We undertook this unannounced inspection on the 2 and 7 October 2015. The last full inspection took place on 9 April 2013 and the registered provider was compliant in all the areas we assessed.
Holme Farm is registered to provide accommodation and personal care for 30 older people, some of whom may be living with dementia. The home is a purpose built, single storey service which has been extended since it was built. It is situated in Elsham village and has access to all local facilities. On the day of the inspection there were 29 people using the service.
The service had a registered manager in post who was also the registered provider. 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 did not have risk assessments in place for specific concerns, such as falls and some of those in place lacked some important information to guide staff in how to minimise risk. Incidents and accidents had not been analysed to help find ways to reduce them. These issues meant the registered provider was not meeting the requirements of the law regarding keeping people safe from risks to their safety. You can see what action we told the registered provider to take at the back of the full version of the report.
Care plans needed to be more detailed and contain more information about how the person preferred to receive their care. Following the inspection the registered provider/manager confirmed they had obtained a new, more up to date, care recording system and had started to make improvements to the quality of the care records.
People had access to a limited range of activities. We made a recommendation that the registered provider/manager provided more training and support for staff based on current best practice, in relation to providing activities and meaningful occupation for people living with dementia.
We found the quality monitoring system had not been effective in highlighting some areas to improve and action had not been consistently taken in order to address shortfalls. Following the inspection the registered provider/manager confirmed they were updating the monitoring systems.
Staff understood their roles and responsibilities for reporting safeguarding or whistleblowing concerns about the service. Training had been provided to them, to ensure they knew how to recognise signs of potential abuse.
We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GP’s, hospital consultants, community mental health nurses, opticians, chiropodists and dentists. Systems were in place to ensure people’s medicines were administered safely.
People received a well-balanced diet and we saw specialist dietary needs had been assessed and catered for. Arrangements at lunchtime to provide one main meal and only offer alternatives on request, could limit some people’s choices. The choice of snack options between meals was limited. On some occasions, the monitoring of people’s weight had not always been carried out effectively so that changes could be highlighted and discussed with health professionals for advice. The registered provider/manager told us they would address this with staff.
Staff were provided in suitable numbers to ensure the needs of the people who used the service were met. Our observations showed staff were attentive to people’s needs and were always available. Recruitment checks were carried out on new staff to ensure they were safe to work with vulnerable people and did not pose an identified risk to their wellbeing. Staff had access to training relevant to their roles.
The Care Quality Commission [CQC] monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which applies to care homes. The registered provider/manager had followed the correct process to submit applications to the local authority for a DoLS where it was identified this was required to keep them safe. At the time of the inspection there was one DoLS authorisation in place and further applications were to be submitted.
Staff supported people to make their own decisions and choices where possible about the care they received. When people were unable to make their own decisions, staff mostly followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made. Improvements were needed with the recording of decisions about resuscitation.
There was a complaints procedure and people told us they would feel able to make complaints and these would be sorted out.