Holywell Home

We found the following examples of good practice.

The home had comprehensive policies and procedures to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis.

People living in the home and their relatives were supported to maintain contact. When visitors were unable to access the home, for example if they tested positive for COVID-19 technology such as on line visiting was utilised. The staff ensured that people were able to visit relatives in the community when safe to do so.

A programme of regular COVID-19 testing for both people in the home, staff, and visitors to the home had been implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

There was an ample supply of PPE for staff and any visitors to use. Hand sanitiser was readily available throughout the service. Staff had received updated training on the use of PPE and we observed staff wearing it correctly during out inspection. Clear signage and information was in place throughout the home to remind staff of their responsibilities.

Daily cleaning schedules were implemented by housekeepers and all staff were involved in undertaking touch point cleaning.

Holywell Home is a residential care home providing accommodation and personal care for up to six people with a learning disability. At the time of the inspection there were four people living there.

The home is a four-storey terraced property close to all the amenities in the town. The top floor is designated for staff use only. The third and second (street level) floors have bedrooms and communal bathrooms. The basement accommodates one bedroom and the communal kitchen and lounge. There is no lift access to the upper floors therefore the home is not suitable for people who cannot manage stairs.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

People’s experience of using this service and what we found

There were enough numbers of suitably qualified staff to meet people’s needs. Staff training was ongoing, and they had received sufficient training to safely support and care for people with a learning disability. Staff were regularly supported by the registered manager through staff meetings, supervision and appraisals.

Hazards to people’s safety had been identified and managed. Where safeguarding concerns or incidents had occurred, these had been reported by the registered manager to the appropriate authorities.

When employing people, the registered manager had completed checks to ensure they were suitable to work with vulnerable people. The staff treated people in a kind and caring way. People enjoyed spending time with and laughing and joking with the staff.

People were supported to access activities that were made available to them and pastimes of their choice. People told us about their recent holiday they had been on supported by staff and how they had enjoyed it. People enjoyed the meals provided.

The staff gave people the support they needed to take their medicines. People received their medicines safely and as their doctors had prescribed. The staff supported people to see their doctors as they needed. The service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.

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; the policies and systems in the service supported this practice. People and their families had been fully involved in planning and reviewing the care and support provided.

People's rights were protected. People were treated with respect and their dignity and privacy were actively promoted by the staff supporting them. People were fully supported to maintain their independence. The provider planned people's care to meet their needs and take account of their choices. People could see their families and friends as they wished.

People knew how they could raise concerns about the service provided. Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the provision. The provider and registered manager monitored the quality of the service and identified areas which could be improved.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 (21 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holywell 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Holywell care home provides accommodation, nursing or personal care for up to six adults with a learning disability. There were five people living at Holywell Home at the time of our inspection.

The home is situated at the West End of Morecambe, close to the promenade and within easy access to local amenities. There is one communal lounge and a combined kitchen and dining room on the lower ground floor. There is no lift therefore the home is not suitable for people who cannot manage stairs.

The registered manager was not present during our inspection visit. We spoke with the registered manager the following day. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the last comprehensive inspection on 08 April 2016, we found the provider was not meeting the requirements of the regulations in respect of safeguarding people from abuse and improper treatment, need for consent, staffing, good governance and the notification of incidents. We carried out a focused inspection to check improvements had been made. At the focused inspection on 29 July 2016, we found the provider was meeting the requirements of the regulations that were inspected. We did not improve the ratings because to do so requires consistent good practice over time.

During this inspection in February 2017, we found staffing levels ensured people were safe. There was an appropriate skill mix of staff to ensure the needs of people who lived at the home were met.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received safeguarding from abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had ensured risks to individuals had been assessed and measures put in place to minimise such risks. A plan was in place in case of emergencies which included detail about how each person should be supported in the event of an evacuation.

The provider had recruitment and selection procedures to minimise the risk of unsuitable employees working with vulnerable people. Checks had been completed prior to any staff commencing work at Holywell Home. This was confirmed from discussions with staff.

Staff responsible for administering medicines were trained to ensure they were competent and had the required skills. There were appropriate arrangements for storing medicines safely.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able to speak with us told us they were happy with the meals available to them. We saw regular snacks and drinks were available between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had liaised with healthcare providers and responded promptly when people had experienced health problems.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the management team were accessible, supportive and approachable.

Comments we received demonstrated people were satisfied with their care. The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

Care plans identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

People told us they were happy with the activities organised at Holywell Home. The activities were arranged for individuals and for groups.

The provider had regularly completed a range of audits to maintain people’s safety and welfare.

Following the inspection, we took enforcement action as the provider did not ensure there were enough staff to respond to the changing needs and circumstances of people requiring support. They also failed in their duty to notify the Care Quality Commission (CQC) about events they were required to.

After the comprehensive inspection in April 2016, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches and enforcement action. We carried out this unannounced focused inspection on the 29 July 2016 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Holywell Home on our website at www.cqc.org.uk'.

Holywell Home provides personal care and accommodation for up to six adults with a learning disability. The home is situated at the West End of Morecambe, close to the promenade and within easy access to local amenities. There are two communal lounges, one on the lower ground floor and one on the first floor. There is also a combined kitchen and dining room on the lower ground floor. There is no lift therefore the home is not suitable for people who cannot manage stairs. At the time of our inspection, five people lived at Holywell Home.

A registered manager was not in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The provider was awaiting their Disclosure and Barring Service (DBS) clearance before submitting their application to become the registered manager. The Disclosure and Barring Service (DBS) helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups of people.

At our focused inspection on the 29 July 2016, we found improvements had been made. We saw documentation that indicated staffing levels were safe. The provider had systems to respond to unplanned staff absence. We saw safeguards were in place to manage risk.

Information we looked at in people’s care records reflected the current needs of people being supported and informed staff how to support them.

We read the diary sheets written by staff concerning people who lived at Holywell Home. We found no evidence incidents went unreported to the Commission.

We could not improve the rating for safe and well led from inadequate because to do so requires consistent good practice over time. We could not improve the rating for responsive from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

We informed the new manager 48 hours before our visit that we would be coming. This was because the home was small and we wanted to ensure people were available to talk with.

We had received several concerns about people’s safety and the management of the home. We checked people were not at risk of receiving unsafe care.

Holywell care home provides accommodation, nursing or personal care for up to six adults with a learning disability. There were five people living at Holywell Home at the time of our inspection.

The home is situated at the West End of Morecambe, close to the promenade and within easy access to local amenities. There are two communal lounges, one on the lower ground floor and one on the first floor. There is also a combined kitchen and dining room on the lower ground floor. There is no lift therefore the home is not suitable for people who cannot manage stairs.

The home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The provider had recently appointed a new manager who was applying to become the registered manager.

At the last inspection on 03 September 2014, we found the provider was meeting the requirements of the regulations that were inspected.

During this inspection, we found staffing levels were not sufficient to keep people safe from harm. Poor staffing levels had meant people who required care and support were at risk.

The provider had not managed risks to two people they supported. Risks had been identified but safeguards to keep them free from danger had failed.

People did not receive care that was responsive to their changing needs. The provider failed to ensure there were systems to manage people’s individual behaviours and keep them safe.

The provider did not have accurate and complete records to instruct staff on how to provide help to people safely. Records identified what help people required but did not instruct staff how to support them.

Not all staff had regular supervision meetings with a member of the management team to review their role and responsibilities.

The management team had not fulfilled their regulated responsibilities. They had not notified CQC and the local authority of all events and occurrences as required.

The provider had oversight of the home but failed to act to maintain the quality of the care provided.

Staff had received abuse training. They understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had recruitment and selection procedures to minimise the risk of unsuitable employees working with vulnerable people. Checks had been completed before any staff started work at the home. This was confirmed from discussions with staff.

Staff responsible for helping people with their medicines were trained so they were competent and had the skills required. Medicines were safely and appropriately stored.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Comments we received showed people we spoke with were satisfied with their care. The provider, new manager and staff were clear about their roles and responsibilities.

A complaints procedure was available and people we spoke with said they knew how to complain. Staff spoken with felt the management team were accessible, supportive and approachable and would listen and act on concerns raised.

The provider had sought feedback from staff and people who lived at the home. They had formally consulted with people and their relatives for input on how the home could continually improve.

The provider regularly completed a range of audits to maintain people’s safety and welfare.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection we looked at the systems the home had in place to keep people safe and well. We looked at care plan records and risks assessments, the safety of the environment, staffing levels, staff support and the quality monitoring systems.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We spoke with several people who lived at the home, observed their care and support, spoke with members of the staff team and the registered manager.

We looked at several care plan records to show us how the staff team supported people to remain safe and well in their home. Information in the care plans identified a range of support required by people. There were detailed behavioural intervention plans in place, and joint working with a range of external professionals was in place to meet people`s needs. Care plan records and risk assessments were regularly reviewed.

Is the service effective?

People's health and care needs were assessed, monitored and reviewed. The staff team worked in partnership with other professionals in order to support people with their changing health conditions. We saw evidence of recent work with local psychiatric and neurology services, GP`s, District nurses and local learning disability services.

Is the service caring?

Staff we spoke with told us they felt well supported and enjoyed their work. They appeared to be caring and enthusiastic. Our discussions confirmed staff were knowledgeable regarding people`s needs and what actions to take if they had any concerns.

Is the service responsive?

We saw evidence to show us that the home was responsive when meeting people`s health care needs. The registered manager worked on a daily basis alongside people and the staff team. This meant that advice and guidance could be given and immediate action taken if there were any concerns. Staff told us the care plans informed them of people`s needs and preferences. They told us they felt well supported and received training and supervision.

Is the service well-led?

There was a range of systems in place to monitor the quality of the services being provided. However due to the increase in safeguarding incidents within the home we discussed that the provider may wish to consider implementing formal ways of gaining the views of relatives in relation to this. This feedback would help to ensure that people received a good quality service at all times.

People also told us that they enjoyed the meals served and that they had helped to plan what they were going to eat. One person said, 'I like the meals here, I can choose what I have'. People also told us that they could make their own drinks or toast at any time they liked. This meant that although staff assisted with main meals, people were encouraged to remain as independent as possible. People chose for themselves when to make a drink or snack.

People spoke positively of the care they received and described staff as, 'All right'. We asked one person if staff helped them properly, we were told, 'Yes they do'. Another person said that the staff that supported him always listened to what he had to say and helped him to achieve his aim.

We spoke with people living in the home about feeling safe. One said, 'Staff always make sure I am ok.' People's bedrooms had been personalised and they all had their own room keys. One person said, 'I like my room, it's my own space.'

On the day of the inspection the home had received the weekly supply of medication. We watched the process for receiving and recording the medication on to individual records. The process was comprehensive and included safeguards to reduce the risk of mistakes.

We spoke with people living in the home about the staff. One person said, 'All the staff are really nice.' Another said, 'Some old staff come back to see us. We are all friends.' One member of staff said, 'I am confident we have the right staff to drive us forward.'

Care files were being reviewed and written information currently being used to inform support needs was basic. A comprehensive assessment of people's current needs had not been completed. Risk assessments were in need of review.