Archived: The Holt Retirement Home

The provider submitted a satisfactory action plan stating that they would be compliant with most areas of action that needed to be taken in respect of fire safety by 3 March 2014 and that they would be fully compliant by 14 March 2014.

We returned to the home on 10 March 2014 and found that the provider had undertaken most of the action needed to achieve compliance. We contacted the provider again on 17 March 2014 and received information to confirm that all actions had been completed by 14 March 2014.

We did not speak to people who lived at the home during this inspection. We spent time touring the premises and checking documentation to ensure that the provider had taken the action that they had recorded in their action plan.

Although the provider is now meeting the requirements of regulation 15 and our warning notice of 19 February 2014 in respect of fire safety, there are still outstanding areas of non-compliance that remain to be reviewed. These include concerns about the general maintenance and cleanliness of the premises.

During our visit we observed people's care and the regime and routines of the service. We spoke with people who used the service, a healthcare professional and a social care professional who were available. We asked members of staff for their views and spoke with a relative who was visiting.

We discussed the inspection and our findings with the registered manager who also acted as the nominated individual for the service provider CCHM Limited. We also left comments cards so people could share their views with us after our visit.

We observed that staff did not engage positively with the people in their care or provide any meaningful activity. We saw that staff were kept very busy and had little opportunity in which they could spend time with people. This was confirmed by staff members we spoke with and from comment cards submitted as part of the dementia themed inspection.

We found that care records including care plans and risk assessments were not up to date. Staff told us that they were not aware of what was in people's care plans and did not have time to look at them. This placed people at potential risk of receiving unsafe or inappropriate care.

Assessments completed by the service provider did not include sufficient detail to identify if the service could meet people's needs. Staff had not received training in dementia to enable them to provide safe and professional care.

We found that staff were not responsive to changes in people's needs. This meant that people were not always supported to obtain the appropriate health and social care support they needed. We observed, for example that one person had difficulty in drinking independently. We saw that a social care professional had to intervene to make sure this person received the right care at the right time.

We identified that staff had failed to seek appropriate treatment following falls and incidents that had resulted in serious injury. This meant that people had been placed at potential risk of harm.

During our visit we saw one member of staff dispensing medicine from the controlled medicine cabinet. This raised some concerns. We therefore extended our inspection to look at the management of medicines in the home. We found that medicines were not always being accurately recorded or monitored. We found that people including one person who had sustained a fracture had not been appropriately assessed for pain. Records did not provide staff with sufficient information about medication that needed to be administered on an 'as required' basis.

Staff including senior staff showed little understanding of good practice guidance in relation to dementia care needs. We found that people were not cared for in an environment that was made safer and more accessible to people with dementia.

The provider was not carrying out relevant checks when they employed staff. This meant that people could not be assured that the staff were qualified and suitable to be able to work with vulnerable adults.

Effective management arrangements were not in place to enable the quality of care to be assessed, monitored and improved.

Because of serious concerns about people's safety and welfare we made a further visit to the service on 13 February 2014 when similar issues and concerns were found. This is being followed up and we will report on any action when it is complete.

We spoke with four relatives and three people who lived at the home on the day of the inspection visit. We made observations of care and found that staff were attentive and responsive to people's needs. People told us that staff were approachable and kind. One visitor told us "I know (my relative) is well cared for, they have been quick to get a doctor for them.'

We found that people were consulted about their care and that the home sought people's consent to their care and treatment. We saw that the home assessed people's capacity to make decisions and that decisions were made in the person's best interests.

We saw that the home assessed people's care needs and developed care plans which were reviewed with risk assessments in place. We saw that staff had training in caring for people with a dementia and that care plans took account of people's dementia care needs.

There had been a number of safeguarding referrals to the local authority since the last inspection. We saw that the management had responded to the results of investigations and that improvements to safety had been made. There were sufficient staff to care for people safely. People were living in a safe and secure environment.

The home monitored the quality of its service through surveys and internal systems so that improvements could be identified and put in place.