We carried out a review of the data available to us about Holmehurst Residential Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Holmehurst Residential Home, you can give feedback on this service.
Holmehurst Residential Home is a residential care home providing personal care for up to 21 older people, some of whom may be living with dementia. At the time of this inspection there were 19 people living there.
Holmehurst Residential Home is a large detached house in a quiet residential area which has been adapted as a care home.
People’s experience of using this service and what we found
At the last inspection of the service the provider had not made sure that governance systems were sufficiently effective to monitor and improve the quality and safety of the service. Since then improvements had been made, but the provider still needed to make sure that any actions were completed. We have made a recommendation about this.
At the last inspection there were no records to show how decisions had been taken by others in the best interest of people who lacked capacity. Records were now in place and these were improving as staff became more familiar with the reasons for supporting people in this way.
People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice.
Relatives made many positive comments about the friendliness of staff and the support that people received. They felt involved and included in discussions about people’s care. They said people enjoyed the meals at the home.
People's needs were assessed to make sure their care could be provided by this service. Staff were familiar with each person's preferences and how they wanted to be supported.
The provider and management team were open and approachable. There was a friendly atmosphere in the home and relatives said the service was homely, personalised and family-orientated.
Relatives and staff were uncertain about future management arrangements. The provider was committed to strengthening on-site management support.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 6 April 2020) and there was a breach of regulation 17 (good governance). 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 improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 28 February 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key domains of Effective and Well-led.
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 coronavirus and other infection outbreaks effectively.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holmehurst Residential Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.
Holmehurst is a residential care home providing personal care for up to 21 older people, some of whom may be living with dementia. At the time of this inspection there were 19 people living there.
Holmehurst is a large detached house which has been adapted as a care home.
People’s experience of using this service and what we found
The provider's quality assurance systems were not fully effective and did not always identify gaps in records and checks.
Decisions taken by others in the best interest of people were not recorded, so it was difficult to see how these outcomes had been reached.
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 interests; but the policies and systems in the service did not always support this practice.
People and relatives had many positive comments about the service at this home. They praised the care and kindness shown by staff. The home had a welcoming and friendly atmosphere. Staff were engaging with people and supported their dignity.
People said they felt safe at the home. There were enough staff to support them whenever they needed it.
The home was clean, warm and comfortable. Staff knew how to protect people from avoidable harm. People at risk of falls or poor health were provided with the assistance and equipment they needed.
Staff said they had training and support to care for people in the right way. Staff worked well with other health agencies and people were supported to access health services.
People said the meals were good. Staff encouraged people to eat and drink enough. There was a range of activities and engagement with visitors to support people’s social inclusion.
People’s needs were assessed to make sure their care could be provided by this service. Staff were familiar with each person’s preferences and how they wanted to be supported.
The provider and management team were open and approachable. They encouraged a friendly culture amongst the staff team.
The provider was committed to improvement and continuously looked at ways to upgrade the building and service.
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 (published on 27 June 2017). At this inspection we found shortfalls and the service is now rated as requires improvement.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach in relation to governance at this inspection. Please see the action we have told the provider to take at the end of this report.
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.
This was an unannounced inspection carried out on 27 June 2017. We last inspected Holmehurst Residential Home in 17 March 2015. At that inspection we found the service was meeting all the legal requirements in force at the time and was rated as Good.
At this inspection we found the service remained Good.
A registered manager was in place. A registered manager (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, relatives and professionals consistently gave us positive feedback about how the home was personalised to meet people's individual needs. One person living in the home told us, “It’s very good indeed.”
People said they were safe and staff were kind and caring. Good relationships had been formed and people were treated as individuals. Staff knew the needs of the people they supported to provide individual care. People living in the home reported that staff all worked well together and many had worked at the home for many years, giving them consistency of care staff.
People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.
Appropriate training was provided and staff were supervised and supported. Staff had received training and had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves.
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.
We have made a recommendation about support plans for people who at times may be challenging for the service.
People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.
Risk assessments were in place to promote people’s independence. These accurately identified current risks to the person in order to minimise or appropriately manage those risks. The emphasis of the home was to support people to keep as much independence as possible.
The environment was well maintained with many areas that had recently been refurbished, such as a new lift and a garden make over that allowed people to comfortably enjoy time outside. The top floor had been completely refurbished in January 2017 to add an extra three bedrooms that were all en-suite.
People were very complimentary about the quality of the meals. They liked that meals were home cooked. Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for.
A variety of activities and entertainment were available for people and this was supported by a newly appointed activities coordinator.
People told us they felt confident to speak to staff about any concerns if they needed to. Staff and people who used the service said the manager and senior team were supportive and approachable. People had the opportunity to give their views about the service. Feedback was acted upon in order to ensure improvements were made to the service when required. The provider undertook a range of audits to check on the quality of care provided.
Further information is in the detailed findings below.
This inspection took place on 17th March 2015 and was unannounced.
Homehurst is two older properties that have been extended and adapted to provide care for up to twenty-three older people. The home is situated in a quiet residential street and is near to the centre of Carlisle and to the local amenities of the area.
Accommodation is in mainly single rooms but there are some rooms which can be shared by two people. Some of the bedrooms have ensuite facilities. There are two large lounges and a dining room on the ground floor.
The provider is also registered as the manager of the service. 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 and associated Regulations about how the service is run. The provider has delegated some management tasks to a care manager.
Staff in the home were aware of their responsibilities in relation to protecting people from harm or abuse. Staff had received training and there was suitable guidance in place about making safeguarding referrals.
The house was safe and there were good risk management plans in place for the environment.
Staffing levels were suitable for people’s needs. The care manager had increased staffing because the needs of people using the service had changed.
Staff recruitment was done correctly so that only suitable staff cared for vulnerable people. There were good disciplinary systems in place.
Medicines were managed correctly. Effective infection control systems were in place.
Staff were given good levels of support. Staff training was in place with any needs being identified and suitable training provided.
The staff understood their responsibilities under the Mental Capacity Act 2005. No one was being deprived of their liberty. Decision making was done correctly when people lacked capacity. Consent was sought for any intervention.
The food provided was of a good standard. Nutritional needs were understood by the staff team.
The house was being upgraded and improved to meet the needs of older adults.
We observed caring and sensitive care delivery. We saw that independence was encouraged. People told us the staff team were kind and caring.
People were given explanations and support and the staff team were able to pre-empt needs where people found it difficult to express themselves.
End of life care was managed appropriately with staff being supported by community nursing teams. Staff had received training in this and further updates were planned.
Assessment and care planning had improved in the service and the senior team were continuing to improve the way they planned care for people in an individual way.
Activities were being developed to meet individual and group needs.
Concerns and complaints were managed appropriately.
Good systems were in place so that people in the service would be supported if they had to go to another service. We saw that admission to hospital was well managed.
We judged that the home was being well managed. There was an open and inclusive culture in the home and people in the home and the staff were confident that their opinions were valued.
The provider had a team development plan and had changed the way that the tasks in the home were developed. A new senior team was being developed by the care manager.
A new quality monitoring system had been developed and staff were following this. We saw that routine matters were covered by this and that changes were made appropriately to allow for improvements.
At this visit we checked on a range of records again. At the planned inspection we saw that record keeping was being done correctly apart from the records concerning residents money. At this inspection we looked at a range of records and we saw that assessment and care planning, staff records and quality monitoring records were suitable and showed ongoing improvement.
We looked at the records specific to money management for people who needed support with this aspect of their lives. We saw that the records were now suitable, were checked weekly and monthly and that they reflected the spending on behalf of the person. Recording and safekeeping of residents' money was being done correctly. The service was therefore compliant with this outcome.
People told us that they were satisfied with the care they received. Here are some of the things people told us:
"I'm quite happy here and I have no regrets about coming in. The staff are very nice."
"I am very well treated but I do get bored as there is not a lot going on."
"I am very settled. I don't spend much time in the lounge and don't join in activities but come down for meals."
We saw people being asked about their options and choices but we did judge that the staff team needed to record in a more formal way how they gained consent from some people.
On the day of the visit the home was clean and suitably equipped to meet people's needs.
When we spoke to people no one had any complaints and we had not received any complaints about the service. Minor changes were needed to the complaints procedure.
We looked at a wide range of records and saw that recording had improved considerably in the three months prior to the visit. We did however find some worrying errors in recording money kept on behalf of people who lived in the home. We made a compliance action about this.
" I settled in quite well...the staff are pleasant and the food is fine...".
"I have a lovely room with all my things around me...I come for meals but spend a lot of time in my own room and that is what I prefer".
"I have been here for a while and the staff are all right with me...and I am satisfied with what I am given...".
"They look after me and they get the doctor out if I am unwell...I have no complaints".
"Staff have been talking to me about what kind of care I need and also what I want and prefer".
In general people told us that they were satisfied with the care and services provided:
"I like my room...the food is OK..it is what I expect".
"The staff are great...nothing is too much trouble".
"The staff are lovely"
"We have a nice time...but we don't do many activities...we are supposed to but we don't."
"I don't know what they write about me...I don't think there are any plans written down for me...I haven't signed anything".
"We go out sometimes but not often...It is a bit quiet here at the minute...".
"The food is all right ...they wash my clothes properly and are nice to me...I don't have any complaints"