Holmwood Gardens Domiciliary Care Services

Holmwood Gardens provides care at home and is a supported living service. People either live in the community in single or shared accommodation. There are also two supported living settings where people have individual or shared apartments with communal space. Staff provide onsite 24-hour care in both the supported living sites, and some people receive 24- hour care in the community. People receiving support are living with a learning disability and some people have physical needs and complex health conditions.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, 18 people were receiving the regulated activity of personal care.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted.

‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People received care and support that enabled them to have choice and control of their care. People’s independence was promoted.

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.

Right Care: People received care and support that was personalised. People were supported to achieve positive outcomes and led an active and fulfilling life.

Right Culture: Relationship difficulties amongst staff and the management team had had a negative impact on the culture of the service.

Medicines management did not follow best practice guidance. People’s support plans and risk assessments did not consistently reflect current care and support needs. Recruitment checks were not sufficiently robust. The provider’s systems and processes that assessed, monitored and improved quality and safety required improvements.

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 7 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the behaviour of some staff, and an allegation of financial abuse. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. The registered manager took some immediate actions to make some improvements. Please see the Safe, Effective 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.

Enforcement

We have identified one breach in relation to the provider’s governance systems and processes 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 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.

Not everyone residing at Holmwood Gardens received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of the inspection 15 people were receiving a service. People’s packages of care varied dependent upon their needs. Some people received continuous support over a 24-hour period, whilst others received support for a differing number of hours each day.

Holmwood Gardens Domiciliary Care Service had a registered manager. 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.

People’s safety was promoted by staff who implemented the guidance as detailed within people’s risk assessments and care plans. Assistive technology and equipment was used to promote people’s safety and independence. People were supported by staff that had been recruited and had checks undertaken to ensure they were suitable for their role. People’s medicine was managed safely and people received their medicine on time.

People’s needs were assessed to ensure the service and staff could meet their needs. The level of support people received was dependent upon their needs, which included support to access health care appointments and dietary needs, which for some included support with grocery shopping, meal preparation and cooking. Staff received support from the management team, however the frequency of formal staff supervision was not consistent. We found, people were supported to have maximum choice and control of their lives and staff supported them in the least restrict way possible; the policies and systems in the service supported this practice. This included the use of assistive technology and working consistent with the Mental Capacity Act 2005.

People using the service and a majority of family members spoke of the positive relationships they had developed with staff. People’s comments and that of their family members evidenced how these relationships had supported people, in gaining confidence to make decisions for themselves. People’s dignity and privacy was promoted and people were aware of their right to confidentiality.

People’s views, and in some instances, those of their family members had been sought to develop and continually review their care and support. Concerns and complaints had been investigated and documents supported this. People’s care plans had considered the individual needs of each person and the role of staff in meeting these. People were supported by staff to access a range of activities within the community, which included for some going on holiday with the support of staff.

People’s communication needs were considered when developing care plans, which included information as to how people communicated. This information was used to ensure people had the opportunity to make decisions and express themselves in a way that was understood by staff.

Systems were in place for people using the service and family members to comment upon and influence the service, which included the sending out of questionnaires seeking people’s views. However, we found areas for improvement were required, to ensure the questions asked fully reflected the service provided and took into account the needs of people and why they used the service.

Staff’s opportunity to develop and comment upon the service provided and learn from events and incidents were not maximised. This was recognised by the registered manager. Staff meetings were regularly held; however, the agenda of meetings did not provide an opportunity for staff to learn from incidents and events to make changes to their care practices. Staff received supervision, however the frequency of staff supervisions was inconsistent. The format and approach to staff supervision was restrictive and did not include an annual appraisal or personal development plan to reflect staff’s aspirations, individual goals or training needs.

The registered person regularly visited the service, speaking with people who used the service, visiting family members and staff. Staff told us they found the registered person to be approachable. The registered person and registered manager regularly met, however their meetings with neither structured or recorded. This meant opportunities to review the quality of the service provided and to formalise ideas with a view to the development of the service within an agreed plan were not taken.

People using the service and a majority of family members expressed satisfaction with the day to day management of the service, and the registered managers approach to listening and acting upon their comments.

The registered manager had attained qualifications and attended courses on management and leadership, they told us their training had helped them in identifying areas for improvement and ideas they wished to introduce to further develop the service. Staff spoke positively about the support they received from the registered manager, which included their approachability and ‘open door’ policy.