Holme House Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.
 

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.
We observed occasions where people’s dignity was not consistently maintained. For example, 1 person’s care plan stated they wished for staff to support them to continue to take pride in their appearance and wished to be presented in a particular way. However, on the first day of the assessment they were in bed wearing a nightdress, without covers, with their door open, exposing their underwear and continence pad. Another person was seen walking around for a prolonged period with their trousers inside out, with pockets hanging out, and there was no staff intervention.
In addition, 1 person who had been supported to have bed rest was left in their room with the door closed and was heard repeatedly calling out for help. Staff walked past without responding. This was not in line with the person’s care plan, which stated they could choose when to rest, preferred their door to remain open, and required access to a call bell.

However, we also observed positive interactions where staff demonstrated kindness and compassion. These included staff crouching down to speak quietly to people, offering reassurance and comfort, and spending time engaging with small groups in conversation about their families and interests.
 

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences.

Some people with protected characteristics had their needs met and were supported to express themselves as they wished. People’s bedrooms were personalised, and we saw evidence of celebrations such as birthdays being recognised within the service.

However, this was not consistent for everyone. We found for some people, particularly those who were cared for in their bedrooms, care was not always delivered in line with their recorded preferences. For example, 1 person’s care plan stated they wished to have the television on whilst in bed; however, during the assessment they were observed in their room in silence. Another person’s care plan stated they preferred to be dressed during the day and wear nightwear at night, yet they were observed wearing a nightdress during the daytime.

Feedback from people about their experiences of care was mixed. Some people told us staff were kind and caring, while others felt staff were not always interested or responsive. One person said, “Some staff are nice and some care, and some are not interested in you, you have to wait a long time.” Another person told us, “When you go into the lounge you hardly get to speak to anyone, I don’t like it, I get lonely.” This indicated people did not always feel emotionally supported or meaningfully engaged.
 

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

People and their relatives told us they were generally able to have visitors at any time and felt welcomed by staff when attending the service. People also told us they were usually able to make choices about their care, including what they wore and aspects of their daily routines. We observed positive examples where relationships, including those between husbands and wives, were supported, enabling people to spend time together and make choices about how and where they spent their day.

However, this was not consistently experienced by all people. In particular, those who were cared for in their bedrooms or who were less able to express their preferences did not always have the same level of choice and control. We found that specific details recorded in care plans were not always implemented in practice, which reduced people’s ability to exercise choice and maintain independence.
 

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

We identified a systemic issue in relation to the management of call bells access across the service. Although call bell audits had been completed, these had not identified the concerns we observed during the assessment. For example, we saw multiple bedrooms where call bells were not plugged into the wall, meaning people did not have a reliable way to request assistance. On both days of the assessment, 1 person’s call bell was looped over a picture on the wall and was out of their reach.

Where care plans indicated people were able to use a call bell and required access to one whilst in their bedrooms, this was not always in place. One person who had been supported to bed did not have access to their call bell and was left calling out for help. Another person was heard repeatedly calling for assistance, but staff were observed walking past their room without responding, which increased their distress and frustration. They were also not provided with a call bell.

When people’s needs changed, it was not always clear how this information was communicated to staff or reflected in care delivery. Care plans were sometimes contradictory and did not reflect people’s current needs. For example, 1 person who was being cared for in bed and was identified as receiving end of life care had a care plan which stated they were able to mobilise independently, access communal areas, participate in activities, and eat in the dining room. This meant we could not be assured that staff had clear and accurate information to respond appropriately to changes in people’s needs.
 

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

During the assessment, staff morale appeared low, and there was a noticeable disconnect within the staff team, which contributed to a tense atmosphere. Staff told us they did not always feel valued and were unable to describe any recognition schemes or initiatives in place to acknowledge their work or support their wellbeing.

Some staff reported leaders were not always visible within the service, although they said they could approach the office if they needed to speak with a member of the management team. This lack of consistent engagement and support impacted on staff wellbeing and had the potential to affect the quality of care provided to people.

Staff meetings were in place which evidenced how the provider was attempting to address the staff morale, lack of teamwork and culture in the service.