Heather Holmes Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There were effective systems and processes in place to make sure people were protected from harm and injury. However, some of these records had not yet been transitioned appropriately across to the new care reporting software. This could have meant some risks were not identified by the manager. We discussed these with the registered manager and area director, and they took immediate action to rectify these and put in place strategies to prevent re occurrence. Staff were recruited safely and received training appropriate to their role which included specific training support for people with a learning disability and autistic people. The home was accessible, clean, and audits for maintenance were being used. Staff understood how to reduce risks to people, to keep them safe whilst ensuring people were not subject to any unnecessary restrictions. The service was safe and welcoming. Individual and environmental risks were assessed and regularly reviewed. People received their medicines when needed, by staff trained in medicines management. Some processes related to medicines management were not as efficient as they could have been, and these were improved upon.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us communication with the registered manager was good. The staff team demonstrated a commitment to ensuring people were supported to achieve good outcomes. One relative told us, “My relative is always happy to return after a day out. They have worked hard to get around any problems there were”. Another relative told us they were not sure there was enough quality time to build up life skills. We saw that this concern was being addressed, and additional resources being sought. We read feedback from one relative who did not feel she had received information she had requested. We saw the outcome of this concern and are assured the area director has taken steps to resolve these issues.

Staff told us they felt supported and able to raise any concerns with the management team and were confident action would be taken. Staff received training suitable to their role to meet people’s needs safely and we saw evidence of an understanding around reporting incidents. The management team understood the need to be open and honest when things went wrong in line with their responsibilities under the duty of candour. We saw evidence that risks are not overlooked or ignored. They are dealt with willingly as an opportunity to put things right, learn and improve.

Staff understood their responsibility to be open and honest and understood the importance of reporting accidents and incidents. Any lessons learnt were discussed in team meetings. These were reviewed by the management team to identify any trends or patterns so actions could be taken to mitigate emerging risks. However, we saw an incident where it was not clear the manager had been aware of an issue the staff had raised regarding a person's health needs. When we raised this the manager rectified this straight away. The area manager had identified some areas for improvement in the service related to this incident prior to our assessment. We were assured with the training plan in place to drive forward these improvements.

People did not raise any concerns with us relating to their ability to access other health and social services. One relative told us “The staff sort out my relatives’ medical appointments and the carers go with him. The staff stay with my relative at the hospital”. We asked for people's experiences of their transition to Heather Holmes. One relative told us “There were quite a few meetings before my relative moved in. A family member stayed with our relative for 3 days to help them settle in. The home visited our relative to see if they were suitable. 2 Main carers went to the day care centre and stayed overnight with my relative.” We saw evidence that people who moved into Heather Holmes were supported to stay in touch with friends from their previous homes.

Staff had good knowledge of which health and social care professionals supported which people. Staff were able to explain when these professionals visited, and what type of support they offered. Staff knew how to monitor people’s health conditions, to ensure timely referrals were made to other services. The manager told us they were confident that people had access to the health and social care services they required to lead healthy and fulfilling lives. We saw evidence of the manager working diligently with outside agencies to enable people to have access to what they needed.

We did not receive feedback from external partners regarding this. No concerns were identified.

Staff kept clear summary documentation on people’s needs. If the person required a hospital admission, health professionals were provided with sufficient information to enable them to provide the care and treatment required. Where people required external health and social care support, documentation showed that suitable referrals had been made. For example, we saw a referral had been made to Occupational Therapy. There were systems to help people move to the service. These included personalised transition plans. For example, arranging visits to the service and spending time with people who lived there. Staff also spent time with people before they moved to the service, providing care and support in their previous homes. We saw a transition plan which included extra training for a specific medical need, and additional support at night initially as this was an area of concern. People’s health and communication needs were known and could be shared with other professionals so they could provide personalised care when people accessed these services. Where a person was transitioning out of the home a plan of sharing information was created in partnership with their social worker to ensure appropriate information was shared.

Some people were unable to give us feedback verbally around safeguarding. However, we observed people to be relaxed, safe and comfortable in their home environment. If possible, they told us they liked living at Heather Holmes and “the staff are very nice”. Relatives told us they felt the home was safe. One said “My relative is massively safe. They have a responsibility for my relative and do everything in my relatives’ best interests.” One relative told us there had been a safeguarding incident involving their relative and they had been informed quickly, and “all the right procedures” were followed.” However, one relative advised us “The place is clean and tidy, but I’ll never know if it is 100% safe especially when they use agency staff.”

Staff had received training in safeguarding adults. Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents, or concerns. We saw evidence of staff being able to recognise the signs of potential abuse and knew the action to take. One member of staff told us, "Sometimes we can tell if somebody feels unsafe because of their actions. We then spend time with the individual and I want them to be able to tell me anything.”

We observed staff being patient with people and supporting them in line with their risk assessment to keep them safe. For example, a member of staff supported a person to eat their lunch, which had been prepared in line with the Speech and Language recommendations. This was done at the persons pace with no rushing.

There were effective systems, processes, and practices to ensure people were safe from risk of harm and abuse. Notifications of incidents had been submitted to CQC in line with regulatory requirements.

Most people’s care plans contained detailed risk assessments linked to their support needs. These plans should include details about people's individual medical conditions and how staff safely supported them, however these were not always in place. We made recommendations to the provider to improve this area, and we are assured it has been addressed and included in training plans for the new ways of working in the home. We are not aware of any harm to people during the previous way of working.

Staff understood the need to protect people and keep them safe while enjoying their local community, and within their day-to-day care needs. Staff knew people well and how to manage their risks. Staff told us they had training to safely care for people. They knew how to use equipment and how to support people to move in a safe way. Some people were at risk of choking when eating or falling when transferring and staff knew how to safely support people without being overly restrictive.

Our observations showed staff supporting people safely and managing risks to their welfare and safety. People were supported to carry out tasks around the service that could place them at risk. For example, assisting one person to have their own work shed in the garden with associated tools. Their risks were assessed, and staff kept people safe.

Risk assessments were in place to support people to be as independent as possible and provided clear and relevant guidance for staff. The risk assessments covered all aspects of people's health, daily living, and social activities other than those reported elsewhere in the report. People were kept safe by staff regularly reviewing and consideration was given to updating their risk assessments as needs, interests, and activities changed.

People felt the home environment was safe and they were supported to maintain their bedrooms and communal areas. People's rooms were highly personalised, and this was encouraged by the staff. People were able to make choices about décor and were involved in making decisions about the environment.

No concerns were raised by staff about the safety of the home environment. We saw audits where maintenance issues could be raised and dealt with. There were plans for improvements to the home to make the stairs safer and give more space for personalised activities to take place.

The environment was suitable to meet the needs of people who lived there. The home was free of clutter, rooms used to store potentially harmful materials such as cleaning products were locked. Equipment used to support people was stored safely. This helped to keep people safe. There was a range of equipment suitable to meet the needs of people who had physical disabilities. The home was well lit and ventilated. Access was available to a safe and secure garden area. People were cared for in a safe environment.

There were effective arrangements to monitor the safety and upkeep of the premises and to ensure facilities and equipment were well-maintained. When equipment required a service, the dates were recorded, and action taken. The staff carried out regular checks on safety including fire safety. The staff had developed personal evacuation plans to describe the support people needed in the event of an emergency evacuation.

We saw that staff took time to sit and talk with people and engage in activities. People were laughing and joking with staff, and staff were always available. One relative told us “I don’t know what they could do to make things better because they do a marvellous job.” However, another relative said “There are no senior staff available at weekends.”

Staff were suitably trained and had their competencies assessed regularly. Staff told us they received regular supervision and were supported by the management team if they made suggestions to improve a person's experience. The registered manager said that “We ensure that there are fully qualified staff on each shift in all mandatory and person specific training areas.” However, some staff told us they did not feel there was always enough staff at weekends which was stressful for them but did not affect people’s care.

We saw staff supporting people safely and attended to them in a timely manner. Our observations confirmed there were enough staff deployed to keep people safe and meet their needs. We saw agency staff demonstrate care, and knowledge around people's needs. We saw evidence of recruitment plans to try and reduce the number of agency staff and plans to create more senior roles for the weekends.

There were enough suitable staff deployed to care for people. Staff vacancies were covered by regular temporary staff who were familiar with people and the home. There were systems to ensure only suitable staff were recruited. These included a range of checks, an induction and training. Staff had access to a range of training and opportunities to meet with their manager to discuss their work and the service. The registered manager had organised for specialist training where they identified the staff needed this e.g. PEG care. Staff had undertaken training to understanding about learning disabilities and autism.

People did not raise any concerns with us about the cleanliness of the home.

Staff knew what personal protective equipment they should wear and when. They knew how to help to control/prevent the spread of infection. The manager was confident that the home met all required infection control regulations and procedures. Staff explained they had undertaken training about infection prevention and control.

The home was clean, and hygienic, with appropriate signage. There was hand sanitiser and personal protective equipment (PPE) also available. We saw that staff had access to personal protective equipment (like gloves) throughout the home. This allowed them to support people in a hygienic way. We saw any dirt or spillages in the home were quickly resolved. All equipment we saw was clean and maintained.

There were processes and policies in place to ensure the environment was kept clean and hygienic. Including Rotas, audits, laundry, and waste management.

People did not raise any concerns with us about medicines optimisation. One relative said, “The staff were trained in using the Buccal medication for my relatives’ seizures.”

Staff said they were trained in medicines management and helped with the stock checking. They know the local pharmacy who works with them and would know who to ask for advice if they needed to.

We reviewed medication policies, medicines administration records (MARS), care plans, and risk assessments. People received medication from trained care staff. People's medicines were stored correctly and safely in line with guidance. The provider demonstrated an understanding of the principles of STOMP (Stopping over medication of people with a learning disability and autistic people). We made some recommendations around the timing of administering medication to reduce the risk of distractions and error. We found some care plans on the new system which were not completed but we saw evidence of these in previous plans. They have since been moved to the new system and we are assured the processes for this to always happen are in place within the training plan.