Background to this inspection
Updated
26 January 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors, an Expert by Experience and a specialist advisor. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Holbeche House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager in place who had applied to register with the Care Quality Commission.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who visit the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.
During the inspection
We spoke with two people who used the service and 14 relatives about their experience of the care provided. We spoke with 11 members of staff including the regional director, the manager, the deputy manager, care workers, the chef and the domestic staff and activities co-ordinator.
We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the manager to validate the evidence found. We looked at training data, quality assurance records and care records.
Updated
26 January 2022
About the service
Holbeche House is a residential care home providing personal and nursing care for up to 49 older people, some of whom live with dementia. At the time of the inspection the service was supporting 42 people. The care home accommodates people in one adapted building which is split into two units. One unit supports people with nursing needs and the second unit supports people who live with dementia.
People’s experience of using this service and what we found
The risks to people had not always been assessed, recorded and plans put in place to manage these. However, staff were aware of these risks and what to do to keep people safe. People had support to take their medicines safely and as prescribed. However, some people’s thickener was not safely stored. People’s relatives and staff gave us mixed feedback on staffing arrangements at the service. Staff knew how to identify and report any abuse concerns. Incidents and accidents involving people were monitored to learn from these.
The environment of the dementia unit was not dementia-friendly. People’s care plans did not always show their health needs had been considered. People had help to access external healthcare professionals and services. Staff received induction and training to enable them to perform their duties. People had the support they needed to eat and drink.
Staff did not always have time to support people in a personal way. We received mixed feedback from people’s relatives on the extent to which they were involved in care planning and people’s care plans did not reflect their involvement. People had support to maintain valued relationships.
People’s care plans were not person-centred or always updated in response to changes in their needs. People did not receive enough support to pursue their interests or participate in meaningful activities. People’s communication needs had been considered.
The provider’s quality assurance systems and processes were not sufficiently robust or effective. We received mixed feedback from people’s relatives and staff on the management of the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 21 September 2020 and this is the first inspection. The last rating for the service under the previous provider was requires improvement, published on 21 August 2019.
Why we inspected
The inspection was prompted in part due to concerns received about medicines, infection control and staffing. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified a breach in relation to the overall governance of the service at this inspection.
Follow up
We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.