Archived: Holmwood

Holmwood is a ‘care home’ for people with mental health conditions and learning disabilities. People in care homes receive accommodation and 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.

The service was registered to have 32 people, there were 24 people living at the service at the time of the inspection. At our last inspection on 16 and 17 March 2017, we rated the service good in all inspection key questions.

Holmwood consists of one large house, with bedrooms, communal bathrooms and toilets across four floors, communal lounges and dining’s areas on the ground floor.

The service did not have 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.’ The service had not had a registered manager since December 2017. At the time of the current inspection, the deputy manager was acting as manager on a temporary basis, with a replacement manager due to start in post January 2019.

At this inspection on 26 November and 6 December 2018, we found the evidence to support an overall rating of Inadequate.

During this inspection we identified that the service was failing to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of the regulations for safe care and treatment, protection of people’s privacy and dignity, adherence to the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards including sourcing consent, management of people’s nutritional and hydration needs, provision of person-centred care, good governance, meeting the requirements of fit and proper persons and safe staffing. The provider was also in breach of the Care Quality Commission (Registration) Regulations 2009 due to not consistently submitting notifiable incidents to CQC.

During this inspection, we identified serious concerns in relation to staff competency in the safe support of people experiencing mental health conditions. Extremely poor cleanliness of the environment and lack of infection prevention control measures which was impacting on the care people received. There were significant shortfalls in the assessment and mitigation of risks to people using the service.

The service had poor governance processes in place for monitoring standards and quality of care provided. We requested in writing for the provider to make improvements to the service between our first and second inspection visits, we identified a lack of governance and provider oversight in response to our requests. Staff did not complete audits in areas such as infection control and the quality of care records, this was reflected in our findings of the condition of the care environment, the quality of documentation and poor standards of care being provided.

Staff were not implementing training and recognised good practice in the care and support provided to people living at the service. People’s records and staff’s understanding demonstrated a lack of adherence to the Mental Capacity Act (2005). Staff did not recognise or understand the risks and support needs of people diagnosed with mental health conditions.

Low staffing levels significantly impacted on people’s access to meaningful activities and care records lacked detail in relation to people’s hobbies and interests. There was not an up to date, daily activity timetable, and people told us there was not enough to do.

People were not consistently treated with care and compassion, and their privacy and dignity was not always protected. The condition of the care environment was not conducive to the provision of high quality care.

At this inspection we found serious breaches of Regulations 9, 10, 11, 12, 14, 17, 18, 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Registration Regulations 2009 . These breaches were assessed by CQC as extreme, as the seriousness of the concerns meant that unless we took the action we believed people would be at risk of harm. The overall rating for this provider is 'Inadequate'.

On 10 December 2018, CQC used its urgent powers to keep people safe, and varied the conditions on the provider's registration to remove this location. This means that it can no longer provide any regulated activities and is closed.

The provider appealed against this decision to the First Tier Tribunal (Care Standards) under section 32 (1) (b) of the Health and Social Care Act 2008. The appeal hearing was held on 28 and 29 January 2019, the decision was made that CQC took appropriate action in light of the seriousness of concern, and the appeal was dismissed by the tribunal judge.

Other stakeholders including the local authority supported people and relatives to find other homes or alternative care arrangements. By 12 December 2018, all people living a the home were safely moved to alternative placements.

Full information about CQC's regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded. You can see the enforcement action we took at the end of this report.

There was 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.

At our last inspection in March 2016 we found the provider was in breach of five of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found improvements had been made. The provider was no longer in breach of these regulations.

Since our last inspection the provider had reviewed and increased staffing levels in the home. Staff confirmed that improvements had been made and there were now sufficient numbers of staff in the service. The increase in staffing levels meant that staff could spend more time interacting with people and supporting them to participate in activities. This helped ensure the service was meeting people’s individual needs and preferences.

People were safe living in the home. The service took a proactive and positive approach to risks and worked collaboratively with other professionals to ensure risks to people were managed. Risk assessments were in place for people and updated when risks changed. Some further work was required relating to risks to people from the premises. However, there was a clear plan in place regarding this and the actions that needed to be taken.

Staff understood how to identify and report any safeguarding concerns. The service worked with people to help them understanding potential safeguarding risks to themselves and how they could take action to keep themselves safe.

Medicines were managed safely and people received their medicines as prescribed.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Improvements had been made in this area. Staff and the management team understood the MCA and DoLS and how to provide support in accordance with it. People were supported to understand and make decisions regarding their care and support needs.

The risks to people from malnutrition and dehydration were well managed. People were supported to access healthcare professionals, and this included in relation to nutritional risks.

Not all staff working in the service had received training in subjects the provider deemed mandatory. The registered manager was addressing this with staff and had introduced other resources such as best practice sessions to support staff to work effectively. Staff worked well together and were supportive of each other, this helped them to provide effective care to the people living in the home.

People were supported by staff that cared for and knew them. Staff listened to people and there were opportunities for people to discuss their needs. Staff identified opportunities for people to be more independent and supported people to achieve this.

People received care that was responsive to their needs and preferences. There were opportunities for people to discuss their preferences in relation to their care, as well as discuss any concerns or issues they had. People’s suggestions were responded to. Activities were on offer in the home and trips out of the home had been arranged. The activities offered took in to account people’s individual interests.

Care plans were accurate, reviewed regularly with people, and updated when required. Care plans provided guidance for staff on how to meet people’s needs detail that was individual to people’s needs, although the depth of information could vary depending on people’s individual care plans.

Effective systems and processes had been introduced to monitor the quality of the service provided and make improvements where necessary. The registered manager engaged in effective networking which brought benefits to the service and people living in the home.

There was an inclusive and positive atmosphere in the service. The management team listened to people and staff, taking action in response to their views. Staff spoke positively of the registered manager, their leadership, and the changes that had taken place since our last inspection.

This inspection took place on 7 March 2016 and was unannounced.

The service is a large two storey older house with an extension built on to one side. The house is situated on the edge of a main road within an area surrounded by trees. Inside the property there are a number of communal rooms and various staircases leading to individual’s bedrooms.

The last registered manager left the service in June 2014. The provider had taken steps to recruit another manager who did not continue in their employment. The current service manager started working at the service in January 2016. They were in the process of completing a CQC registered manager’s application at the time of our visit. 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.

There were insufficient staff at the service to meet people’s needs. This meant that people had to wait to receive the support they needed from staff. Because there were not enough staff people had limited opportunities to take part in activities.

Care plans did not contain all of the relevant information that staff required so that they knew how to meet people’s current needs. people did not always receive the care and support that they needed. Where risks were identified there was not always information to show what actions were being taken to reduce these risks.

Staff were recruited safety with criminal record checks in place and references taken up prior to them commencing employment. The staff training matrix included a lot of training which staff could attend, however much of the training was either out of date or had not been undertaken yet.

Staff were aware of the procedure to follow if they thought someone had been harmed in any way. Some concerns raised by staff were not appropriately reported by the manager. A complaints procedure was in place and was being used effectively?.

People had access to healthcare professionals when they needed them; however where necessary, care plans were not always updated as a result. People did not always have their nutritional support needs met. Records were not up to date and staff were not aware of some people’s current nutritional needs.

Staff did not always comply with the Mental Capacity Act 2005 (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.

There were procedures in place which were being followed by staff to ensure that people received medication as prescribed. The service manager had made improvements to the medication processes at the service in response to some medication errors which had occurred.

There was a quality assurance audit in place however the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Shortly after the September 2013 inspection we were provided with an action plan which detailed a timescale for a 'deep clean' of all communal bathrooms, shower rooms and toilets. We were advised that the lounge carpet would be professionally cleaned pending replacement after the lounge had been refurbished.

We found that the 'deep clean' had taken place and further improvements were being made in the bathrooms to bring them up to a better standard.

People participated in and consented to their care planning and monthly reviews. We saw that staff treated people respectfully. Staff were aware of their responsibilities under the Mental Health Act.

The staffing levels were sufficient for the service being delivered and plans were in place which enabled shifts to be covered at short notice as necessary. Staff recruitment procedures were robust.

We found considerable shortcomings in the cleanliness and hygiene of some areas of the home, mainly the bathrooms and toilets. We showed the manager what we had found and discussed it with them. They have subsequently advised that professionals are being contracted to undertake a 'deep clean' of the areas identified.

The complaints process was available for people on noticeboards in the home. Where complaints had been made the manager had responded appropriately, in full, within a few days.

At our inspection on 25 January 2013 we found that a boiler within the home was not working and this was affecting the daily lives of the people living at Holmwood. We told the provider they had to make improvements.

During this inspection carried out on 5 March 2013 we found the necessary improvements had been made.

This inspection was carried out in response to that information and we found the concerns to be substantiated.

We found that three out of four bathrooms were affected, with no hot water being available, leaving only one bathroom to meet the needs of the 25 people receiving care and support at the time of our inspection.

We spoke with five people using the service who all confirmed that they were being affected from the lack of hot water in the building. One person commented "I can't shave in cold water; it's very hard and pulls at my skin."

The purpose of this inspection was to follow up on those areas of concern to ensure that improvements had been made. We found that they had.

The manager was able to demonstrate, by showing us, that they had bought new weighing scales for the home to ensure that those people who were unable to weight bear had accurate weight records in place. We further reviewed the weight records of three people living at the home and found these to be up to date with monthly reviews having taken place.

We were provided with training certificates which confirmed staff had attended training in infection control and manual handling. We were also provided with evidence which confirmed further training had been booked. For example, we saw that mental health awareness and safeguarding adults training had been arranged. We also found that a new monitoring system had been put in place which would allow management staff to review and identify staff training needs in future.

We are confident that the manager of the home had acted upon all our identified areas of concern, to ensure that improvements for the people living at Holmwood were made.

As our previous concerns were based mainly around systems and proceedures, we did not on this occassion speak to people using the service.