• Care Home
  • Care home

Archived: Holmwood House Care Centre

Overall: Requires improvement read more about inspection ratings

40 Whitecross Road, Swaffham, Kings Lynn, Norfolk, PE37 7QY (01760) 724404

Provided and run by:
Integrated Nursing Homes Limited

Important: The provider of this service changed. See new profile

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Background to this inspection

Updated 31 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.

We carried out this inspection over two dates: 25 January and 31 January 2018. The first date was unannounced but we arranged with the registered manager to come back on a second day to finish the inspection. On the first day of our inspection, we had an expert by experience and a specialist advisor with us. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The specialist advisor was a trained nurse.

Before the inspection, we reviewed information already held about this service including the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This was received from the provider. We also reviewed the statutory notifications we had received which relate to events that have happened in the service that the provider is required to tell us about by law. Information that had been sent to us by other agencies was also reviewed. We spoke with the Local Authority and the Clinical Commissioning Group who had no concerns with the service.

We spoke with the registered manager, the cook, the domestic, the laundry assistant, the activity coordinator, three registered nurses, a senior carer, three care staff, maintenance staff and the activities co-ordinator. We spoke with fifteen people using the service and spoke with six relatives. We spoke to two district nurses and a mental health nurse.

We observed the medicines round, made observations of care, looked at four care plans, medication records, staff records and other records relating to the management of the service.

Overall inspection

Requires improvement

Updated 31 May 2018

The service was last inspected on 7 December 2015 and was rated good overall. We carried out this unannounced, comprehensive inspection on 25 January and 31 January 2018 and have rated the service requires improvement in Safe and Well Led and good in all other areas.

Holmwood House Care Centre is a care home. 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. The care home accommodates up to 59 people in one adapted building and was full at the time of this inspection. The three double rooms had been converted into single rooms. Most of the home is on one level; however, there are 6 bedrooms on the first floor in the main house accessible by a dedicated lift” for residential and nursing, the other predominantly for people living with dementia. The home was on the outskirts of the market town of Swaffham and had a dominant position in the town with far reaching views across the garden. There was ample parking.

The service has a registered manager who is a registered nurse. There was also a deputy manager and a registered nurse working on each floor. 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.

Our overall finding for this service was positive but we did identify a number of areas for concern, which constituted a breach of Regulation 17 Good Governance. We have rated the key question for safe and well led as requires improvement because we found records did not always tell us what people’s current needs were. Records were not always updated in a timely way when people’s needs changed. The service was not always proactive in reviewing its records of accidents, incidents or hospital admissions to assess if they had taken all the action they could to lower or mitigate risks. We therefore could not see how lessons were learnt to improve people’s safety and in ensuring good outcomes for people. There was a lack of management oversight for these areas although we saw the manager worked very hard and was a good organiser and communicator.

There were enough staff to provide timely care to people using the service and most of the staff had been at the service a long time. This meant they were familiar with people’s needs and offered continuity of care. Staff had the necessary skills and told us they were well-supported and provided with lots of training opportunities. The service had a robust recruitment process, which helped to ensure that only suitable staff were employed.

Risks to people’s safety were mostly mitigated. The environment was fit for purpose and free from hazards. Some people were identified as high risk of falls. This was clearly documented and actions had been taken to reduce the risks such as regularly monitoring people. The service ensured people had the right equipment and some beds were on a low setting with bedrails and, or crash mats. The service where possible monitored and reduced risk and there were enough staff to keep people safe. However, record keeping in this area could be improved upon particularly in regards to how the service learnt from events and incidents.

People were supported to eat and drink enough for their needs. Where risks of dehydration or unplanned weight loss were identified there was some additional monitoring of people’s needs. Food and fluid charts seen did not give enough information to be of any real value. For example, where people were on supplements these were not included on the charts and they did not always show quantities consumed or if snacks had been offered. We saw in practice this did happen but not recorded.

People received their medicines as intended by staff that were suitably trained. There were audits in place to help identify if people had received their medicines as required although we identified one error not picked up by the audit. .

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found people’s rights were being upheld and staff supported people lawfully and in line with legislation around mental capacity and deprivation of liberties. Records keeping in this area could be improved.

Staff understood what constituted abuse and what actions they should take to safeguard people. They were confident in raising concerns and the registered manager made themselves available and was responsive to people’s concerns or that of their friends and relatives.

The environment was appropriate to need and was maintained to a high standard. The environment was stimulating and designed in consideration of people’s needs. There was access to outside space and sufficient private and communal space. Visitors were made welcome and could meet with their relatives in private.

Staff kept up to date with best practice and worked across the service to help ensure people received a seamless service. Staff worked in conjunction with other services and sought advice from other professionals as required. People’s health was promoted and we saw staff had the necessary understanding and skills in relation to people’s needs.

Staff were observed treating people well and with respect. Staff demonstrated patience and kindness and enhanced people’s well –being through frequent and positive interactions. People were supported to live well and stay independent. Where people could, they were encouraged to join in different activities and socialise with others to reduce social isolation.

People were consulted about their care needs and relatives felt involved with the planning and reviewing of their family member’s needs.

Care plans were not concise and did not always include relevant information or accurately demonstrate how a person’s needs or risks were managed. However, staff knew people’s needs well and provided good standards of care. Activities were organised around people’s individual needs and were both spontaneous and planned ahead to help ensure people remained active.

Complaints and feedback about the service was acted upon and the service was responsive to issues raised.

The service had an established, experienced registered manager who staff held in high regard. The service was for most part well planned and feedback received was positive. Risks were mostly mitigated but records were not as robust as they could be.