Archived: Holme Bank Residential Home

Holme Bank is a ‘care home’. 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 care home accommodates up to 20 people in one adapted building. At the time of our inspection there were 15 people living at the service. Most of the people living at the service were older people living with dementia.

The provider had failed to ensure a registered manager was 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. A manager remained registered with CQC although they had left their post in 2017. A new manager had been appointed although had left prior to registering with CQC. An ‘acting manager’ was in place during the inspection who had recently taken on this role.

There were widespread and significant concerns identified about the management of risk within the service. People were exposed to multiple risks including those connected with choking, challenging behaviour and skin integrity without appropriate mitigation being in place. People were not protected from potential abuse due to safeguarding incidents not being recognised and reported. People were exposed to the risk of harm due to the poor management of medicines within the service.

People were not supported by sufficient numbers of suitably skilled and experienced care staff. There were widespread issues with the lack of training and supervision of care staff.

People’s rights were not being upheld as the Mental Capacity Act (MCA) was not being used effectively. Decisions were being made about people’s care without the required legal steps being taken under this Act.

People’s nutritional needs were not always met. Advice and intervention from healthcare professionals was not always sought in a timely manner which exposed people to the risk of harm.

While people recognised individual staff members as being kind and caring, they did not always feel the support they received was caring. We found the lack of staff numbers, training and supervision resulted in care standards being poor. Support provided was not always caring. People’s dignity was not always upheld and their independence was not actively promoted.

People were not always fully involved in the planning of their care. People’s needs were not always appropriately assessed and the care and support people received did not always meet their needs. People did not have access to sufficient leisure opportunities.

People’s complaints were not always actively sought and listened to. These complaints were not always responded to appropriately and they were not used to drive improvements across the service.

People were being supported by a staff team who were demoralised and under supported. The culture within the service had become closed and care staff had become afraid to speak out about concerns they had.

People were exposed to significant risks due to the inadequate governance and management arrangements in place. We found there were no auditing and quality control systems in place which had resulted in the provider not identifying the significant issues present within the service.

Due to concerns being identified during the inspection about people’s immediate safety, we contacted the local safeguarding authority and commissioners to raise concerns. As a result the local authority were present during the final part of our inspection and took immediate action to safeguard people living at the service.

We found the provider was not meeting the regulations around providing person-centred care, obtaining appropriate consent, safeguarding, staffing, safe care and treatment, nutrition, complaints and the overall governance of the service. The provider had also failed to send CQC certain statutory notifications which are required by law. You can see what action we told the provider to take at the back of the full version of the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Following the completion of our inspection, the local authority decided to move all people living at the service to alternative homes due to concerns about the standards of care being provided. The provider had also announced their intention to close the service. At the time of publication of this report nobody was living at Holme Bank and receiving care.

A registered manager was in post at the time of our inspection. 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.

People were supported by staff who understood their safety needs and took action to reduce risks. Staff knew how to keep people free from the risk of abuse and knew what action to take if they had any concerns for people’s safety or well-being. There were enough staff to care for people and people were able to obtain support from staff promptly when they needed this. People were supported to take their medicines so they would remain well.

People and their relatives told us staff had received the training they needed and developed the knowledge and skills required to meet people’s individual care needs. Staff provided support to people in ways which recognised and promoted people’s rights to make their own decisions. People said they enjoyed their dining experiences at the home. Staff knew what action to take so people’s health needs would be met as their needs changed.

People were positive about the relationships they had built with staff and told us staff were considerate and caring. People told us they enjoyed spending time with the new registered manager and staff team, who they felt knew them well. People said their rights to dignity and privacy was understood and acted upon by staff. People were encouraged to make their own decisions about their day to day care.

People had opportunities to do things they enjoyed doing, both in the community and at the home, so they enjoyed an increased sense of well-being. People’s care was planned in ways which took into account their preferences and life histories and their current care needs. People, their relatives and representatives said their views were listened to when people’s care was planned. People had not needed to raise any complaints about the service, but were confident action would be taken if complaints were made.

There were opportunities for people and their relatives and representatives to provide feedback on people’s experience of living at the home. Actions were taken to further improve people’s experience of living at the home. Checks were made on the quality of the care by the registered manager and provider. The registered manager provided assurance the way medicines were recorded and stored would be further developed in line with best practice. The registered manager had also identified people’s experience of living at the home could be further enhanced by offering additional opportunities for people to do things they enjoyed, based on people's individual preferences. The registered manager and provider were working to improve these areas. Staff understood what was expected of them and were supported by the registered manager and senior staff to provide good care to people.

We found that people's consent to care was sought. We saw that staff respected people's preferences. A relative of a person living at the home told us, 'They always ring me. The communication is very good'.

People received care which met their needs and promoted their wellbeing. One person told us, 'They always help me'.

Staff used equipment correctly and followed guidance to limit the risk of the spread of infection. One person told us, 'They always wear gloves and aprons'.

Staff were supported to ensure they were knowledgeable and skilled in assisting people safely. People praised staff. One person told us, 'Staff are very good, as far as I'm concerned'.

We found that the provider had a robust complaints procedure. People we spoke with were confident that they could raise any issues they had with staff or management.

Some people had difficulties with communication and as such we observed practice and saw that staff interacted well with people, ensuring they were treated with dignity and respect.

Evidence of verbal encouragement was noted to good effect and staff demonstrated their detailed knowledge of people by responding appropriately to gestures, tones or other expressions. During the course of the inspection, staff were heard to be offering people choices, ensuring a degree of person centred care.

Family members who visited during the course of the inspection were observed as being well known to staff members with appropriate pleasantries exchanged and refreshments being offered.

The home was in a good state of decoration, was clean and well maintained, with pleasant seating areas in the garden.