Archived: Holehird - Care Home with Nursing Physical Disabilities

Holehird provides care and nursing for up to 29 people with physical disabilities. At the time of the inspection there were 25 people living there.

The home is a detached period property that has been suitably adapted. Accommodation is provided over two floors and has accessible outdoor areas with extensive gardens. It is close to the town amenities of Windermere and the Lake District.

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

The service continued to provide exceptional effective treatment and person-centred care which had outstanding results and for some people life changing. The in-house physiotherapy and clinical teams worked exceptionally well with other organisations in helping people achieve positive and life changing outcomes. They built people’s confidence and supported them in regaining their independence sufficiently to leave residential care.

Visiting professionals told us the team at Holehird were extremely effective and totally committed to extending their clinical knowledge for the benefit of people in their care. We were told the team used their extended skills and made a huge effort in enabling people to develop their functional skills and daily activities. The service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.

The provider had safeguarding systems to protect people from the risk of abuse or unsafe care. Staff were aware of the procedures, had received training on it and knew what action to take. We saw that staff treated people with kindness and respect and made sure their dignity was maintained.

The provider had policies and procedures to support the safe recruitment of staff. The registered manager made sure sufficient numbers of appropriately trained staff were on duty throughout the day and night to make sure people received the support they needed.

Staff gave people the support they needed to take their medicines. People received their medicines safely and as their doctor had prescribed. People received support to maintain good nutrition and hydration in line with their personal choice.

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. People and their families had been fully involved in planning and reviewing the care and support provided.

People's rights were protected. People were treated with respect and their dignity and privacy were actively promoted by the staff supporting them. People were fully supported to maintain their independence. The provider planned people's care to meet their needs and take account of their choices. People could see their families and friends as they wished.

People knew how they could raise concerns about the service provided. The provider and registered manager monitored the quality of the service and identified areas which could be improved. Governance and quality assurance were well-embedded within the service. Staff said they felt valued and respected.

The leadership of the service promoted a positive, open culture. The registered manager and staff team displayed knowledge and understanding around the importance of openness and working closely with other agencies and healthcare professionals to make sure people had excellent effective 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 3 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, in March 2015 the service was rated overall as Good. At this inspection we found the service remained Good.

Medicines were being administered and recorded appropriately and were being kept safely. We saw that improvements had been made in the recording of medications that were topically applied.

When employing fit and proper persons the recruitment procedures of the provider were robust in ensuring suitable people had been employed.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager or care manager to the appropriate authorities and we could see records of the actions taken by the home to protect people.

People’s rights were protected. The staff team was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body and was required to maintain their safety and welfare. We noted that four of these authorisations had not been notified to the commissions in a timely manner.

We have made a recommendation that the registered provider ensures the commission is notified in a timely manner when DoLs have been authorised by the local authority.

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.

Staff had completed training that enabled them to improve their knowledge in order to deliver care and support safely.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made.

There was a clear management structure in place and staff were happy with the level of support they received.

People living in the home were supported to access meaningful and individually tailored activities and pass times of their choice.

The in house physiotherapy services provided in the home positively impacted on people’s independence and physical movement potential. The on site physiotherapy service was available to people using the service as and when they required it. It also meant people had an individual postural management plan that supported intensive rehabilitation. A variety of facilities and specialised equipment was provided to support individual people’s levels of abilities that promoted their independence.

A variety of facilities and specialised equipment was provided to support individual people’s levels of abilities’ to promote their independence and ensured safe moving and handling.

Audits and quality monitoring systems were in place to allow the service to demonstrate effectively the safety and quality of the home.

Further information is in the detailed findings below.

The records we saw for assessing risks had been consistently reviewed. This meant that the information about the welfare and safety of people using the service was accurate and where changes in their needs had been reported the plans of care reflected them.

Senior managers in the organisation had carried out increased visits to assess and monitor the quality of the care and facilities provided to people. The manager told us that they had recruited more qualified staff which meant they were using less agency staff.

The records we saw for assessing risks were not consistently reviewed.

Staff we spoke with told us about their training in infection control. One member of staff told us,'We refresh our training regularly'.

Staff we spoke with told us about their induction programme. One member of staff said,'The training was very thorough''.

There was evidence that learning from incidents did not implement the appropriate changes required to risk assessments and care plans.

People using the service we spoke to told us they had no complaints about the service but would be happy to raise their concerns directly with the manager or staff.

Staff we spoke with told us the systems used to review assessments and care plans were being updated.