About the service: Holmpark is a residential care home registered to provide accommodation with nursing and personal care for up to 39 people. Most people living at the service were older people, some of whom were living with dementia. A total of 35 people lived at the service, however one person was in hospital at the time of our visit.

People’s experience of using this service:

•There were enough staff to meet people’s assessed needs and support their planned activities.

•Risks which affected people’s daily lives, were documented and managed by staff.

•Staff had completed safeguarding training and knew what actions to take if they were concerned about people’s well-being.

•Staff provided support for people to take medicines when they required these.

•Staff received training which enabled them to provide care and support in line with current practice to meet people’s needs.

•People were supported to make daily living choices such as what they wanted to eat and how to spend their time.

•People benefitted from following their own interests and hobbies. Further improvements had been implemented with the ‘Anchor Active’ scheme and activities champions.

•Staff knew when to seek advice from other health care professionals and services.

•People were encouraged and supported by staff to make decisions about their care.

•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 treated with respect and spoke highly of the staff. Staff knew people well and had a genuine interest in caring for them.

• Staff encouraged and supported people to be as independent as possible.

•Overall, care plans contained clear information for staff to help them provide consistent care to people. Care records were personalised and were in the process of being improved by the management team.

•The home environment was kept clean and was well maintained. Further work was being completed both internally and externally to enhance the environment further.

•People, relative and staff feedback was sought to improve the service further.

•Lessons were learned when incidents occurred to prevent further reoccurrences.

•A robust system of audits were in place which identified where improvements were required.

We found the service met the characteristics of a “Good” rating in all five areas; For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good, with ‘Requires Improvement’ in Safe. At this inspection we found the previous issues in relation to medicines and risk management had been addressed. The last report for Holmpark was published on 30 November 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The previous ‘good’ service provided to people had remained consistent.

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

This inspection took place on 11 and 12 October 2016 and was unannounced. The service was previously inspected in October 2015. During that inspection breaches of legal requirements were found. The issues identified that the provider did not have suitable arrangements in place for assessing and monitoring the quality of service provision and did not always keep records and information up to date in relation to the care and support provided. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. The provider took action and at this inspection we found improvements had been made.

Holmpark is registered to provide care and support for up to 37 older people who have needs relating to their age or dementia. Nursing care is not provided. On the day of our inspection there were 35 people at the home and two people were in hospital.

The registered manager was present during 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 told us that they felt safe living at the home. Staff knew how to protect people from avoidable harm and abuse. Staff knew how to keep people safe and reduce risks but this information was not always reflected in people’s care records. There was enough staff to support people in a timely manner. People generally received their medicines as prescribed. However, we found some signatures missing and omissions in the frequency of when to apply creams on some topical medicine (prescribed cream) charts.

Staff were appropriately trained and skilled to provide care and support to people. The registered manager and staff we spoke with understood the principles of protecting the legal and civil rights of people. Staff supported and encouraged people to eat a healthy and balanced diet and to have access to other health and care services when needed.

People were cared for by staff who were kind, caring and empowering. Staff understood the needs of people they were providing care for. People were involved in making decisions and planning their own care. People told us that staff respected their privacy and treated them with dignity.

People told us that they were happy and involved in their care and support planning. We saw people had access to activities and interests that they enjoyed. People knew how to complain and the provider had a system in place to manage complaints.

People told us that they felt the home was well-managed and that the registered manager was approachable. People were consulted about all aspects of the home. Staff told us they were supported by the registered manager. The registered manager had used feedback from the last inspection to make improvements. Quality assurance audits were in place to monitor the quality and safety of the home, however, some of these audits had not identified some of the record keeping issues that we found.

This inspection was undertaken as part of our scheduled plan of inspections, however we also followed up to make sure improvements had been made to people’s health and welfare.

During our visit we spoke with ten people who live at the home, two relatives who were visiting and with five members of staff. Some people were not able to share their views of the service so we used a number of different methods to help us understand the experience of people using the service.

People we spoke with were complimentary about the home and told us that they were happy with the care they received. One person told us, ‘’If I need anything I ask and staff are always checking with me if there is anything I want or need.’’ Another person told us, “If you have to be in a home, this is the one to be in.”

Appropriate arrangements were in place for the management of people's medicines.

There were systems in place to assess the quality of the service people received.

We visited Holmpark and spoke with six people who lived at the home about the care and support they received.People told us they were happy with the service they were receiving and how their needs were being met.

During our visit we spoke with four relatives of people who lived at the home. They told us they were satisfied with the care provided. We found that improvements were needed to how the risks were managed for people who were identified as being at risk of falls.

Throughout the inspection, we found that staff treated people with respect and supported them in a friendly, engaging manner. People living at the home confirmed their privacy was respected. Not all people spoken with could remember planning their care but we found evidence of consultation, wishes and preferences in records.

Staff told us that they were well trained and felt they had been provided with the appropriate training in order to do their job effectively.

People living at the home told us they felt safe and were able to raise any concerns they had.

We spoke with seven people who live at Holmpark about the care and support they received. We found that people like the staff that support them, and have positive relationships with them. People told us they were happy at the home. One person told us that staff were all very caring and looked after her well.

People we spoke to told us they were happy with the care they received. People told us:

‘’It’s a good home’’.

‘’I’m very happy here’’.

People told us they are involved in making decisions about their care and their views are taken into account. Comments from people included:

‘’I have my own key to my room and open my own post’’.

‘’Staff ask me what I want and I make my own decisions’’.

‘’Staff consult me, I’m very independent’’.

‘’Staff always knock or ring my doorbell before coming into my room’’.

‘’ We are asked at residents meetings about the food, but there are never any complaints. We did have soup at lunch times but it was too filling and so we asked for it at tea time and they have done this. We are consulted’’.

All of the people we spoke to were happy with the meals provided. People told us:

‘’ The food is lovely’’.

‘’The food is nice, we get a choice. If we do not want what is on the menu you can ask for something else’’.

‘’It’s like a 5 star hotel’’.

‘’I’m weighed regularly and had lost some weight so I had to have cream with my drinks and I have now put weight back on again’’.

‘’Food is excellent here, If you are not happy with it you can complain. If you did not like the food here you would be a strange person’’.

People spoken with were happy with the premises. People told us:

‘’I’m happy with my room, I have everything I need’’.

‘’The home is well looked after, we have just had a new state of the art fire alarm system fitted’’.

‘’It’s very well maintained’’.

‘’The home is spacious which I like’’.

People using the service told us:

‘’Staff are lovely, they always answer the call bells quickly’’.

‘’Staff are nice, the staff come and help you if you call them’’.

‘’Staff look after me and are nice, they come and check to make sure I am alright’’.

‘’I had a fall a little while ago and had to go to hospital, I used the call bell and staff came very quickly’’.

People spoken with were confident about whom they could raise concerns with and that their concerns would be addressed. People told us:

‘’The food is excellent here, but if you are not happy you can complain’’.

‘’I would speak to the manager if I had any complaints’’.

‘’I have never found anything to complain about, we have meetings with the manager and are always asked if we have any complaints’’.

We inspected this home on 13 and 14 October 2015. This was an unannounced Inspection. The home was registered to provide residential care and accommodation for up to 39 older people. At the time of our inspection 35 people were living at the home.

The registered manager was present during 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 we spoke with told us that they felt safe living at the home and relatives we spoke with confirmed this. We found that staff knew how to recognise when people might be at risk of harm and were aware of the registered provider’s procedures for reporting any concerns.

At the time of our inspection there were adequate staffing levels to meet people’s individual needs. It was identified that at times more staff were needed to ensure staff responded to people’s needs in a timely manner. The registered manager advised that recruitment had commenced to address this issue.

People were supported by staff who had received training and had been supported to obtain qualifications. This ensured that the care provided was safe and followed best practice guidelines. Recruitment checks were in place to ensure new staff were suitable to work with people who needed support. More robust checking of references needed to be undertaken to reduce the risk of unsuitable staff being employed by the service.

Most people received their medicines as prescribed; however, the management of medication was not always safe and improvements were needed to ensure that every person received their medication as prescribed. There were errors noted in respect of some medication administration where medicines were not needed routinely or were not in a monitored dosage system.

People’s needs had been assessed and person-centred care plans were being developed to inform staff how to support people in the way they preferred. Measures had been put into place to ensure risks were managed appropriately.

People’s nutritional and dietary needs had been assessed and people were supported to eat and drink sufficient amounts to maintain good health. People were supported to have access to a wide range of health care professionals.

Staff we spoke with were knowledgeable of the requirements and their responsibilities of the Mental Capacity Act 2005.The registered manager had plans to review people’s consent in respect of sensor mats in their rooms and to improve the exit arrangements at the front door of the home. Some necessary applications to apply for Deprivation of Liberty Safeguards (DoLS) to protect the rights of people had been submitted to the local supervisory body for authorisation.

People told us, or indicated by body language that they were happy living at the home. We saw that staff treated people with respect and communicated well with people. People told us they wanted to go out more in their local communities. Some people were not offered the choice of social activities.

There was a complaints procedure in place and this was displayed in different formats to support people’s preferred way of communicating. People told us they knew who to speak to if they had any concerns. Relatives told us they knew how to raise any complaints and were confident that they would be addressed.

We found that whilst there were systems in place to monitor and improve the quality of the service provided, these were not always effective in ensuring the home was consistently well led and compliant with the regulations.

We found the provider was in breach of Regulations. You can see what action we told the provider to take at the back of the full version of the report.