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We are carrying out a review of quality at Holbeche House Care Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 15 December 2016

During a routine inspection

This inspection took place on 15 December 2016 and was unannounced. At our last inspection in January 2016 we found that the provider ‘required improvement’ in three questions, namely safe, effective and well- led and was found to be ‘good’ the remaining two questions, caring and responsive.

Holbeche House Care Home provides accommodation for up to 49 people who require nursing or personal care. The home is split into two units. The general nursing unit, ‘Holbeche’ and a unit for people living with dementia which was referred to as ‘Littleton House’. At the time of the inspection there were 44 people living at the home.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

People told us they felt safe in the home and were supported by staff who had receiving training in how to recognise signs of abuse. Staff were aware of the risks to people on a daily basis and knew the procedures to follow if they any concerns or if someone had suffered an accident.

People were supported by sufficient numbers of staff who had been safely recruited. Medication records demonstrated that people received their medicines as prescribed by their doctor.

Staff received induction training and regular support from management which provided them with the skills, information and confidence to meet people’s needs safely and effectively.

People’s human rights were respected by staff because staff applied the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards in their work.

Staff supported people with their preferred diet and the registered manager had identified areas for improvement in the dining room experience for people. People were supported to maintain good health and had access to a variety of healthcare professionals which helped promote their health and wellbeing.

People were supported by staff who were kind and caring and who treated them with dignity and respect. People were supported to make their own decisions and were supported by staff who knew them well.

People were involved in the planning of their care and staff were aware of people’s needs, preferences and interests. The home was split into two units and there was an inconsistency in how people were responded to by some staff across the units. There was a lack of activities available for people to participate in or items of interest available to occupy people. People were aware of how to make complaints and where complaints had been raised, they were investigated and action taken where appropriate.

People were complimentary about the registered manager and the changes she had introduced. People, relatives and staff all considered the quality of service to be good. Efforts were made to support and develop staff in order to improve the delivery of care.

There were a number of quality audits in place to identify any areas of improvement that were required within the service. Where areas where identified, action plans were put in place to address any issues.

Inspection carried out on 19 and 20 January 2016

During an inspection to make sure that the improvements required had been made

This inspection took place on 19 and 20 January 2016 and was unannounced.

At our last inspection in May 2015, we found that the provider was not meeting three of the regulations associated with the Health and Social Care Act 2008 which related to safeguarding people from abuse and improper treatment, good governance and failure to notify the commission of abuse or allegations of abuse. Following the inspection we told the provider to take action and make improvements. The provider sent us an action plan outlining the actions they had taken to make the improvements. During this inspection we looked to see if these improvements had been made and found that they had.

Holbeche House Care Home provides accommodation for up to 49 people who require nursing or personal care. The home is split into two units. The general nursing unit and a unit for people living with dementia which was referred to as Littleton House. At the time of the inspection, there were 38 people living at the home.

The home had a manager who had been in post since December 2015 and was currently applying for their registered manager status. A registered manager is a person who has registered with the Care Quality Commission 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.

People living at the home told us that they felt safe and they were supported by staff who knew them well. Staff had receiving training on how to recognise different types of abuse and were confident that if they raised any concerns, appropriate action would be taken.

Medication records were not always completed in a consistent manner and it was difficult to demonstrate that some people had received their medication as prescribed.

Staff felt well trained to do their job and supported by the manager, but had not been able to access the online training facility for two months in order to update their skills and knowledge.

Staff obtained consent from people before they provided their care, but had a mixed understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to eat and drink enough to keep them healthy and were offered choices at mealtimes. Staff were aware of people’s individual dietary needs. People were supported to access a variety of healthcare professionals to ensure their health care needs were met.

People told us the staff in the home were kind and caring. Relatives told us they found the manager and staff group to be supportive and approachable.

Staff were aware of people’s likes and dislikes and what was important to them. They were aware of how to respond to people, what interested them and influenced their behaviour. There were a number of activities planned for people to be involved in on a daily basis.

There were a number of quality audits in the home which were used to improve the service but the medication audit had failed to identify the concerns raised during the inspection.

People living at the home, their relatives and staff alike all thought the home was well led and spoke positively about the manager and staff group. Visitors to the home felt welcomed and always listened to.

Inspection carried out on 18 and 19 May 2015

During a routine inspection

This inspection took place on 18 and 19 May 2015 and was unannounced.

At our last inspection on 20 August 2014, the provider was not meeting the law in relation to complaints and records. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made.

Holbeche House Care Home provides accommodation for up to 49 people who require nursing or personal care. The home is split into two units, the general nursing unit and a unit for people living with dementia which was referred to as Littleton House. At the time of the inspection, there were 40 people living at the home.

The home had a manager in post who was currently applying for their registered manager status. A registered manager is a person who has registered with the Care Quality Commission 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.

People and their relatives told us that they felt safe in the home. Staff were aware of the risks to people living at the home but risk assessments were inconsistently reviewed and not always completed in a timely manner.

We found a number of incidents of concern that had not been recognised as safeguarding concerns that neither us or the local authority had been notified about.

The manager had recently successfully recruited new staff to fill vacant positions in the home. However, despite attempts to provide consistent agency staff to cover vacancies this was not always the case leading people to receiving care from a number of different agency staff within a short space of time.

We found that people were receiving their medicines as and when they should. However, the system in place to ensure people received their medicines at specific intervals was not robust.

Staff felt well trained to do their job and felt fully supported by the manager.

The manager and staff had recently attended training in respect of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However, there were inconsistencies in staff’s level of knowledge and how it was put into practice; meaning there was a risk that people’s rights would not be appropriately supported.

We saw that people were supported to have a nutritionally balanced diet and adequate fluids throughout the day. We saw that people were offered a choice at mealtimes. However, there was a lack of information regarding people’s likes and dislikes which meant people were not always offered their preferred choices.

Parts of the environment required attention in the home and were sparse and unwelcoming. The manager had raised this with the provider and was also involving people and their families in the redecoration of their rooms. There was only one bath available for people to use in the home as the other three were out of action.

Relatives told us that staff were kind and caring and told us they felt involved in their relative’s care plan. We saw instances where staff spoke warmly to people and offered reassurance when they became distressed. However, we also observed other instances where people were not treated with dignity and respect.

We saw that complaints received had been investigated, however the manager had failed to manage complaints in line with their own complaints procedure.

Arrangements had been made to carry out reviews of people’s care needs every six months, but care records looked at were inconsistent and were not always completed in a timely manner.

We observed that there was a lack of activities and/or stimulation for people living at the home.

Staff and family members were confident in the abilities of the manager and commented on the difference she had made to the home since arriving in post. However, we found that the manager had not fully met the requirements of the action plan they had sent us to improve on shortfalls we had found at our previous inspection and that work was still needed to be done in these areas.

We found a number of concerns during our inspection which the manager’s own audits had failed to identify. This meant that issues which could affect people’s experience of the service were not being routinely identified and addressed.

The manager had failed to notify us of a number of matters which they are required to do so by law, in a timely manner.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009 (Part 4). You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 20 August 2014

During an inspection in response to concerns

We carried out this inspection in response to a number of concerns that we had received about the care and treatment that people received. Some allegations raised centred on concerns over a number of staff leaving the provider’s employ and the impact this had on the care delivered to people. It was stated that people were at risk due to a lack of consistency in the way care was provided.

We checked to see that people’s health and well-being was being promoted by the care home.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with four people using the service, two visitors, six members of staff, and the acting manager and area manager. We also looked at five records relating to people’s care and other records related to the running of the service.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe at the home although we heard some concerns about the availability of staff. One person told us staff responded in a reasonably time. Another told us, “Sometimes there are not enough girls, they work very hard”. A relative told us, “There are not enough staff” and, “Changes need to be made” but was encouraged by the response of the new manager in providing reassurance as to what they were doing about the views of relatives.

The manager and staff told us that a number of staff had left the home recently and this had impacted on the ability of staff to provide effective and consistent care. The manager told us what steps they had taken to minimise the impact of reducing staffing levels, for example agency staff that were employed were as far as possible the same staff. They also told us that they were actively recruiting new staff. From our observations and looking at the staff rotas we saw that the provider was working to maintain staffing levels so that people’s needs were met and they were safe.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. People’s records did not always describe how their safety should be promoted. For example ensuring monitoring systems were in place to alert staff when someone maybe at increased risk of falls.

The manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do so. At the time of our inspection the manager had made some applications and they, and senior staff were able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

People all had an individual care plan which set out their care needs. People’s relatives told us they had not been involved in the assessment of the health and care needs for people they represented and had not contributed to developing their care plan. People told us that the care and support they received was as they wanted it to be. We saw that assessments included people’s specific health care needs although we did see that information in some care plans was not always accurate. Staff we spoke with did understand how to meet people’s needs appropriately.

People told us that staff ensured they saw external healthcare professionals as needed to promote their healthcare.

We saw that staff knew people’s individual care needs and wishes although planning for people’s individual needs was not always accurate.

Is the service caring?

We saw on the day of the inspection that people were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

Staff we spoke with were aware of people’s preferences, interests, aspirations and diverse needs. Our observations of the care provided showed that people’s individual wishes for care and support were taken into account and respected. People we spoke we told us that, “The girls are nice” and, “The people that look after me are alright”. We did hear concerns from relatives about some people’s care that the manager was to investigate.

Is the service responsive?

People told us, that they were satisfied with their day to day routines although we saw limited activities on the day of our inspection. The manager and staff told us this was an area that needed improvement. A relative commented that, “They do dancing, singing, used to do baking and have fun days such as the Black Country day”.

People knew how to make a complaint if they were unhappy. Some relatives told us that concerns they had raised had not been responded to. This meant that some relatives felt their complaints were not taken seriously.

We did see that the manager was putting forums in place to gain the views of people and their relatives. We heard that the manager had changed residents and relative’s meetings to an evening time so as to assist their attendance. Staff we spoke with also told us they felt the manager was listening to them one telling us the manager, “Listens to our views”.

We have asked the provider to tell us what improvements that will make in relation to responding to people’s complaints.

Is the service well-led?

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed. We saw this had helped the new manager, who had been in post a short while, to identify areas that required improvement and tell us how they intended to put right any shortfalls they had found.

Information from the analysis of accidents and incidents had not always been used to identify changes and improvements to minimise the risk of them happening again.

People’s personal care records, and other records kept in the home, were not always accurate and complete.

We have asked the provider to tell us what improvements that will make in relation to improving people’s personal care records.

Inspection carried out on 20 September 2013

During an inspection to make sure that the improvements required had been made

At the previous inspection on 25 June 2013 we identified areas of concern with medicine management in the service. We gave the service a compliance action. This inspection visit was made in order to follow up on the compliance action.

We found that the service had made improvements in order to manage the risks associated with the unsafe use and management of medicines.

Inspection carried out on 25 June 2013

During an inspection to make sure that the improvements required had been made

This inspection was carried out by a Pharmacist Inspector to check whether improvements had been made to the management of medicines since our previous inspection on 20 May 2012.

We found that arrangements continued to put people at risk of not receiving their medicines in a safe manner as prescribed.

Inspection carried out on 3 January 2013

During an inspection to make sure that the improvements required had been made

We carried out this inspection to check whether improvements had been made in the way people’s care was delivered, in the systems used for assessing the quality of the service and in the way that records were completed. There were 35 people living at the home on the day of the inspection. We spoke with six people, two relatives, four staff, the home manager, and the regional manager.

We found that improvements had been made and people received care that met their needs. We saw staff deliver care in a timely manner. One person said, “They look after me.”

We found that arrangements were in place to identify shortfalls, and action was taken to make improvements. Records were detailed, complete, and reviewed regularly. We saw improvements in the recording of information that related to people’s care.

Inspection carried out on 22 October 2012

During an inspection to make sure that the improvements required had been made

We carried out this inspection to follow up concerns we identified from our previous inspection on 28 June 2012. There were 36 people living at the home on the day of the inspection, including 22 people in the dementia unit. We spoke with two people, five staff, the deputy manager, the home manager, and the regional manager.

We found that improvements had been made in the way people were offered choices One person said, “I get a choice for what I want to eat.”

We continued to find that people were not receiving appropriate care in a timely manner. People’s care records were not always accurate and updated regularly. This meant that improvements had not been made to ensure people received care that met their needs.

We found that improvements had been made in the way that staff reported safeguarding concerns and in the way that people’s finances were being managed.

We found that improvements had been made in supporting staff with regular supervision and training. One staff said, “It is better now than before.”

We found that the registered provider and the registered manager had failed to make necessary improvements following our previous inspection, where we identified concerns. We found evidence to show that concerns had not been addressed appropriately to ensure better outcomes for people.

We found that records were inaccurate, incomplete, and unclear which continued to pose a risk of people not receiving the care they needed.

Inspection carried out on 28 June 2012

During an inspection to make sure that the improvements required had been made

We visited Holbeche House in May 2012 and identified concerns in a number of areas. The provider sent us an action plan and we carried out this inspection in June 2012 to review improvements that had been made.

The home had a nursing unit and a separate dementia care unit. We spoke to two people, five staff, the manager, and two health and social care professionals.

We found that opportunities for people and their relatives to be involved in the planning of care continued to be limited. However, the provider informed us that care-planning reviews would take place shortly. We found that although some improvements had been made, these were not consistent throughout the home and further improvements were required.

We found that there had been some improvements, particularly in the dementia unit. There was use of instruments, improved ways to stimulate people and the introduction of dolls, which was known to help with dementia. We saw that interactions between staff and people had improved. We found that healthcare professionals were not always involved in people’s care in a timely manner. This meant that concerns that we previously raised relating to care and welfare were not all met.

People at the home continued to be at risk of not being safeguarded appropriately. We found that staff were not appropriately escalating safeguarding concerns and any incidents to management. We found that we were not being notified of incidents, which the home has a duty to report to us. There was an ongoing risk that people’s finances were not appropriately safeguarded.

We found that not all actions from the provider’s action plan had been completed. We were not updated with the progress on a regular basis. We found similar concerns during this inspection that we had raised in May 2012. This meant that not all necessary changes had taken place.

Inspection carried out on 6 June 2012

During an inspection in response to concerns

We carried out this review to check on the care and welfare of people using the service. The home had a nursing unit and a separate dementia care unit.

People do not always receive their medication at the times they need them. Medicines are not stored safely.

Inspection carried out on 9 May 2012

During a routine inspection

We carried out this review to check on the care and welfare of people using the service. The home had a nursing unit and a separate dementia care unit. The manager told us there were 20 people in the nursing unit and 24 people in the dementia care unit on the day of the visit. We spoke to seven people, two relatives, six staff, the manager, the regional manager and seven health and social care professionals.

Records showed that people and their relatives were not involved in making care and treatment decisions. One person said, “If I had the choice, I probably would like to be involved.”

Staff were able to describe basic care needs for people. However, we found that staff did not take timely action to seek expert advice for people’s healthcare needs.

We saw that arrangements in place did not ensure that people and their finances were appropriately safeguarded.

We saw that staff were not approaching people who were anxious when they were wandering in the dementia care unit. Staff made some positive interactions with people when giving them drinks and their meals. This meant that staff were not proactively engaging with people to reassure them and relieve their anxiety.

We found that there were minimal arrangements to monitor the quality of services being provided at the home. The action plan we saw following an audit did not prioritise or identify immediate actions that were needed to provide appropriate care and keep people safe. We received inconsistent information and explanations from the regional manager, the manager, and the staff throughout the visit.

We saw that records were inconsistent, inaccurate, and not stored in a systematic manner. People’s care records did not provide an overview of people’s needs and health conditions. This meant that there is a risk that staff may not be appropriately providing care for people.