet them.

People had an assessment of their needs. Each person’s care plan identified their individual care needs and the specific support needed to ensure these were met. People were a part of their local community and attended various outdoor activities. At the time of the inspection, there were no people receiving palliative care support or end of life care.

There was an established complaints procedure at the service. Complaints were managed well and each complaint was investigated and a response provided to the complainant.

Staff gave mixed views on the overall management of the service. The registered manager completed audits of the quality of care provided to people on a regular basis. The registered manager sent suitable notifications to the Care Quality Commission of events that occurred. The registered manager had developed joint working relationships with health and social care services.

Holmbury Dene provides accommodation, personal care and support for up to ten people on a short term basis. The service offers interim placements and respite care to people with learning disabilities. Throughout the year approximately 40 people regularly stay for respite at the service. Care is commissioned by the London Borough of Lewisham.

At the time of the inspection there were five people staying at the care home. Four people were being provided with interim placements whilst one person was receiving respite care.

The service has a registered manager in post at the time of the 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 were safe. Staff understood the providers safeguarding policy and their responsibilities within it to protect people from abuse and to report if they suspected abuse. People were protected from avoidable harm by detailed risk assessments that were reviewed regularly. There were enough staff available to meet people’s needs and staff recruitment procedures were thorough. Medicines were stored safely, administered correctly and checked daily.

The provider followed the principles of the Mental Capacity Act 2005 and best practice with regards to the Deprivation of Liberty safeguards. The consent of people was sought before care and treatment was provided.

People had access to health and social care services. The provider worked closely with local healthcare specialists to assess people’s needs and plan their support.

Staff received supervision and training to deliver good quality care.

People’s privacy and dignity were protected by a caring staff team. Staff knew people well and records noted people’s preferences for care and support. Positive relationships were developed between people and staff and relatives were made to feel welcome in the service.

People’s needs were assessed and care records were updated regularly to reflect changing needs. People chose the activities they participated in and the provider supported people to meet their cultural needs. The provider investigated and responded appropriately to complaints and acted on feedback.

There was a registered manager in post who had an open management style. The provider had robust quality assurance processes and used them to improve the quality and safety of people’s care and support. Health and social care professionals spoke positively about the support people received from the registered manger and staff.

On this visit we found that repairs had been carried out to window restrictors so that people using the service were no longer at risk from the dangers associated with windows above ground floor level that could be fully opened. We also found that cleaning materials that could be hazardous to health were now being appropriately stored.

The service had a new, acting manager in place. They had carried out regular supervision with all staff and were in the process of arranging staff appraisals.

We found that the systems in place to assess the quality of the service being provided had been improved, and where monitoring checks identified issues, staff were taking action.

Each of the people currently using the service had a care record. We saw that care was planned and delivered in a way that was intended to ensure people's safety and welfare. Support plans had been reviewed and risk assessments were in place.

Staff were aware of safeguarding procedures and knew who to report concerns to. Records relating to monies belonging to people using the service were up to date and accurate.

The premises were in acceptable decorative order. People using the service had their own preferred bedrooms and staff tried to facilitate this on each visit.

We found that staff had access to appropriate training and received regular supervision from their manager.

The service had systems in place to monitor the quality of the service being provided, and ensure the safety and welfare of people using the service however we found that these systems were not robust enough and needed improvement.

There were documents relating to the care planning process but a number of them were overdue for review.

We spoke with one of the people using the service. They enjoyed coming to the home, and staff looked after him well. Staff asked him what he wanted to do, and helped him to do it.

We found the home to be in satisfactory decorative order and it was being satisfactorily maintained. However we found that action had not been taken to resolve issues relating to the gas installation or that the specialist bath used by people living at Holmbury Dene had been serviced.

Staff said that they felt well supported by the provider. They felt that they were provided with a satisfactory amount of training; however the training records showed that a number of staff had not undergone mandatory refresher training.

The provider visited the home regularly to monitor the quality of the service but we found that issues that were raised at these visits were not always being dealt with. We were unable to assess if complaints were appropriately dealt with as the complaints log could not be located.