Archived: Holmwood House

Below is a summary of what we found. This is based on our observations during the visits, speaking with people using the service, their relatives and staff, and from looking at records. Please read the full report if you want to see the evidence supporting our summary. Our Pharmacist Inspector looked at the arrangements in place for the management of medicines and only assessed whether the service was safe in this regard.

Is the service safe?

Action had been taken to safeguard people from abuse. Staff had received training so that they understood the signs of abuse and what they needed to do to safeguard people. Allegations of abuse were now being reported to the relevant agencies to ensure that they were properly followed up.

The service was safer for people because there was a more thorough system in place for the recruitment of staff. Checks were being carried out on applicants to ensure that they were suitable to work at the home.

Changes had been made which meant that infection control risks were being managed. However there were still shortcomings and the registered manager had identified further actions that needed to be taken. These included reducing the risk of cross infection by obtaining more hoist slings and people would not be using the same sling. We also found that procedures in place for checking health and safety in the home were not being implemented consistently. This meant that health and safety items in need of attention may not be identified and responded to promptly.

There continued to be concerns about the way in which medicines were being managed, for example with the availability of pain relief medicines. People were not protected against the risks associated with medicines because the provider was not ensuring that appropriate arrangements were always in place to safely manage medicines.

Is the service effective?

A new system was in place for the planning of people's care. Staff commented positively on its features; these included alerting them to actions that needed to be taken such as reviews of people's care and the writing of daily reports. We found however that care planning arrangements and delivery of care were not always being carried out effectively. For example people who needed support with baths and showers were not receiving this on a regular basis.

The effectiveness of the arrangements being made for people's care was also compromised because of discrepancies in information and a lack of detailed monitoring. For example, there was conflicting information about the risk of people developing pressure ulcers. Where people had been assessed as being at risk, procedures were not always in place to ensure that the risk of pressure damage to people's skin was reduced.

Relatives we met with felt that the needs of their family members in the home were met. We heard that the registered manager was making improvements in the care and service that people received but more needed to be done. One relative commented 'Things have changed since the new manager has been here ' they're doing their best in the circumstances'.

There had been a change in the GP arrangements and we heard positive comments about the support that people received from a local GP surgery. We were told, for example, that referrals for specialist health services were being responded to promptly.

Action had been taken since the last inspection to develop an effective system for supporting staff. Staff told us that they felt supported in their work and were able to undertake training to develop their skills and knowledge.

Is the service caring?

Some actions had been taken to help ensure that staff worked in a respectful and personalised way with the people they cared for. The role of 'dignity champion' had been created to highlight the importance of staff treating people with dignity and respect. The new care planning system provided better information about people's life histories and diverse needs.

People were not always treated with respect. For example, staff referred to people as 'feeds' when talking about those people who needed assistance with eating. CCTV was being used in a number of areas in the home although a policy which set out its purpose and how people's privacy and confidentiality were being respected was not available.

People who used the service were appreciative of the support they received from staff. One person, for example, said they had a good relationship with members of staff and said that 'some had become friends'. People also told us that the registered manager was approachable and listened to any concerns.

Is the service responsive?

Some actions had been taken since the last inspection to develop a service that was responsive to people's needs. Surveys had been used to obtain people's views of the service. One person, for example, had suggested that the staff wear name badges and we saw that this had been implemented.

The registered manager had also held meetings to update people on developments affecting the home and give them the opportunity to raise any issues. However, information for people in the home was not always up to date. For example, an inspection report in the front hall related to an inspection which took place in 2012. This report presented a picture of the home that was not up to date, as there had been more recent inspections during 2013 and 2014. This meant that people may not have access to up to date information about the home and whether it was suitable for their needs.

We were told that a number of people enjoyed the singing and musical activities that were arranged in the home. We found however that the arrangements being made for social activities did not reflect people's individual and diverse needs.

There continued to be shortcomings in the procedures for obtaining consent from people and the undertaking of mental capacity assessments.

Is the service well-led?

The home had a manager who has been registered with the Commission since our last inspection. Relatives told us that the registered manager had brought some stability to the running of the home.

The registered manager had identified a range of improvements and aspects of the service to develop further. Plans had been produced in connection with these, although actions were not always being completed within the timescales that had been set.

The provider visited the home on a regular basis. However actions were not being taken in accordance with the home's policy on quality assurance to ensure that the provider maintained an overview of standards in the home and made improvements where shortcomings were found.

Holmwood House has not had a registered manager working at the home since May 2012. Whilst the provider has appointed to the post no registered manager application has been submitted to the Care Quality Commission. One manager was appointed in May 2013 and then left in October 2013. A further manager was appointed in October 2013 but they have been absent since 6 December 2013 and we were informed by the provider on the third day of our inspection that they had resigned from their post.

We provided feedback to the provider at the end of the first two days of our inspection and to the provider and the provider's representative, an independent consultant, at the end of the third day.

We met with people who used the service, their visitors and with staff. We also spoke with members of the management team. Staff were observed supporting people in a friendly and courteous manner. People we met with were appreciative of the care they received and said that the staff were approachable. We were also told that staff could be rushed and that the deployment of care staff could vary. One person for example described the staffing as 'up and down'.

There was a plan in place for staffing the home although there were shortcomings in how well this took account of people's individual needs. We also found that the planned level of staff was not always being maintained. There was a risk that people's needs were not being met and that support would not be provided in a consistent and timely way.

We served a warning notice requiring the provider to make the necessary improvements by 24 August 2013.

We inspected on the 6 September 2013 to check that the necessary improvements had been made. Whilst there were some improvements in relation to the care and welfare of people shortfalls in the provision remained. This was because three peoples' care was not delivered in line with their individual care plan to ensure their needs were met. We carried out a further visit on the 30 September 2013 where we found that the improvements had been made and the provider had met the requirements of the warning notice. Systems had been put in place to ensure people's care was planned, delivered and reviewed to ensure their needs were met.

We will be completing a further inspection to check up on the compliance actions set at the July inspection. The provider has sent us an action plan setting out how they will address these areas.

People's needs were assessed. However, the care and treatment was not always planned and delivered in line with the person's care plan. This included moving and handling, meeting a person's nutritional needs and managing continence for a person.

There were no planned activities delivered by the staff for people who lived in the home. This meant that where people had been assessed in relation to hobbies and interests these were not all being planned and delivered to ensure they were engaged in activities within the home.

Concerns about the handling of medicines in Holmwood House were raised by the manager when she started working at the home in May 2013. We saw that some improvements had been made so that medicines were looked after more safely. However, we found that further action was needed to ensure that people were better protected from the risks associated with medicines.

Comments from people who used the service included 'I am quite contented but sometimes staff shout, some staff are kind but firm' and 'we are pleased with the care mum receives at all levels, we feel she has settled very well and is happy in spite of herself'.

Systems were in place to monitor the quality of the service, but these were not identifying the shortfalls in care delivery.

During our visit we spoke with four people who used the service, three members of staff, the acting manager and the provider.

In addition, we spoke with an independent consultant. They had been employed to provide advice on improving systems to ensure ongoing compliance with the Health and Social Care Act 2008.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us that there were some activities being organised in the home. This included a monthly entertainer visiting the home, a weekly hairdresser and a monthly church service.

We spoke with people who received a service about what it was like living in Holmwood House. Comments from people using the service were positive, in relation to the care and support they were receiving. We were told 'the staff are kind and caring', 'the food is ok, there is always enough', 'I choose how to spend my time, although I have to rely on the staff to get me up and assist me to the lounge, but generally I am happy here' and 'the staff respond as quick as they can, I am not the only person here so sometimes there is a delay'.