Archived: Holderness House

Holderness House is a residential care home providing accommodation and personal care to up to 33 people. There are five floors altogether, although two were smaller split levels. The service provides support to ladies, some of whom may be living with dementia. At the time of our inspection there were 23 people using the service.

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

Governance systems in place were not always effective at identifying and addressing issues. Audits were carried out and identified areas for improvement, but action plans were not always developed.

Medicines were not always managed in line with best practice, records were not always in place, such as protocols to guide staff when to administer as and when required medicines and special instructions were not always recorded. Medicines were stored safely, and staff had received medicines training. We have made a recommendation about this.

Checks were not always in place to ensure risks were managed, such as window safety checks. Some single pane glass did not have measures in place to manage the risks. The provider started to address this during the inspection. Care plans and risk assessments were in place but required further detail. We have made a recommendation about this.

Staff had been recruited safely and we received positive feedback regarding the staff. The provider used a dependency tool to assess the staffing levels, however information in this did not correspond with people’s care records.

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. However, some records were not sufficiently detailed.

People were happy with the support they received, and we received positive feedback regarding the staff. Staff were supported in their roles and felt there was good teamwork at the service. Communication systems were in place to engage with staff, people and their relatives such as meetings and satisfaction surveys.

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 30 July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 Holderness House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to governance at this inspection and recommendations in relation to medicines and risk management.

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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Staff knew how to safeguard people from the risk of abuse and harm. They completed risk assessments which helped to guide staff in how to minimise risk whilst accepting people liked to be independent. There was sufficient staff employed and they were recruited safely ensuring full employment were in place before they started work.

People’s health and nutritional needs were met. Staff contacted people’s GPs or other health professionals when required and ensured they received their medicines as prescribed. The menus provided people with a balanced diet and they were very pleased with the meals they received.

People’s needs were assessed and care plans produced, which helped to guide staff in how to care for them in the way they preferred. 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.

People told us the staff were kind and caring and respected their privacy and dignity. They were supported to be as independent as possible and included in decisions such as menus and activities. There were activities for people to join in or simply watch, and the opportunity to access community facilities and events.

Staff had access to training, supervision and support which ensured they had the right skills to care for people. They all said Holderness House was a nice place to work and the registered manager was accessible and listened to them.

Management completed audits and checks so that shortfalls could be identified and addressed. People knew how to make a complaint and felt able to do so. The environment was clean and tidy.

Further information is in the detailed findings below.

The service is required to have a registered manager. A registered manager is a person who has registered with the CQC 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.

We undertook this unannounced inspection on the 6 and 7 January 2015. At the last inspection on 1 October 2013 the registered provider was compliant in all areas assessed.

We found the culture of the organisation was one of openness and a willingness to listen and improve the quality of care for people who used the service. There was an organisational structure in place to support and oversee systems.

The environment was safe, clean and fresh. We noted some areas that required attention to ensure good infection prevention and control and these were mentioned to the registered manager to address.

There were assessments for people to ensure specific areas of risk had been identified but we noted two areas had been overlooked. For example, with the use of bed rails for one person and the risk of pressure ulcers for others; we saw the care people required to keep them safe was in place though.

Staff had received training in how to safeguard people from the risk of harm and abuse. They knew the different types of abuse, signs and symptoms and how report any issues of concern.

We found staff were recruited safely and in sufficient numbers to care for people safely and effectively. Staff had access to training and support to ensure they felt confident when supporting people who used the service.

We observed the staff approach to be kind, caring and attentive. Staff listened to people and provided explanations and information to them. We saw people were treated with respect and dignity and their independence was maintained as much as possible. There was an activity co-ordinator who arranged meaningful occupations and stimulation for people.

We found people were supported to make their own decisions. When people were assessed as not having capacity, the registered provider acted within the law when making decisions on their behalf.

We saw people who used the service received their medicines as prescribed. Staff were aware of people’s health care needs and how to recognise when this was deteriorating; their health needs were monitored and met. People had access to health and social care professionals in the community when required.

People liked the meals provided. Their diet was varied with choices and alternatives available to them at each meal to ensure their nutritional needs were met.

People knew how to make a complaint. They told us they would feel able to complain to staff or management and this would be addressed for them.

We found quality monitoring took place and checks were completed to make sure any areas of improvement were addressed quickly. People were able to make suggestions and we saw they were listened to and actions taken when required.

We observed the lunchtime experience and saw that the food was well presented and was plentiful. Food was presented on shared warm trays and allowed people to serve themselves which promoted independence.

We looked at medicine administration records (MAR) that was accurate with the amount of drugs that remained in stock and the amount of drugs that was administered. These records were found to be accurate, precise and transcribed in a clear and consistent manner.

We spoke with three members of staff who told us they had been on a range of training courses and that their personal development was supported. They also told us management was really effective about supporting their career progression.

People we spoke with said they knew how to make a complaint and felt assured that if they needed to make a complaint they would be satisfied the service would deal with it effectively .

People told us they felt safe in the home. They also said they liked their room and the

home was clean and tidy. During our visit we also spoke with visiting relatives who confirmed the home offered excellent care and support for their relatives in the home. A relative commented that, "My mother feels safe here and personal care could not be better."

We saw from documentation that people had their needs assessed and were involved in the planning of their care. We looked at staff appraisal records which showed us staff had not undertaken an appraisal to ensure that staff training and development needs were assessed.