Holmes House Care Home provides accommodation, care and support for up to 78 older people. At the time of our inspection there were 67 people using the service.

At the last inspection on 17 September 2015 the service was rated Good. At this inspection the service remained Good overall. However, we rated the safe domain as requires improvement.

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.

People continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risks to people were assessed and monitored regularly. The premises were maintained, however some works took longer to complete based on the availability of the estates department. We found equipment to ensure people’s food was served at the correct temperature was not available in one dining room.

The environment required updating. Work was planned for this and had been started. The provider was working to ensure the design and décor of the premises was in line with best practice guidance for people living with dementia.

People’s property was not always safe. People had things go missing from their rooms. This had not always been reported to the provider to enable them to look for the missing items.

Staffing levels ensured that people's care and support needs were met. Safe recruitment processes were in place. Medicines were managed in line with the prescriber’s instructions. The processes in place ensured the administration and handling of medicines was suitable for the people who used the service. Medicines had not all been dated when opened and guidance was not always in place for staff for medicines which were taken when required. The deputy manager took action to rectify these concerns during our inspection.

Systems were in place to ensure the premises were kept clean and hygienic. However, cups in use were very chipped. These could harbour infection. There were arrangements in place to make sure action was taken and lessons learned when things went wrong, to improve safety across the service

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. They received care from staff who had received training and support to carry out their roles.

People were supported to maintain their health and well-being. Staff supported people to attend appointments with healthcare professionals. People were encouraged to eat healthily and staff made sure people had enough to eat and drink.

People’s diverse needs were taken into account for the planned development of the adaptation, design and decoration of the premises. Staff demonstrated their understanding of the Mental Capacity Act 2005 and they gained people's consent before providing personal care.

Staff were caring and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided. Staff had a good understanding of people's needs and preferences.

People were listened to; their views were acknowledged and acted upon. Care plans were focused on the person and their wishes and preferences. People and their relatives were involved in the assessment process and the on-going reviews of their care.

People were supported to take part in activities which they wanted to do, and encouraged to participate in events within the local community. There was a complaints procedure in place to enable people to raise complaints about the service.

People, their relatives and staff felt confident to approach the registered manager and felt they would be listened to. Quali

At our inspection we gathered evidence that helped answer our five questions.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with 19 people who used the service, two relatives, 14 staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe living at the home. One person told us, "I feel safe here, I'm very well looked after. I know no one will harm me." Another person told us, "We are safe. The staff respond to alarms quickly." When we looked in people's bedrooms we found that call-alarms were connected.

We saw that staff treated people with dignity and respect and as individuals. Staff spoke politely to people and offered encouragement when they supported them. All six care staff we spoke with knew the forms of abuse recognised in the Health and Social Care Act 2010. Staff knew how to identify and report concerns about people's safety internally within the home and with the relevant outside agencies.

Earlier in 2014, allegations of abuse were investigated by the local authority social services and the police. We found the provider had made changes and improvements to how people were protected.

Care plans we looked at contained risk assessments of things that could potentially harm people. Care plans included plans of how to protect people from risk of falls and risk of injury whilst receiving personal care. We found that people had been protected from the risk of falls and that the number of falls had significantly reduced compared to 2013.

People who used the service and staff told us that they felt enough staff were on duty.

Senior staff we spoke with understood the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control.

We saw that people's bedrooms and communal areas were clean and tidy. We saw areas of the older building that required attention. We noted that these were included in a list of maintenance to be carried out.

Is the service effective?

People’s health and care needs were assessed with them or their relatives. Care plans included details of people's needs and information about how they were supported with their needs. Care workers we spoke with told us that they regularly referred to people's care plans. Care worker's made daily records of how they had supported people. We looked at those records and we found that they showed that care workers had supported people in line with their care plans.

People who used the service told us that they had been well cared for and supported. One person told us, "I've been told about my care and support. I know what to expect. I know they'll look after me." Many people who used the service did so for short stays to give respite to their carers. One of those people told us, "I always get better when I come here." Another person told us, "They've helped me get a lot better."

All the people who used the service were registered with a GP surgery. The provider had arranged weekly GP visits so that people's health could be checked.

People told us that relatives were able to visit the home at times they wanted. One person told us, "Visitors can come at any time, family can have meals with us." We did not see many visitors during our inspection which began at 4pm, but we saw from the visitors' book that several relatives visited the home each day.

We found from the evidence we gathered that the service had effectively planned and delivered care that met people's needs.

Is the service caring?

People told us they were well cared for. One person told us, "I'm treated as an adult. I'm not patronised. The staff are kind and caring." We saw that staff referred to people by their preferred name and took time to have meaningful conversations with people. One person told us, "We can have a laugh with the staff."

Staff did not wear name badges but people told us they knew the names of staff. Every person had a key worker whose photograph and name was on display in people's bedrooms. One person told us, "I'd feel intimidated if staff wore name badges." We saw people refer to staff by name. We found that staff and people who used the service had a good rapport.

The provider had taken steps to improve staff awareness of what dignity-in-care meant in practice. The registered manager and three care staff acted as `dignity leads' who promoted dignity-in-care in staff meetings and supervisions meetings. We found that the provider had taken steps to prevent undignified staff behaviour that had occurred earlier in the year. The registered manager and senior care workers observed care staff to ensure they were attentive to people's needs.

People had been supported with their health and nursing needs because the service worked closely with providers of those services. We found that staff monitored people's health and made referrals to the appropriate specialists when required.

People’s preferences, interests and diverse needs had been respected. People had been able to attend church services or receive visits from representatives of local churches. People took part in social activities that involved other people and had also been supported to enjoy activities that were of particular interest to them. We found that the provider was further developing a range of activities for people with dementia.

We found that the staff understood people's individual needs and had supported people with those needs in a caring way.

Is the service responsive?

People told us they were well looked after. Records we looked at showed that people had been supported with their personal care, nursing and health needs. People told us that they knew how they could make suggestions or raise concerns and that they were confident they would be listened to. A person who used the service told us, "Everybody is interested in us." Another person said, "I know I can definitely report any concerns to the manager."

We saw that the service had responded to changes in people's needs. People's care plans had been updated to show how their needs had changed. We saw that people's care and support routines had been modified or added to in order to support people with new or short term requirements. Staff regularly read people's care plans and had provided care and support that met people's new and changing needs.

We found that the service had been responsive to people's on-going and new needs.

Is the service well-led?

The provider had a system for monitoring the quality of service. This included checks of documentation and records and observations of care worker's practice. Staff meetings took place at regular intervals. We saw from records of those meetings that the manager had shared information about the outcome of monitoring activity.

The service had procedures for reporting of accidents and injuries. We saw that reports were reviewed and analysed and that action had been taken to reduce the risk of the same type of accident occurring again.

The manager regularly sought the views of people who used the service and their relatives. That had been through one to one discussions with people and reviews of people's care plans. The provider also used a satisfaction survey to obtain people's views.

The service worked closely with doctors, district nurses and other health professionals to ensure that people's health and well- being had been provided for.

We found that the service had introduced changes and improvements in response to outcomes of investigations of abuse.

We inspected the service unannounced on 9 September 2015 and returned announced the next day.

Holmes House provides accommodation and personal care for up to 78 older people. At the time of inspection there were 62 people living in the home. The home is made up of two units, Holmes House and a newer purpose built facility, Holmes Court.

The service has a registered manager. 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 using the service told us they felt safe. Staff knew how to recognise signs of abuse and knew how to report concerns about people’s safety. The provider had procedures to investigate and learn from incidents and accidents.

The service worked closely with the local authority to reduce the risk of people experiencing injuries as a result of falls. Risks associated with people’s care and support were assessed and actions taken to minimise the likelihood of those risks occurring. People received their medicines at the right times apart from when that had not been possible. The service had discussed those instances with the prescribing doctor.

The provider had robust recruitment procedures that ensured as far as possible that only people suited to work at the service were employed. Enough staff were deployed to meet the needs of people using the service.

Staff received support through training and supervision to be able to meet people’s needs. Special training was arranged to teach staff how to support people who at times demonstrated behaviour that challenged others. Staff had opportunities to attend specialist dementia awareness training. Staff were aware of the relevance and requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People using the service were supported to have their nutritional and health needs met. Staff made appropriate referrals to health service specialist and people were supported to access health services when they needed them.

Staff were caring and showed compassion when they supported people. Staff understood people’s needs and involved people in decisions about their care. Staff respected people’s privacy and dignity.

People received care and support that was centred on their individual needs. People’s care plans were regularly reviewed. Information about people’s interests and hobbies was used to develop a range of meaningful activities. People using the service and their relatives knew how to raise concerns and were confident they would be listened to.

People using the service, their relatives and staff were involved in developing the service. Their views and suggestions were acted upon. Some staff felt the reasons their ideas and suggestions were not acted on were not always explained. However, staff felt well supported by the management team and felt that the home was improving and that staff morale was good.

The provider had robust procedures for monitoring and assessing the quality of service. They were committed to continuous improvement.