About the service: Holmewood Manor Care Home is a residential care home that provides personal care for up to 37 people, some of whom are living with dementia. At the time of inspection 34 people were using the service. The accommodation is in a purpose-built home split over two floors. Each floor contained bedrooms, a communal lounge and a dining area. There were accessible outdoor spaces.

People’s experience of using this service: People were supported to have choice and control over their lives. However, at the time of the inspection there were limited opportunities for people to take part in meaningful activities and people expressed a wish for more intervention in this area. Most staff engaged well with people and responded to their individual needs promptly. Care was delivered on the whole, by staff who were well trained and knowledgeable about people’s support needs.

People’s needs had been assessed, plans developed, and care delivered, in line with good practice. However, they had not fully considered implementing the Accessible Information Standards which all organisations that provide adult social care are now legally required to follow.

There was a friendly, welcoming atmosphere for people using the service and they gave positive comments about the staff and care provided. People were cared for by staff who were kind and compassionate and who respected their privacy and dignity. Staff were considerate to the people they cared for. People overall said they felt involved in their care and supported in decision making.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Sufficient staff were available to meet people’s needs and people told us staff responded promptly when they called them. People received their medicines regularly, systems were in place for safe administration management. Incidents and accidents were investigated, and actions taken to prevent re-occurrence. The premises were clean, and staff followed infection control and cleaning procedures.

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. People were provided with a choice of varied diet and were complimentary about the food.

Systems were in place to monitor the quality of care and to drive and improve the level of service. At the time of inspection, a new registered manager was being recruited, the service had clear procedures for management cover during this period. Staff had developed good positive working relationships with other services.

More information is in the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published 06 January 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection which was good.

Follow up: We will continue to monitor intelligence we receive about this service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 6 December 2016 and was unannounced. At our last inspection in September 2015, the service had two breaches of the Health and Social Care Act 2008. This was in relation to infection prevention and control, and people receiving appropriate care to meet their needs and preferences. At this inspection, we found improvements had been made.

There is a requirement for Holmewood Manor Care Home to have a registered manager and a registered manager was 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.

The service is registered to provide residential care for up to 40 older people, some who are living with dementia. At the time of our inspection 36 people were using the service.

People told us they felt safe and able to raise any worries or concerns. Staff had been trained and had an understanding of safeguarding and how to keep people safe from potential abuse. Processes were followed to control and prevent any risks associated with infections. Staff were recruited in line with the provider’s policy and procedures, and checks were completed to ensure staff employed were suitable to work at the service.

Staffing levels were based on meeting people’s needs and enough care hours were provided to do so. However, there had not always been two senior care assistants planned on to the rota to enable the senior care assistant role and responsibilities to be completed.

Medicines were stored securely and were well managed. Medicines were administered and records kept in line with the provider’s policy. The provider had identified where improvements were required, for example, in respect of covert medicines management. Other risks to people’s health, for example from risks of weight loss and falls, were identified and actions taken to reduce those risks.

Staff understood how to provide care to people in line with the Mental Capacity Act 2005 (MCA). The registered manager had identified, and was taking steps to improve, the records made of people’s decision making. Applications for Deprivation of Liberty Safeguards (DoLS) had been made when required by the registered manager.

Most people were happy with the meals they received, although some people commented they would like more variety. We saw people’s special dietary requirements were catered for and people had access to snacks and drinks throughout the day.

Other healthcare professionals were involved in supporting people’s health care needs when needed. For example, people had access to district nurses and opticians when needed.

Staff were supported by their line managers and found meetings with their managers useful. Staff were trained in areas relevant to people’s needs and told us they received the support and training they needed to enable them to feel confident in their role. Staff spoke highly of the ‘experience based’ dementia training that helped them understand people living with dementia.

Staff provided care that respected people’s privacy and dignity. Staff had built warm and caring relationships with people and their families. Care plans were developed to include people and their relatives’ views. Care plans were regularly reviewed and people and families felt involved in the process.

Staff helped to create a happy and inclusive atmosphere in the main communal areas. People who told us they preferred their own company told us this choice was respected. Events and activities were open to family members, and arrangements were made to support families to celebrate special times with their relatives.

Staff supported people with personalised and responsive care. People were supported to enjoy activities that were of interest to them. For peop

As part of our inspection we met with six people who used the service and three relatives. We spoke with three care staff and a visiting healthcare professional who visited the home often.

We sat with people over lunch and talked to them about what it was like to live at the home including their views about the food. We also examined four care plans and other records. There were 33 people using the service at the time of our inspection. A summary of what we found is set out below.

Is the service safe?

The service assessed peoples’ needs and had care plans in place to ensure the care provided was safe and appropriate. A healthcare professional who was visiting the home on the day of our inspection told us the home were, “Very quick to contact us about anyone they had concerns about." They said they visited the home often and they had no concerns about the quality of the service provided.

Some people had dementia and we found the service had arrangements in place to assess which decisions the person could make for themselves and which decisions the service needed to make in the person’s best interests. There were two Deprivation of Liberty Safeguards (DoLS) in place. The Deprivation of Liberty Safeguards are a legal framework designed to ensure that the care people receive does not unlawfully deprive someone of their liberty.

Is the service effective?

Care plans were designed to maintain people's independence and ensure people experienced a good quality of life. The service worked closely with the local primary care team who supported people with long term conditions. On the day of our visit we saw people involved in a movement and exercise session designed to keep people active and mobile.

The service monitored peoples weight and recorded the person’s dietary intake and information was recorded about what the person had done during the day. The information was used to update peoples’ care plans and monitor their well being.

Is the service caring?

People who used the service told us staff were caring. We observed staff at several points during the course of our inspection and saw staff treated people as individuals. When we spoke with care staff they told us the quality of the care they provided was important to them.

Relatives we spoke with told us staff were kind and treated people with respect.

Is the service responsive?

Someone told us they had raised concerns with the manager about their relative’s care. The person was receiving end of life care. They told us they were pleased with how the service responded. They said extra staff had been brought in to support the person and that they had been fully involved in plans for their relative’s care.

The visiting healthcare professional we spoke with told us the service asked for their advice which they followed.

Is the service well led?

The provider had a monthly quality reporting system in place which enabled them to review the quality of care provided.

The manager told us they were trying to develop a more open culture which involved people who used the service, relatives and staff in the organisation of the service. Staff told us things had improved recently and they felt able to raise issues they were concerned about.

During our last inspection we found that suitable arrangements were not in place for obtaining and acting in accordance with the consent of people receiving care or to establish and act in accordance with people’s best interests. We also found that the provider had not taken proper steps to ensure that the care and support of people was planned and delivered in a way which met their needs or protected their safety and welfare.

At this inspection we spoke with the manager of the service, reviewed a selection of records and briefly spoke with two people living at Holmewood Manor.

We found that improvements had been made to the way that people’s needs were being assessed, which included their capacity to consent, and the way that their care was being planned and delivered.

There were 21 people living at Holmewood Manor at the time of our visit. We spoke with four people, including relatives of people receiving care in the home. Feedback we received was generally very positive about the care provided in the home. People told us, “It’s nice here, staff look after me” and, “The staff are lovely, very welcoming. They look after my (relative) well."

We found that a new manager of the home had recently been appointed. We spoke with the manager during our inspection and they provided information on work they had put in place since joining the home. We found that staff had recently had supervision with the new manager and that staff meetings were being held regularly. Staff we spoke with felt that they were receiving a lot of support from the new manager.

During this inspection we found that there had been improvements in how people’s care was planned and delivered. However we were disappointed to find that there were ongoing issues with delays in writing and introducing care plans for people moving into the home. We also observed that people were not always being asked for their consent before receiving care and that formal assessments of people’s capacity were not being appropriately completed.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

There were 25 people living at Holmewood Manor at the time of our visit. We spoke with three people about their experiences of the care provided in the home; they told us “I am involved and I let staff know if there are any problems but its best for me to be here, they give me the help I need”, “I’m included in meetings so I get to tell people what I think about it here and I’m a straight talker so I always tell it like it is”. Another person said “I came here as I didn’t feel safe at home anymore and I feel safe now, that’s why I like it”.

There were notice boards displaying information for people living in the home and their relatives. They displayed information on activities in the home such as arts and crafts, upcoming events including a christmas fayre and christmas party, the dates / times for upcoming relatives meetings and the results of a survey completed in August 2012.

We found that it took a number of weeks before a full needs assessment and care plans were completed for people moving into the home. We also found that people’s needs were mostly assessed however people’s care and treatment was not always delivered in line with their individual care plan.

People told us they liked living at the home, that they receive the care and support they need and described suitable arrangements for them to access outside health and social care professionals where necessary. They said staff, help them to maintain their dignity and privacy and that they were able to make choices about their daily living arrangements and personal routines.

They said they were asked about and enjoy the choice of meals provided and are offered a choice of drinks at regular intervals throughout the day. We saw fresh fruit was provided for people in dining areas, together with cold drinks for them to help themselves where able.

We received many positive comments from people who use the service, these include,

“The food is excellent, good home cooking.”

“The staff here know what I like and now to help me. Nothing is too much trouble.”

People were also positive about recent management changes and to arrangements for the activities in the home. They said the new manager was approachable, spoke with them individually and had also recently held a residents and relatives meeting, with further planned. One person told us about positive changes that were introduced by the manager as a result of matters raised by them at that meeting.

During the course of our visit we observed staff supporting and assisting people, in a manner sensitive to their individual needs. We also saw staff encouraging people to engage in a number of recreational activities, including board games and gentle exercise.

This inspection took place on 25 and 29 September 2015 and was unannounced. We had previously inspected the service in June 2014 and found no breaches in the regulations at that time.

Holmewood Manor Care Home is required to have a registered manager. The manager had been in post since September 2014 and had not completed their registration with the Care Quality Commission. 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 is registered to provide nursing and residential care for up to 40 older people. At the time of our inspection 35 people were using the service and no-one had nursing needs.

People were not protected from the risks of infection as staff did not always use and dispose of personal protective equipment in a safe way. People were also at risk from infection as a clean and hygienic environment had not been maintained.

Care was not always provided to meet individual people’s needs, for example at lunch times when people required timely staff interventions. At other times staff were able to provide individual care and support.

Staffing was usually sufficient to meet people’s needs, however on some occasions there had not been sufficient staff, and sometimes staff were not deployed to meet people’s needs effectively.

We were not assured that some people, whose dementia needs could cause a risk, always received responsive care, suited to their individual needs, because monitoring of their behaviour was not completed as required. We were also not assured that people received appropriate health advice when they had special dietary needs.

Quality assurance systems were in place, however they were not always effective at identifying shortfalls in the quality and safety of the service. This included shortfalls in infection prevention and control, cleaning and areas of the building requiring maintenance and repair. Some potential risks associated with the environment were also identified for further risk assessment during the inspection.

Some existing practices, for example, not offering a person the option to receive their care and treatment in private, did not fully consider people’s dignity and privacy. At other times staff were careful to promote people’s dignity and respect their privacy and had contributed to developing dignity practices in the service.

People were cared for by staff that were caring and who respected people’s views and choices. Staff had the skills and knowledge to meet people’s needs and their skills were kept up to date and current through on-going and regular training. The manager had a good understanding of the Mental Capacity Act 2005, however staff practice in checking people consented to their care varied.

There was no registered manager in place, however the service was led by a manager who engaged people and had an open and approachable management style. Both the manager and senior managers had a clear aim for the service.

People received sufficient food and drink and people and families told us the food had recently improved with the new chef. The manager had further plans to develop the menu choices based on people’s preferences.

People living at the service told us they felt safe using the service and we found people received their medicines safely. Staff understood what steps to take to safeguard people and knew how to raise concerns and report accidents. Risks to individuals, for example, risk of falling, were identified and kept under review.

People and families told us they enjoyed the trips out organised by the service. We also saw they were involved in meetings to discuss the service and they told us they knew how to make a complaint or suggestion.

At this inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.