Background to this inspection
Updated
25 September 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 team consisted of one inspector and an evidential review officer on the first day of inspection. An evidential review officer is a member of our regulatory support team. On the second and third day, one inspector visited the service.
Service and service type
Holwell Villa 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 registered with the Care Quality Commission. This means that 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 used the information the provider sent us in the provider information return. This is information
providers are required to send us with key information about their service, what they do well, and
improvements they plan to make. This information helps support our inspections. We reviewed the previous inspection report and other information we had received about the service. We used all of this information to plan our inspection.
During the inspection
We spoke with six people who used the service and three relatives about their experience of the care provided. We spoke with six members of staff including the registered manager. To help us assess and understand how people's care needs were being met we reviewed five people’s care records. We also reviewed records relating to the running of the service. These included staff recruitment and training records, medicine records and records associated with the provider's quality assurance systems. 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.
Updated
25 September 2019
About the service
Holwell Villa is registered to provide accommodation and personal care for up to 17 older people. At the time of our inspection, 13 people were living at the service.
People’s experience of using this service
People told us they were happy and felt safe living at Holwell Villa; One person said, I’m happy living here.” We found the service was not operating in accordance with the regulations and best practice guidance. This meant people were at risk of not receiving the care and support that promoted their wellbeing and protected them from harm.
Although the registered manager demonstrated a strong commitment to the people living in the service and spoke passionately about providing good quality care. They did not have sufficient oversight of the service to ensure people received the care and support they needed.
Systems and processes to monitor the service were not effective and did not drive improvement. These included concerns with care records, risk management, medicines, The Mental Capacity Act 2005 (MCA), recruitment, training as well as the overall leadership and management of the service.
People were not protected by safe recruitment procedures. We looked at the recruitment files for four staff members. Whilst some recruitment checks had been carried out, others had not.
Staff told us they felt supported and appreciated by the service’s management team. However, we found staff had not been provided with the appropriate training necessary for them to undertake their role.
People were not supported to have maximum choice and control of their lives. Staff did not always act in accordance with the Mental Capacity Act 2005 (MCA). Where people's capacity was in question MCA assessments were not always taking place and best interests decision processes had not always been followed.
People’s medicines were not managed safely. We looked at the Medication Administration Records (MARs) for 13 people. We found people’s MARs were not accurate and therefore staff were unable to assure themselves that people had received their medicines as prescribed by their doctor.
People were not always protected from the risk of avoidable harm. We found where some risks had been identified, it was unclear what action had been taken to mitigate those risks and keep people safe.
Other risks were well managed, for example, risks had been identified in relation to people’s care needs such as mobility, falls and skin care. Records demonstrated that action had been taken to minimise these.
Regular checks were undertaken in relation to the environment and the maintenance and safety of equipment, and fire safety systems were serviced and audited regularly.
Holwell Villa was clean, and people were protected from the risk and/or spread of infection as staff had access to personal protective equipment (PPE).
People's privacy and dignity was respected, and their independence promoted. People had access to healthcare professionals when required and were supported to maintain a balanced healthy diet.
People and staff were positive about the leadership of the service and told us the home was well managed. Relatives did not raise any concerns about people’s safety and told us people were well cared for. One relative said, “The home is very well run, the registered manager has always gone above and beyond, we have always been very happy with the care they provide.”
People, along with family members were encouraged to share their views through regular reviews and felt comfortable raising complaints and were confident these would be acted on.
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 last rating for this service was ‘Requires Improvement’ (published on 25 August 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvement had been made and the provider was still in breach of regulations.
Following this inspection, we issued a ‘notice of decision’ to impose a condition on the providers registration. This required the provider to undertake a review of the quality assurance systems in place and carry out monthly audits in respect of pressure area care, risk assessment, care planning and recruitment. The provider was required to send to the Care Quality Commission a monthly report confirming the dates on which these audits had taken place, and include the actions taken or to be taken as a result of these audits to demonstrate any areas of risk were being properly identified, assessed and mitigated.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, the need for consent, recruitment, training, notifications, governance and requirements relating to the registered manager at this inspection. We have also made recommendations in relation to the environment, staffing levels, care planning and meeting the Accessible Information Standard (AIS).
Please see the action we have told the provider to take at the end of this report. 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 ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress and continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme.