Holmes House Care Home

Updated 20 January 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.

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 and an Expert by Experience. 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

Holmes House Care Home 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. Holmes House Care Home 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 registered with CQC, however they had ceased working at the service shortly before our inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service about their experience of the care provided and 12 relatives. We spoke with 9 members of staff including the deputy manager, operations manager, senior care workers, kitchen staff and care workers. We spoke with 3 professionals about their experience of the care provided at the home. We reviewed a range of records. This included 7 people's care records and multiple medicine records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including training records, policies and procedures were reviewed.

Updated 20 January 2023

Holmes House Care Home is a residential care home providing personal care to 44 people some of whom were living with dementia at the time of our inspection. The service can support up to 49 people in one large building across two floors.

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

Risks relating to people’s environment had not been fully assessed and placed people at risk of harm. Medicines were not consistently managed safely, and people were at risk of not receiving their prescribed medicines. Infection prevention control measures in place were not effective and required further development to ensure people were protected from the risk of infection. Staff reported and recognised safeguarding incidents however action was not always taken to prevent incidents from reoccurring meaning lessons were not always learnt and there was an increased risk incidents would be repeated.

Governance systems and processes had improved following a recent change in management. However, the provider had not always highlighted areas for improvement. At the time of our inspection the providers senior leadership team were supporting the service to make changes in order to improve the quality and safety of care. Relatives told us they were not consistently involved in planning and reviewing peoples care. The service referred to health and social care professionals when needed. However, feedback relating to communication from professionals was mixed.

Staff were recruited safely and there were enough staff to safely meet people’s assessed needs. Staff told us they felt supported in their roles and felt the recent change in management had implemented positive changes.

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.

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 10 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of incidents and overall management of the service. 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 that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the management of incidents and overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of 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 Holmes House Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to infection control, medicines management, the environment and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.