We inspected Holmlea Care Home on 21 September 2018. The service is a ‘care home’. People in care homes receive accommodation and nursing or 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.

Holmlea Care Home provides personal care and accommodation for up to 40 people in one single storey building across four wings. The service provides a permanent residence for people and short-term care beds are available for people to access. At the time of the inspection there were five community specialist beds that were funded by the NHS. These beds were used to provide step - up or step-down beds for people living in the community. The beds were to prevent people requiring hospital admission or support people following hospital discharge before returning home. People using the community specialist beds were supported by a multi-disciplinary team of staff including health care professionals. On the day of our visit a total of 35 people were using the service.

At the last inspection in December 2015, the service was rated ‘Good’ in all the key questions. At this inspection, we found the fundamental care standards were not being fully met, resulting in the rating for the service changing to ‘Requires Improvement.’

At the time of our inspection there was a registered manager in post and they were present during the day of the inspection. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons”. Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

People’s daily social needs were not always met. People did not always receive their meals in a timely way and some people did not receive sufficient support or have adaptations made available to them, to support them with eating. People’s dignity and preferences regarding how they received support were not always considered. Staff received an induction and ongoing training, but had not received regular opportunities to formally review their work and this was being addressed by the registered manager. Quality monitoring systems were in place to support the manager in driving improvement. However, they had not, at the time of the inspection identified the improvements that were needed at meal times and to the daily social opportunities available for people.

Staff were clear about what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. People received their medicine in a safe way and when they needed it. Recruitment checks were done before staff started working at the home to check they were suitable to support people.

Risks to people’s health and safety were assessed and care plans directed staff on how to reduce identified risks. Staff had the equipment needed to assist people safely and understood about people’s individual risks. The provider checked that equipment was regularly serviced to ensure it was safe to use. The checks in place for the prevention and control of infection were effective in reducing the risk of cross contamination.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the provider’s policies and systems in the service supported this practice. People’s capacity to consent to their care and treatment had been considered where required. Information about independent advocacy services was available.

The registered manager and staff team worked with health care professionals and people’s health was monitored to ensure any changing needs were met.

People received a choice of meals and their nutritional care needs had been assessed and planned for, but some staff’s unders

At our visit there were 36 people living at Holmlea, including some people receiving short term care. We observed how people were supported and cared for, looked at three people’s care records and spoke with six people and five staff. This helped us to understand people’s experiences of the service.

During our visit people we spoke with told us they felt mostly satisfied with their care and support and the cleanliness of their own rooms and communal lounges. One person said, “Staff are very kind, I’m well looked after.” Another person told us, “I am happy living here and feel safe.” However, we found that people were not cared for in a clean and hygienic environment and were not fully protected from the risk of infection.

We found that people often experienced care, treatment and support that met their needs and protected their rights. They were asked for their consent to their care and consulted about their daily lives in the home. This included choice of clothing and meals, social activities, medicines arrangements, personal hygiene assistance and for morning rising and going to bed

However, we found people were not always protected against the risks of receiving inappropriate or unsafe care and the appropriate management of their medicines was not consistent.

This inspection was unannounced and took place on the 21 December 2015 and 6 January 2016.

Holmlea provides accommodation and personal care for up to 40 older adults, including some people who may be living with dementia. At the time of our visit, there were 31 people were living in the home. There was a registered manager at this service. 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 August and September 2014, people were not always protected from receiving unsafe or ineffective care. This was because there were not always sufficient staff and records associated with people’s care and safety were not always properly maintained. Following that inspection, the provider told us what action they were going to take and at this inspection we found that the required improvements were made.

People felt safe in the home and they were safely supported by staff when they received care. Revised staffing arrangements and recruitment procedures helped to make sure that people’s needs were safely met and that staff were suitable to work and provide people’s care at the service.

Risks to people’s safety associated with their care needs, equipment and environment were identified and managed in a way that helped to protect them from the risk of harm and abuse.

Staff understood people’s health needs and supported people to maintain and improve their health. Staff consulted with and followed instructions from external health professionals concerned with people’s care when required.

Staff understood people’s nutritional care needs. People were provided with the support they needed to eat and drink and they mostly enjoyed their meals. Improvements were planned to improve people’s mealtime experience in consultation with them.

The provider’s arrangements helped to ensure that staff followed the Mental Capacity Act 2005 (MCA) to obtain people’s consent or appropriate authorisation for their care. Action was agreed to ensure that care being delivered to people in their best interests was fully accounted for and understood by staff.

Staff were the trained and supported and tthey understood their roles and responsibilities for people’s care and safety needs. Staff were kind and caring and they supported the appropriate involvement of others who were important to people in their care.

Staff treated people with dignity and promoted their independence, rights and choice in their care. People were positive about their daily living arrangements and content that staff understood and supported their related needs and wishes.

Staff understood people’s needs and knew how to communicate with them. People were actively encouraged and supported to engage and participate in a range of social, leisure and recreational activities.

People were appropriately consulted and they were happy with their care. They were confident to raise any concerns or complaints, which were listened to and addressed by the service.

The home was well managed and run and people, relatives and staff were confident about this.

The provider’s arrangements to regularly check the quality and safety of people’s care helped to make sure that people received safe and effective care, They also helped to make sure that improvements were made when required.

Staff understood their roles and responsibilities and they were motivated and informed about service improvements. Staff were appropriately supported to share their views or raise any concerns about people’s care.