Holt Mill House

Updated 16 December 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection team consisted of 1 inspector.

Service and service type

Holt Mill House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Holt Mill House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

The inspection was announced. We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. This also allowed the registered manager time to notify the people they support that we would be visiting.

What we did before the inspection

We reviewed information we had received about the service since registration. We sought feedback from the local authority, and we used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service and 1 relative about their experience of the care provided. We spoke with 4 members of staff including the registered manager, 2 care workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

During the inspection, we visited both floors of the home and we reviewed a range of records. We visited the home twice, once in normal hours and once out of hours, this was to check consistent care was being provided. This included reviewing 2 people's care records in detail. During the inspection we also looked at various medicine’s records and the storage of medicines. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including audits, policies and procedures, were also reviewed.

Updated 16 December 2023

About the service

Holt Mill House is a residential care home providing personal care to up to 3 people. The service provides support to people with a physical disability, sensory impairment, learning disability or autistic spectrum disorder. At the time of our inspection there were 3 people using the service, who resided in 1 building which had 2 floors.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

Staff were not up to date with all necessary training. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Appropriate staffing levels and recruitment practices were in place. People's rooms and communal areas was clean and tidy. People were supported with their healthcare needs and staff supported people to eat, drink and prepare food in line with their abilities. People took part in activities and spoke positively about this and were supported to maintain relationships with loved ones.

Right Care

Various risks had not been appropriately addressed/assessed. People received person centred care and records reflected this. Medicines were being safely administered. People's needs were assessed and details of this was recorded in people’s care plans. People's equality and diversity needs were respected, and people were supported to be as independent as possible. People's records were securely stored, and staff were kind and considerate. People were able to express their views and could access advocacy services should they need or want to. No one in the service was end of life, though some work was required to improve paperwork and staff training in this area. The registered manager had previously supported LeDer (Learning Disabilities Mortality Review) following a death in the service, and complied with their request for information.

Right Culture

Quality assurance systems needed to be more robust. There were limited examples of lessons learned and the registered manager told us how they would improve this. The registered manager knew about their responsibility to be open and honest and were supportive of our inspection. Staff meetings were taking place and relatives were kept up to date during visits or over the telephone. Some surveys for people had been conducted. The service had a positive and open culture and staff told us they enjoyed their roles. Feedback about the management was positive. Staff worked in partnership with various agencies and health professionals to ensure people received the required support. Processes were in place to safeguard people. People's communication needs were being met and a complaints process was in place, though there had been no recent complaints relating to care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 11 January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified breaches in relation to risk (including staff training) and governance. Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.