Holmewood Manor Care Home

Holmewood Manor Care Home is a residential care home that provides personal care for up to 40 people, some of whom are living with dementia. At the time of inspection 23 people were using the service. The accommodation is in a purpose-built home split over two floors. Each floor contained bedrooms, a communal lounge and a dining area. There were accessible outdoor spaces.

People’s experience of using this service and what we found

People’s medicines were not always managed safely, and people were at risk of not receiving their prescribed medicines. The home was clean; however, it was not free from unpleasant odours. There were enough care staff to meet people’s needs, however more staff were needed to work in the kitchen and laundry. People told us they felt safe living at the care home. Risk’s to people and environmental risks had been assessed and managed. Staff had been recruited safely.

People told us they liked living at the home, however they felt there was not a lot of activities to keep them occupied. The provider had systems in place to monitor the quality and safety of the service. However, these had not always been effective in identifying medicine issues. Staff felt supported by the management team. Staff told us they enjoyed working in the home and were committed to ensuring people received high quality care

People were not always supported to have maximum choice and control of their lives. People told us their preferences in regard to their personal care were not always considered. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

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 from our last comprehensive inspection was Good (Report published 11 May 2019). We also carried out targeted inspection to look at infection prevention and control systems however the service was not rated at that time (Report published 26 February 2021).

Why we inspected

The inspection was prompted in part due to concerns about safeguarding, staffing and infection control we found during our last inspection at another service under the same provider. A decision was made for us to inspect and examine those risks at Holmewood Manor Care Home.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvements. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holmewood Manor on our website at www.cqc.org.uk.

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 breaches in relation to safe management of medicines at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a planned schedule of cleaning within the home, however between these times there was no additional touch surface cleaning. Some bathrooms contained mobility equipment which could impact on the effective use of these rooms. Audits in relation to infection control had not been completed regularly to address any outstanding areas of concern. After our inspection the provider reviewed these areas to make improvements.

We found the following examples of good practice.

¿ At the time of the inspection there were no planned visits. However, there were clear arrangements in place for when visitors were allowed to return. These involved questionnaires, temperature checks and lateral flow tests. which provided a rapid test result.

¿The staff had received training to ensure they understood how to use their personal protective equipment (PPE). We saw all the PPE stocks were in place and staff had access to all items they required.

¿ Staff and people using the service had received regular testing. Daily checks were completed so that early intervention can be made to reduce transmission.

¿There were sufficient staff to support people’s needs and contingency arrangements to block book agency staff in the case of annual leave or sickness. Staff were cohorted on to the different floors to reduce the risk of infection

About the service: Holmewood Manor Care Home is a residential care home that provides personal care for up to 37 people, some of whom are living with dementia. At the time of inspection 34 people were using the service. The accommodation is in a purpose-built home split over two floors. Each floor contained bedrooms, a communal lounge and a dining area. There were accessible outdoor spaces.

People’s experience of using this service: People were supported to have choice and control over their lives. However, at the time of the inspection there were limited opportunities for people to take part in meaningful activities and people expressed a wish for more intervention in this area. Most staff engaged well with people and responded to their individual needs promptly. Care was delivered on the whole, by staff who were well trained and knowledgeable about people’s support needs.

People’s needs had been assessed, plans developed, and care delivered, in line with good practice. However, they had not fully considered implementing the Accessible Information Standards which all organisations that provide adult social care are now legally required to follow.

There was a friendly, welcoming atmosphere for people using the service and they gave positive comments about the staff and care provided. People were cared for by staff who were kind and compassionate and who respected their privacy and dignity. Staff were considerate to the people they cared for. People overall said they felt involved in their care and supported in decision making.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Sufficient staff were available to meet people’s needs and people told us staff responded promptly when they called them. People received their medicines regularly, systems were in place for safe administration management. Incidents and accidents were investigated, and actions taken to prevent re-occurrence. The premises were clean, and staff followed infection control and cleaning procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were provided with a choice of varied diet and were complimentary about the food.

Systems were in place to monitor the quality of care and to drive and improve the level of service. At the time of inspection, a new registered manager was being recruited, the service had clear procedures for management cover during this period. Staff had developed good positive working relationships with other services.

More information is in the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published 06 January 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection which was good.

Follow up: We will continue to monitor intelligence we receive about this service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

There is a requirement for Holmewood Manor Care Home to have a registered manager and a registered manager was in place. 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.

The service is registered to provide residential care for up to 40 older people, some who are living with dementia. At the time of our inspection 36 people were using the service.

People told us they felt safe and able to raise any worries or concerns. Staff had been trained and had an understanding of safeguarding and how to keep people safe from potential abuse. Processes were followed to control and prevent any risks associated with infections. Staff were recruited in line with the provider’s policy and procedures, and checks were completed to ensure staff employed were suitable to work at the service.

Staffing levels were based on meeting people’s needs and enough care hours were provided to do so. However, there had not always been two senior care assistants planned on to the rota to enable the senior care assistant role and responsibilities to be completed.

Medicines were stored securely and were well managed. Medicines were administered and records kept in line with the provider’s policy. The provider had identified where improvements were required, for example, in respect of covert medicines management. Other risks to people’s health, for example from risks of weight loss and falls, were identified and actions taken to reduce those risks.

Staff understood how to provide care to people in line with the Mental Capacity Act 2005 (MCA). The registered manager had identified, and was taking steps to improve, the records made of people’s decision making. Applications for Deprivation of Liberty Safeguards (DoLS) had been made when required by the registered manager.

Most people were happy with the meals they received, although some people commented they would like more variety. We saw people’s special dietary requirements were catered for and people had access to snacks and drinks throughout the day.

Other healthcare professionals were involved in supporting people’s health care needs when needed. For example, people had access to district nurses and opticians when needed.

Staff were supported by their line managers and found meetings with their managers useful. Staff were trained in areas relevant to people’s needs and told us they received the support and training they needed to enable them to feel confident in their role. Staff spoke highly of the ‘experience based’ dementia training that helped them understand people living with dementia.

Staff provided care that respected people’s privacy and dignity. Staff had built warm and caring relationships with people and their families. Care plans were developed to include people and their relatives’ views. Care plans were regularly reviewed and people and families felt involved in the process.

Staff helped to create a happy and inclusive atmosphere in the main communal areas. People who told us they preferred their own company told us this choice was respected. Events and activities were open to family members, and arrangements were made to support families to celebrate special times with their relatives.

Staff supported people with personalised and responsive care. People were supported to enjoy activities that were of interest to them. For people living with dementia, the service had developed the environment to help stimulate interest and discussion for people.

People were able to have their views listened to, either through meetings with staff, through making a suggestion or more formally by making a complaint. Where complaints had been made we saw the provider had a policy in place to ensure these were investigated.

The service was managed by a registered manager who was open and approachable. The provider had sent in notifications when required. Notifications are changes, events or incidents that providers must tell us about. The service was developed with consideration for the views of people and their families, and in response to feedback. Other developments in the service, for example dementia care, had been taken in line with good practice. Systems and processes were operated to identify any shortfalls and steps were taken to secure improvements; this helped to ensure the quality and safety of services. Other systems and processes to ensure good practice were in place, for example infection prevention and control audits.

We sat with people over lunch and talked to them about what it was like to live at the home including their views about the food. We also examined four care plans and other records. There were 33 people using the service at the time of our inspection. A summary of what we found is set out below.

Is the service safe?

The service assessed peoples' needs and had care plans in place to ensure the care provided was safe and appropriate. A healthcare professional who was visiting the home on the day of our inspection told us the home were, 'Very quick to contact us about anyone they had concerns about." They said they visited the home often and they had no concerns about the quality of the service provided.

Some people had dementia and we found the service had arrangements in place to assess which decisions the person could make for themselves and which decisions the service needed to make in the person's best interests. There were two Deprivation of Liberty Safeguards (DoLS) in place. The Deprivation of Liberty Safeguards are a legal framework designed to ensure that the care people receive does not unlawfully deprive someone of their liberty.

Is the service effective?

Care plans were designed to maintain people's independence and ensure people experienced a good quality of life. The service worked closely with the local primary care team who supported people with long term conditions. On the day of our visit we saw people involved in a movement and exercise session designed to keep people active and mobile.

The service monitored peoples weight and recorded the person's dietary intake and information was recorded about what the person had done during the day. The information was used to update peoples' care plans and monitor their well being.

Is the service caring?

People who used the service told us staff were caring. We observed staff at several points during the course of our inspection and saw staff treated people as individuals. When we spoke with care staff they told us the quality of the care they provided was important to them.

Relatives we spoke with told us staff were kind and treated people with respect.

Is the service responsive?

Someone told us they had raised concerns with the manager about their relative's care. The person was receiving end of life care. They told us they were pleased with how the service responded. They said extra staff had been brought in to support the person and that they had been fully involved in plans for their relative's care.

The visiting healthcare professional we spoke with told us the service asked for their advice which they followed.

Is the service well led?

The provider had a monthly quality reporting system in place which enabled them to review the quality of care provided.

The manager told us they were trying to develop a more open culture which involved people who used the service, relatives and staff in the organisation of the service. Staff told us things had improved recently and they felt able to raise issues they were concerned about.

At this inspection we spoke with the manager of the service, reviewed a selection of records and briefly spoke with two people living at Holmewood Manor.

We found that improvements had been made to the way that people's needs were being assessed, which included their capacity to consent, and the way that their care was being planned and delivered.

We found that a new manager of the home had recently been appointed. We spoke with the manager during our inspection and they provided information on work they had put in place since joining the home. We found that staff had recently had supervision with the new manager and that staff meetings were being held regularly. Staff we spoke with felt that they were receiving a lot of support from the new manager.

During this inspection we found that there had been improvements in how people's care was planned and delivered. However we were disappointed to find that there were ongoing issues with delays in writing and introducing care plans for people moving into the home. We also observed that people were not always being asked for their consent before receiving care and that formal assessments of people's capacity were not being appropriately completed.

There were 25 people living at Holmewood Manor at the time of our visit. We spoke with three people about their experiences of the care provided in the home; they told us 'I am involved and I let staff know if there are any problems but its best for me to be here, they give me the help I need', 'I'm included in meetings so I get to tell people what I think about it here and I'm a straight talker so I always tell it like it is'. Another person said 'I came here as I didn't feel safe at home anymore and I feel safe now, that's why I like it'.

There were notice boards displaying information for people living in the home and their relatives. They displayed information on activities in the home such as arts and crafts, upcoming events including a christmas fayre and christmas party, the dates / times for upcoming relatives meetings and the results of a survey completed in August 2012.

We found that it took a number of weeks before a full needs assessment and care plans were completed for people moving into the home. We also found that people's needs were mostly assessed however people's care and treatment was not always delivered in line with their individual care plan.