Archived: Holmside Residential Care Home

We last carried out an inspection on 6 June 2014, where we found the provider was meeting all the regulations we inspected.

Holmside Residential Care Home provides care to a maximum of 39 older people, including those with a dementia related condition. There were 30 people living at the home on the first day of our inspection and 29 on the second day.

There was a registered manager in post. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

A quality assurance system was in place. We found however, that this was not always effective in identifying the concerns which we had highlighted. We highlighted some shortfalls with health and safety and the management of controlled drugs. We also found deficits regarding the maintenance of records relating to recruitment, the MCA and assessments relating to people’s care and support.

A new extension had been built in 2015 comprising of 12 bedrooms and a reception area with tea and coffee making facilities. The premises were well maintained, we saw however, that some of the first floor windows had not been fitted with window restrictors to reduce the risk of any accidents or incidents. In addition, a comprehensive Legionella risk assessment had not been undertaken although water checks and tests had been carried out to monitor for Legionella bacteria.

We received mixed comments about whether there were sufficient staff on duty. There were two staff on night duty to look after 30 people. An assessment had not been carried out to ascertain whether night staffing levels were adequate to evacuate people safely in an emergency. We passed our concerns to the local authority’s fire safety team.

Following our inspection, we wrote to the provider using our legal powers to request information about how they were going to ensure people's safety. The provider informed us that window restrictors had now been fitted to all windows and there were now three staff on duty at night. We will follow this up at out next inspection.

We found shortfalls in the management of controlled drugs (CD’s). Not all CD’s had been entered into the CD register in line with legal requirements.

We checked recruitment procedures at the service. Staff told us that the checks were carried out before they started work at the service. We found that documented risk assessments had not been completed if any concerns were found during these checks.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. We spoke with a local authority contracts safeguarding officer who told us that there were no organisational safeguarding concerns regarding the service.

The manager provided us with information which showed that staff had completed training in safe working practices and to meet the specific needs of people who lived there such as dementia care training.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.” The manager had submitted DoLS applications to the local authority to authorise in line with legal requirements. She was strengthening the service’s paperwork to ensure that it evidenced how the requirements of the MCA were met.

We observed that staff supported people with their dietary requirements. Staff who worked at the home were knowledgeable about people’s needs. We observed positive interactions between people and staff. There was a part time activities coordinator employed to help meet the social needs of people.

There was a complaints procedure in place. Feedback systems were in place to obtain people’s views. Meetings and surveys were carried out.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, staff supporting them and from looking at records.

Is the service caring?

We looked at the care records for four people who used the service. We found that pre-admission assessments had been carried out and people's care and support was planned and delivered according to their individual needs.

We observed the interactions between staff and the people they cared for. We saw staff interacted well with people, and were caring and sensitive to their needs.

We spoke with four people who used the service and their comments included, "I'm more than happy," "I settled the first day I came here," "It's home from home, I want for nothing," "The staff take me shopping" and "I've been here for three years and I couldn't be cared for better."

Is the service responsive?

There was a complaints procedure displayed in the home and each person was provided with a copy of this. People told us they knew how to make a complaint but they had never needed to. They felt the manager would take their complaint seriously should they ever need to complain in future.

Monthly meetings were held for people who lived at the home to discuss day to day issues and ask people their opinions of the service provided.

Is the service safe?

Care records contained risk assessments detailing how people's individual risks should be managed. For example, we saw risk assessments for using the hoist, choking and leaving the building.

Safeguarding procedures were robust and staff received up to date training on how to safeguard the people they supported. The manager was aware of incidents that should be reported and who should be contacted. Staff were aware of the procedure to follow if they observed bad practice. They were aware of the different forms of abuse and told us they would not hesitate to report concerns. Comments included, "I wouldn't think twice about reporting anything I didn't think was right."

The provider had systems in place to ensure the premises and equipment were well maintained and safe.

Systems were in place to make sure that managers and staff learnt from events such as accidents, complaints, concerns and investigations. This reduced the risks to people and helped the service continually improve.

There was a system in place to ensure people's money was safe and any expenditure was appropriately recorded.

The home had policies and procedures in place related to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS)to help ensure people were appropriately assessed and that people were cared for in a way that did not inappropriately restrict their freedom. Relevant staff had been trained to understand when a DoLS application should be made, and how to submit one. This meant that people would be safeguarded as and when required.

Is the service effective?

People's health and care needs were assessed and care plans were developed with people and their representatives. The care plans provided staff with information about how each person's care needs should be met.

Staff were able to describe the individual needs of the people they cared for and how these needs were met.

The service worked well with other agencies and prompt referrals were made to health care professionals which helped ensure people's health care needs were addressed.

People were provided with good nutrition and referrals were made to dieticians when needed. People told us they enjoyed the food served to them. Comments included, "The meals are lovely," "If I don't want what is on the menu I can ask for something else and I always get it," "I don't think anyone could fault the food," "Marvellous food" and "I enjoy every meal I get."

Is the service well-led?

The service worked with other agencies to help ensure people received care in a joined up way. The records showed that health care professionals, such as GPs, chiropodists, physiotherapists and dieticians were consulted regarding people's care when necessary.

An effective quality assurance system was in place which helped to ensure good standards were maintained by monitoring the service provided and addressing concerns promptly. The provider regularly asked people for their views on the service so improvements could be introduced.

Regular resident and staff meetings were held to discuss day to day issues and health and safety checks were carried out regularly. In addition, accidents, incidents and safeguarding matters were monitored regularly, to ensure care delivery was appropriate.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We spoke with a district nurse who was visiting the home at the time of our inspection. She described the care as 'very, very good.' We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

People and relatives told us that there were enough staff to look after people. People were complimentary about the staff themselves. One person said, 'The staff are marvellous.' We considered that there were enough qualified, skilled and experienced staff to meet people's needs.

People and relatives told us they had no complaints about the service and felt that if they had any concerns, these would be addressed immediately. We found that people were made aware of the complaints system. This was provided in a format that met their needs.