About the service:

Holmewood is a residential care home that was providing personal care to people aged 65 and over. At the time of the inspection there were 23 people living or staying in the home.

People’s experience of using this service:

¿ People told us they felt safe and happy. There were positive and caring relationships between staff and people, and this extended to relatives and other visitors. Staff understood the importance of providing person-centred care and treated everyone as individuals, respecting their abilities and promoting independence.

¿ Staff knew how to recognise and report any concerns they had about people's welfare and how to protect them from abuse.

¿ 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.

¿ Care plans included risk assessments, which identified any risks, associated with people’s care and had been devised to help minimise and monitor the risks without placing undue restrictions on people.

¿ People's medicines were managed safely.

¿ The provider ensured incidents and accidents were fully investigated.

¿ Staff were recruited safely and only suitable staff were employed to work in the service.

¿ There were enough staff to keep people safe and to meet people’s individual needs, and the staff told us they received good training and support. Staff knew people well and had built good relationships. There was also a good mix of staff.

¿ People were encouraged to make decisions about meals, and were supported by staff if they needed any assistance with eating and drinking.

¿ People were involved and consulted about all aspects of their care and support.

¿ Staff spoke to people in a caring and positive way, treated people with respect and were mindful of their rights and dignity.

¿ There was a nice, relaxed atmosphere and people were relaxed and smiling in the staff’s presence.

¿ The environment was clean and fresh and good signage made it easy for people to find their way around the building.

¿ People and their relatives were encouraged to give the views about the service. People could join in activities if they wished and comments received were positive.

¿ The registered manager showed effective leadership and the home was well run.

¿ Staff knew their roles and understood what was expected of them.

¿ Staff felt supported by management and each other.

¿ People, their relatives and staff told us management were approachable and that they listened to them when they had any concerns or ideas.

¿ Feedback was used to make continuous improvements in the service. The provider had good oversight of the service and used effective systems to monitor quality and safety. Where improvements were needed or lessons learnt, action was taken.

Rating at last inspection:

Requires Improvement (report published 27 December 2017). The overall rating has improved following this inspection.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection was undertaken on 6 November 2017 and was unannounced. At the last inspection in September 2016 we rated the service ‘Requires Improvement’ overall and identified a breach of regulation relating to ‘Good Governance’ as records of best interest decisions were not consistently kept. At this inspection, although we found action had been taken to address this breach of regulation, we found a new breach of regulation relating to ‘staffing’ as staff training and supervision was not kept up-to-date. We rated the service ‘Requires Improvement’ again.

Holmewood is a ‘care home’. People in care homes receive accommodation and 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. It is registered for a maximum of 32 people within one adapted building split into four wings. The service specialising in care for people living with dementia. So that everyone can have a single bedroom the maximum number of people living at the service is 28. The home provides long term care, intermediate care and respite (short term) care. People living at Holmewood also have access to a day centre, which is attached. The home is in the town of Keighley. On the day of the inspection there were 28 people living or staying in the home.

A registered manager was not in place. 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 had been recruited, had applied to become the registered manager and was going through the assessment process with the Care Quality Commission.

People said they felt safe and secure living in the home. Safeguarding procedures were in place and we saw these had been followed to keep people safe. Most risks to people’s health and safety were assessed and staff had a good understanding of the people they were caring for. However more robust care planning and staff training was required to mitigate the risks of people living with diabetes.

The medicines management system was in the most part safely managed and people received their medicines as prescribed. Recording arrangements for topical medicines such as creams needed improvement to demonstrate these medicines had been consistently applied.

There were enough staff deployed at the service to ensure people received prompt care and regular supervision. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable adults. There was a low turnover of staff which helped create a stable and experienced team.

Staff training was not consistently kept up-to-date. We saw many staff were overdue training updates in a range of subjects. Supervisions and appraisals needed bringing up-to-date.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was sought and people were involved in decision making to the maximum extent possible.

People had access to a suitable choice and variety of food. People’s nutritional needs were assessed and action taken to address any nutritional concerns.

The service worked in partnership with a range of health professionals to help meet peoples’ needs. Health professionals reported good working relationships with staff and said that the multi-disciplinary team worked well together. Technology was appropriate used to compliment this approach.

Staff were kind and caring and treated people well. People reported good relationships with staff and staff demonstrated they knew people well. People were listened to and staff took time to comfort people and relieve any anxieties people had.

The service re

This inspection took place on 14 September and was unannounced.

Holmewood is registered to provide accommodation and personal care to a maximum of 32 people living with dementia. So that everyone can have a single bedroom the maximum number of people living at the service is 28. Accommodation is provided on two floors and is split into four separate units. The home provides long term care, intermediate care and respite (short term) care. People living at Holmewood also have access to a day centre, which is attached. The home is in the town of Keighley.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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.

At the previous inspection, which took place on 11 April 2014, the provider met all of the regulations we assessed at that time.

Not everyone at the service was able to tell us about their experiences at Holmewood. We therefore made sure we spoke with visitors and other health care professionals visiting the service to seek their views. Everyone we spoke with told us people were safe. Staff were recruited following a robust selection process, to ensure they were suitable for their role in the home. We found that staff training was relevant and up to date.

A number of staff, including the registered manager, had worked at the service for significant number of years and were familiar with people who lived at Holmewood and their care needs. We observed that staff demonstrated a positive regard for the promotion of people’s personal dignity and privacy. Throughout our inspection we found staff were kind, considerate and competent in their roles.

Staffing levels were assessed according to the individual needs and dependencies of the people who used the service. The service was fully staffed, however when necessary the registered manager used ‘bank’ or agency staff who were familiar with the service and this helped to minimise any disruption to people using the service.

Relatives told us staff were always available when they visited. Our observations during the inspection showed there was appropriate deployment of staff, including staff providing care, catering and housekeeping tasks.

Although attention was needed to improve the paperwork associated with the principles of the Mental Capacity Act 2005 (MCA), the registered manager and staff followed the principles of the MCA and Deprivation of Liberty Safeguards (DoLS) ensured people were not being deprived of their liberty in an unlawful way. The lack of appropriate MCA assessments was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was well maintained, clean, fresh smelling and comfortable.

Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They had received appropriate safeguarding training and there were policies and procedures to support them in their role. Risk assessments were in place to identify risks due to people’s medical, physical and mental health conditions and to make sure these were minimised.

Medicines and creams for people who used the service were managed safely. Staff had received the appropriate training and checks took place to make sure medicines were given safely and at the appropriate times. We made a recommendation about the storage of medicines.

People told us the quality of their food was good and their nutritional needs were monitored to ensure risks from malnourishment and dehydration were acted on with involvement of specialist health care professionals when required. Food and fluid monitoring charts were being completed, however some only included a description of the menu provided but not th

During our inspection we looked for the answers to five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

Is the service effective?

People's health and care needs were assessed with them or their relative and responded to as part of the care planning process

Is the service caring?

Care staff were attentive and spent time talking to people and making sure their needs were being met. People commented, “It’s brilliant, really good care.” Another relative told us they visited their family member at any time without notice. They were confident their relative was well cared for and said staff discussed care with them and were always available.

A person who used the service said; “Staff treat me very well.” Another said; “They always knock before they come in, and I often have to say come in.”

Is the service responsive?

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

People who used the service, their relatives and other professionals involved with the service had completed provider satisfaction surveys. Feedback was very positive and comments included “Staff are always very welcoming, friendly and informative”. Other comments included “The management team are very professional and approachable, always supportive and helpful” and “The home is always clean and tidy and smells pleasant”.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. This enabled the provider to focus on improvement.

You can see our judgements on the front page of this report.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people had complex needs which meant they were not able to tell us their experiences. We observed how people spent their time and how staff interacted with people.

The staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

We talked with two peoples relative who told us they were “happy” with the care their relatives received at the home. They said there were generally enough staff to meet their relative's needs and the staff kept them informed about any changes to their relatives care and treatment.

We found people had care plans and risk assessments in place which provided staff with the information they needed to care for them safely.

We also found there was enough skilled staff to meet people’s needs..

During our visit we spoke with three people who lived at Holmewood. They told us they could make decisions about what they did. One person said, “There is always something to do if you want to”.

People we spoke with told us staff were kind to them. One person said, “Staff treat me well, they always take their time when helping me”.

People said they were given their medicines when they needed them.

We were unable to speak with relatives during our visit but we reviewed responses from the relative’s survey of the service in January 2012. One response said there was “Good communication between staff and relatives”. Another comment said, “I am thrilled at the level of care and time staff spend with individuals”.