Background to this inspection
Updated
29 August 2019
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 Care Act 2014.
Inspection team
The inspection was conducted by three inspectors and a specialist nurse advisor.
Service and service type
Holmwood Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager in post who was in the process of registering with the Care Quality Commission. Registering means they, and the provider, are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed action plans and information shared with CQC by the local authority, information we held about the service including feedback received and statutory notifications. Statutory notifications are reports of events that providers have a legal duty to notify us of.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We spoke with five people, three relatives and eight members of staff. This included the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with a visiting GP. We reviewed a range of records including five care plans and medicines records. We looked at two staff files in relation to recruitment and a variety of records relating to the management of the service, including policies and procedures
After the inspection
We asked for information to be sent to us by the provider to confirm what they had told us on inspection.
Updated
29 August 2019
About the service
Holmwood Nursing Home is a care home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. Some of the people may be living with dementia. The service can support up to 48 people.
People’s experience of using this service and what we found
There had been some improvements at the service. The previous manager had left which had slowed the pace of improvements, despite the provider remaining legally responsible for the quality of the service at all times. The new manager had been in post since May 2019 and acknowledged more work was needed. The further, recent change in management had led to some confusion to people and relatives about who was responsible for the care to be delivered. Staff felt supported but work needed to be done to ensure staff worked together effectively as a team.
People were not always protected from the risk of abuse as incidents were not always recognised as potential safeguarding concerns or reported where appropriate, to the local authority. Risks to people were managed well with improvements in the recording of people who required specialist input to keep their skin intact. Medicines were administered appropriately however action was needed to make sure medicines did not take too long to be given. There were enough staff to meet people’s needs and action was taken to monitor incidents and accidents to prevent a re-occurrence.
People’s needs were not always appropriately assessed. This is an area that needs to be addressed particularly when the service starts admitting new people. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. People were not always treated with dignity and respect through occasional lack of thought by staff. Care planning had improved however time was needed for this to be embedded into staff practise.
The mealtime experience was positive for people however there needed to be consideration as to how the environment and people’s rooms could be decorated in line with their needs and wishes. People were involved in the planning of their care and encouraged to be independent where possible. Activities had improved with thought being given as to how people could be encouraged and engaged. Staff were aware of people needs and care planning, including for end of life, care planning had moved fully to an electric system which had enhanced accuracy. Feedback form visiting healthcare professionals was that the service was improving.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update – The rating at the last inspection was Requires Improvement (published 3 May 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvements had been made but these need to be sustained and the provider was still in breach of some regulations.
Why we inspected
This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holmwood Nursing Home on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to person-centred care, dignity and respect, consent and good 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
The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We have done this as there is still one key question rated as 'Inadequate'. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. 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.