Archived: Holmesley Nursing Home

Updated 11 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

This unannounced comprehensive inspection was carried out on 5 and 9 November 2018. The first day of the inspection was completed by one inspector. On the second day the inspection team consisted of two adult social care inspectors, and an expert by experience. An expert by experience is a person who has experience of using, or caring for someone using, this type of service.

We reviewed all information the Care Quality Commission (CQC) held about the service before the inspection. This included all contacts about the home, previous inspection reports and notifications sent to us. A notification is information about important events which the service is required to tell us about by law.

We also reviewed the service's Provider Information Return (PIR). This is a form that is completed at least annually. It asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

During the inspection we spoke with 22 people to hear their views of the service. We spoke with six relatives and friends. We also spoke with the registered manager, the two providers, the assistant manager, ancillary staff and 12 care staff. We received feedback from five professionals during the inspection, including a falls nurse specialist; speech and language therapy assistant; a palliative care nurse; a GP and a community phlebotomist (a professional who is trained to draw blood from people for clinical or medical testing). Following the inspection, we received feedback from a GP, a tissue viability nurse and speech and language therapist.

We looked at records relating to the management of the service including six people’s care plans and associated records including medicines administration records. We looked at three staff personnel files including staff training and recruitment records. We reviewed a selection of compliments and the complaints log as well as the accident/incident records. Documentation relating to the maintenance and safety of the premises was also reviewed.

Updated 11 January 2019

This unannounced inspection took place on 5 and 9 November 2018. The service was last inspected in February 2016. The overall rating was good and the key question for Caring was rated as outstanding.

At this inspection, we found the key questions of Safe and Well Led were now rated Requires Improvement. This was because staffing levels had not always been maintained to ensure people’s needs were met in a timely way. Fire safety checks had not been always been completed. The key question of Caring is rated good at this inspection. This was because of the mixed feedback we received about staff’s approach at times.

Holmesley Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Holmesley Nursing Home is registered to provide accommodation for 55 people who require nursing and personal care. The service is intended for older people, who may be living with a physical disability, mental health needs or a dementia type illness. At the time of the inspection there were 53 people living at the service. The service provides accommodation over two floors, with access provided by a passenger lift. Many bedrooms have en-suite facilities and patios leading to the mature and well planted gardens.

The service had a registered manager in post. 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.’

Staffing levels did not always ensure people’s needs were being met in a timely way. Conversations with people and our observations confirmed staff were stretched and busy which led to a delay in some people`s support needs being met. This was being addressed by the provider who had agreed to increase the staff team. We have recommended the provider keep staffing levels and the deployment of staff at the service under review.

Improvements were made during and after the inspection to ensure that medicines were stored at the correct temperature. People received their medicines as prescribed from trained and competent staff.

The registered manager had begun to implement a new system to monitor that regular safety checks were being completed. Some fire safety checks had not been completed as necessary.

The majority of people said staff were kind, caring, friendly and thoughtful. However, some people had less positive experiences and said staff could be “short” with them when busy or short of staff. We received a mixed response from people about how staff promoted their privacy. We have made a recommendation to ensure staff attitude and approach improves.

Quality assurance systems were in place. However, the processes in place had failed to identify the shortfalls found at this inspection. We have made a recommendation to ensure the provider has a clear process for setting and achieving improvement plans.

People felt safe at the service. Comments included, “I am very happy here”; “They (staff) help me…” and “I like it here and feel safe”. They were protected from abuse and their safety was maintained because staff had a good understanding of the risks associated with the people in their care. Risk assessments were in place and provided guidance.

Staff were appropriately recruited, trained and supervised to provide care and support to people who used the service.

People had access to relevant health care professionals. Health professionals provided positive feedback about the service and the good working relation developed. A varied and nutritious diet was offered to people which reflected their needs and preferences.

Staff protected people’s rights by following the principles of the Mental Capacity Act 2005 (MCA). People were supported to have choice and control of their daily lives.

People’s care plans had been developed to identify what support they required and how they would like this to be provided. People had opportunities to take part in activities which they enjoyed and which met their abilities and interests. They were confident that any concerns raised would be dealt with.