Holme House Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent at the service.
 

This service scored 46 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

Care records were not always accurate and frequently contained contradictory information. This meant we could not be assured staff had access to the most up-to-date and reliable information about people’s assessed needs and preferences. We reviewed 5 care plans and found all contained inconsistencies. For example, care plans provided conflicting information in relation to people’s repositioning requirements, the equipment required to support them safely, their preferences for mealtimes and activities, and their ability to engage. There were also discrepancies regarding where people were cared for, such as whether they remained in their bedroom or accessed communal areas. These inconsistencies increased the risk that people’s needs may not have been met in a consistent and person-centred way.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.
We saw people’s weights were being recorded, and in some cases weight loss had been identified over the previous month. Some level of review and analysis had also taken place for certain individuals. People appeared to receive sufficient food and drink throughout both days of the assessment. However, documentation did not always fully reflect the choices available to people or demonstrate how these choices were supported.

Care plans outlined people’s assessed nutritional and hydration needs; however, there was no formal system in place to monitor or audit whether prescribed fluid targets were consistently achieved where these had been identified. As a result, oversight of hydration was not always effective, increasing the risk that potential dehydration may not be promptly identified or addressed.
 

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.
During the assessment, we found there appeared to be a poor working relationship both within the staff team and between staff and leaders. Communication systems were not clearly defined or effectively embedded, which meant important information relating to people’s care was not always shared appropriately. For example, incidents such as bruising or changes in presentation were recorded by staff but not consistently communicated or reviewed. Daily ‘flash meetings’ did not consistently capture key information or emerging risks. The aim for the meetings was for information on changes and new risks to individual service users to be shared with leaders. This was to ensure they had clear oversight of and were fully aware of changes in people’s needs. This lack of awareness meant leaders were unable to take timely action.

This lack of effective communication and collaborative working increased the risk of oversight in care delivery. However, we did see evidence of improved collaborative working with the GP surgery, which had resulted in better access to healthcare services, including face-to-face consultations and more comprehensive health checks for people using the service.
 

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Activities provided within the service did not consistently focus on supporting people with tasks of daily living or promotion of their overall health and wellbeing. In some cases, activities were not aligned with people’s assessed needs. For example, 1 person’s care plan identified the need for balance-based exercises to reduce the risk of falls; however, we found no evidence this support was being provided.

Opportunities for people to access the wider community were also limited. Feedback from people and their relatives indicated they would like more opportunities to go out, visit different places, and participate in a wider range of activities aligned with their interests.

People were provided with a varied and nutritious diet, and initiatives such as snacks and themed events were in place to support nutritional intake.
 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and
consistent, or that they met both clinical expectations and the expectations of people themselves.

Systems to monitor and improve outcomes for people were not consistently effective. We found recording of behavioural incidents , where required, were not always completed or reviewed after incidents had occurred. This meant there was limited evidence of analysis or action taken to reduce the likelihood of recurrence. For example, during the assessment we noted incidents involving 1 person were not always fully recorded, and there was no clear evidence of strategies implemented to reduce their distress or the impact on others.

Although some clinical tools such as Waterlow risk assessments for pressure ulcers were in use, these were not always aligned with the service’s own risk assessments, and they did not always reflect accurately within care plans. In some cases, individuals assessed as being at very high risk of pressure damage did not have clear, detailed guidance in place to inform staff how to mitigate these risks. This reduced assurance that risks were being effectively monitored and managed.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Mental Capacity Assessments (MCA) and best interest documentation was not consistently in place. Six out of 9 people whose records we reviewed did not have MCA or best interest documentation completed for the use of equipment such as bedrails or sensor mats , despite being assessed as lacking capacity.

The provider was already aware capacity assessments were not in place and had this on their service improvement plan. Despite not adhering to the principles of the Mental Capacity Act 2005, we found the restrictions in place were proportionate for the people we reviewed.

Consent to care and treatment was not consistently recorded within care plans. Where people were assessed as lacking capacity, there was limited evidence to demonstrate the closest relative or legally appointed representatives had been appropriately involved in decision-making processes. We also observed instances where care plans had been updated by leaders without evidence of consultation with the individual or their representative. This meant it was not always clear how decisions had been made in line with best interest principles.

However, during the assessment we observed staff seeking consent from people before providing care and treatment. We also saw when visiting professionals attended the service, staff appropriately sought people’s permission for consultations to take place and for information to be shared.