This inspection took place on 4 January 2018 and was unannounced. This meant no-one at the service knew we were planning to visit.

We checked progress the registered provider had made following our inspection on 15 August 2016 when we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were Regulation 11, Need for consent and Regulation 17, Good Governance. We found the registered provider was no longer in breach of these regulations.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of effective, responsive and well-led to at least good. We found improvements had been made in effective and well-led. Further improvements were still required in the key question of responsive.

Holmwood Nursing Home 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. Holmwood Nursing Home is a purpose built care home located on the outskirts of Sheffield. The home provides accommodation for up to 41 people over two floors. The care provided is for people who have needs associated with those of older people, particularly those living with dementia. On the day of our inspection there were 36 people living in the home.

The manager had worked for the registered provider for six years and had been at Holmwood Nursing Home for approximately two months at the time of our inspection. She was in the process of registration with CQC. 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.

We saw people received appropriate care and support to meet their needs. However, some people’s care records needed updating to reflect this. We saw the manager was in the process of reviewing and updating everyone’s care records.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by management.

There were enough staff available to ensure people’s needs were met. The registered provider had robust recruitment procedures to make sure staff had the required skills and were of suitable character and background.

Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.

We saw the premises were clean and well maintained. Staff understood their roles and responsibilities in relation to infection control and hygiene.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People were supported to access relevant health and social care professionals to ensure they were getting the care and support they needed to best meet their needs.

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role. We saw plans were in place for regular staff supervision and appraisal meetings to ensure staff were fully supported.

People and their relatives told us they enjoyed the food served at Holmwood Nursing Home, which we saw took into account their dietary needs and preferences.

We saw the signage and decoration of the premises were suitable to meet the needs of people living with dementia.

Positive and supportive relationships had been developed between people, their relatives, and staff. People told us they were treated wi

This inspection took place on 15 August 2016 and was unannounced. The service was last inspected on 23 October 2013 when we found no breaches of regulation.

Holmwood Nursing Home is a purpose built care home located on the outskirts of Sheffield. The home provides accommodation for up to 41 people on two floors. The care provided is for people who have needs associated with those of older people, particularly relating to dementia. There is a car park at the service for visitors to use.

There is a registered manager in place 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the registered provider was in breach of two Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the need for consent and good governance. The Mental Capacity Act 2005 (MCA) had not been followed in regard to gaining consent regarding covert medicines. There was a lack of effective auditing in place. You can see what action we told the provider to take at the back of the full version of the report.

Staff understood they had a duty to protect people from abuse and knew they must report concerns or potential abuse to the management team, local authority or to the Care Quality Commission (CQC). This helped to protect people.

We observed that the staffing levels provided on the day of our inspection were adequate to meet people’s needs. Staff were aware of the risks to people’s wellbeing. Staff were trained in a variety of subjects to help maintain and develop their skills.

People’s nutritional needs were assessed and monitored; their preferences and special dietary needs were known and were catered for. Staff encouraged and assisted people to eat and drink, where necessary. Advice from relevant health care professionals was sought to ensure that people’s nutritional needs were met.

Staff supported people to make decisions for themselves and they reworded questions or information to help people living with dementia understand what was being said. People chose how to spend their time and were encouraged to live the life they chose.

People who used the service were supported to make their own decisions about aspects of their daily lives. However, we found that staff did not always follow the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made. We found two people did not have care plans in place for requiring covert medicine and best interest meetings had not taken place to ensure their rights were protected. We found a variety of audits took place to help the registered manager monitor the quality of the service provided. However, the audits undertaken had not identified the issues that we found during our inspection. You can see what action we told the provider to take at the back of the full version of the report

There was signage in place to help people find their way to the toilets and bathrooms. Staff helped to guide people to where they wished to go. The environment was well adapted for people living with dementia.

General maintenance occurred and service contracts were in place, which helped to ensure the home was pleasant and safe for people to live in.

A complaints procedure was in place. People’s views were asked for feedback and received was acted upon to help people remain satisfied with the service they received.

We used different methods to help us understand the experiences of people who used the service. This was because people had different degrees of dementia which meant they were unable to comment directly about their experience of their care. We observed positive interaction between staff and people.

Staff told us relatives and representatives took a greater involvement when deciding on care and treatment.

Family members told us that staff co-ordinated with external agencies to make sure people received appropriate services.

Dedicated members of staff were seen carrying out cleaning duties during our inspection. Staff had a clear understanding of the measures they took to prevent and/or to treat people with infection. They said maintaining cleanliness was everybody’s business.

We observed medicines been handled appropriately by the nurses. People were given their medicines at the correct times. Nurses made sure people had taken the medicines before moving on to the next person.

People had access to safe and suitable equipment because the provider had made sufficient resources available so that people were supplied with correct equipment.

Appropriate checks were undertaken before staff began work. The manager told us that the process ensured staff applying for a position were honest, reliable, trustworthy and were able to treat people who use service with respect.

People’s personal records including medical records we saw were accurate and fit for purpose.

We were unable to gain the views of all the people who were at the home. Therefore we observed how care was provided, reviewed records and spoke with staff and visitors to help us understand their experiences.

We spoke with four people who used the service and two visitors. They told us staff asked them what they wanted and respected their decisions. If anyone was unable to give consent, systems were in place to consult other people to make sure things were carried out in their best interest.

People’s comments indicated staff provided the care and support people needed and they were happy with how staff delivered care. One person said, “I’d give them 15 out of 10, it’s great here.”

We saw that people were provided with a choice of suitable and nutritious food and drink. They told us they enjoyed the meals available and confirmed they offered variety and choice.

We saw the premises were in a satisfactory state of repair and was designed to promote independence and safety. The people we spoke with told us they were happy with the home’s facilities.

Staff had access to a varied training programme which they said helped them meet the needs of the people they supported. A visitor commented, “They are good at their job and speedy to tend to him.”

We saw the complaints procedure was available to people who used and visited the service. People told us they had no complaints, but said they would feel comfortable taking any concerns to the manager.

Some people who live at Holmwood have some conditions that mean we had difficulty talking with them. Other people were able to express their views clearly. Due to people’s communication needs we used informal methods of observation during the site visit. We sat with people in the lounges, observed care practices ,and saw how staff and people interacted with each other.

Throughout the observation we saw all staff treat people with dignity and respect by using a positive, friendly and kind approach. We observed examples of good communication skills by staff that utilised eye contact and touch to engage people who use services.

People who we were able to communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People said, "I am doing nicely here." "It's nice here and the staff are smashing."

We spoke with 8 relatives who were visiting the home and they confirmed that they were very satisfied with the care provided. One told us "We have no grumbles at all; we think the staff are fantastic.” And another confirmed that "The staff are marvellous, they don’t just look after the residents they really care about the relatives as well."

One relative added “I am extremely happy with the care my husband receives.”

We spoke with Sheffield Local Authority, Contracting, Commissioning and Safeguarding and they told us that they had not identified any concerns at the home.

Two authorised representatives from Sheffield Local Involvement network (LINk’s) visited the service this year. They reported that they were very impressed by the pleasant ambience of the home and the efforts made by staff to create a comfortable, welcoming and homely environment at Holmwood.