Background to this inspection
Updated
6 July 2019
The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection Team: One inspector, a specialist advisor and an expert by experience carried out this inspection. The specialist advisor had a nursing specialism. The expert by experience had personal experience of caring for older people.
Service and service type: Holmfield Nursing Home is a care home. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission (CQC). An existing nurse staff member has accepted promotion to the home manager role as from January 2019. The new manager was in the process of applying to become registered with CQC. A registered manager, as well as the owner and provider, are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection: The inspection was unannounced.
What we did when preparing for and carrying out this inspection:
We reviewed information we had received about the service since the last inspection. This included details about incidents the provider must notify us about, such as abuse. We also sought feedback from the local authority and professionals who work with the service. We assessed the information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During our inspection we spoke with a nurse, the care team leader, four care staff, the cook, and housekeeper. We spoke with seven relatives and spent time with people to see how staff supported them.
On the day of our inspection visit, the new manager was on planned leave. Neither the provider nor the nominated individual (NI) were at the home that day. The NI made herself available to speak with us on the telephone. Like a provider, a Nominated Individual has legal responsibilities for supervising the management of the regulated activity, and ensuring the quality of the services provided.
We reviewed a range of records, including five people's care records and multiple medication records. We looked at records relating to the management of the home, including audits and systems for managing any complaints. We asked to look at the provider’s visits to check on the quality of care provided, however, the NI told us these were informal and not recorded.
Updated
6 July 2019
About the service:
Holmfield Nursing Home is a care home, providing personal care, nursing and accommodation. There were 17 people with frailty due to older age living at the home at the time of the inspection.
What life is like for people using this service:
• People felt care staff were kind towards them and looked after them well. However, there were not enough staff. Planned for activities did not always take place because sufficient staff were not on shift to meet people’s needs.
• Most people had individual plans of care, so staff had the information they needed to care for them. However, this was inconsistent and one person had no individual plan of care.
• Risks were not always identified, and risk management plans were not always in place.
• People’s prescribed medicines were available, but medicines were not always managed safely which posed risks to people’s health and wellbeing.
• Staff did not always have the necessary skills to meet people’s needs.
• Staff employment files did not contain the information required to show the provider had undertaken required checks to ensure staff suitability.
• Care staff understood the need to gain people’s consent before personal care was provided. However, the provider had not ensured staff consistently understood, and worked within, the requirements of the Mental Capacity Act 2005.
• Most staff completed self-guided training, however some told us they had not received training.
• People were supported to eat and drink adequately.
• Care staff, the cook and the housekeeper interacted positively with people, showing kindness and compassion.
• People and relatives were, overall, complimentary about staff and had no current complaints. However, some complaints had not been recorded.
• There was no managerial oversight of the home in the provider’s, nominated individual’s and home manager’s absence. The lack of effective governance meant aspects of the quality and safety of the service were poor.
• The provider’s quality assurance system did not ensure quality and safety. General décor and maintenance required repair. Some maintenance issues posed potential risks of cross infection because effective cleaning could not take place.
Following our inspection, we notified relevant stakeholders including the Local Authority and Local Clinical Commissioning Group (CCG) about the areas of concern we identified.
We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:
Regulation 9 Regulated Activities Regulations 2014 - Person centred care
Regulation 11 Regulated Activities Regulations 2014 – Need for consent
Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment
Regulation 17 Regulated Activities Regulations 2014 - Good governance
Regulation 18 Regulated Activities Regulations 2014 - Staffing
Rating at last inspection: The last report for Holmfield Nursing Home was published on 29 May 2018 and we gave an overall rating of Good.
Why we inspected: We received information of concern including infection prevention and control, and the administration of medicines, from a joint quality monitoring visit undertaken by the local Clinical Commissioning Group (CCG) and Local Authority (LA). The CCG and LA commission (purchase) packages of care on behalf of people. A relative contacted us about their complaint about the services provided.
Enforcement: Action provider needs to take (refer to end of report). Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.
Follow up: On the day of our inspection visit, the provider, nominated individual and home manager were not available to be at the service. We gave detailed feedback to a senior person, by a telephone meeting, which took place with the nominated individual the day following our inspection visit. During our telephone meeting, we told the nominated individual about our immediate concerns. The nominated individual sent us evidence of some immediate actions they had taken to ensure the safety and wellbeing of people living at the home. We will continue to monitor any regulatory action as an outcome of this full inspection report.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will act to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.