About the service:

¿ Holmwood Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Holmwood Residential Home accommodates up to 32 older people in one adapted building. During our comprehensive unannounced inspection on 12 March 2019, there were 29 people using the service, some living with dementia.

People’s experience of using this service:

¿ At our last inspection of 6 April 2016, the service was rated requires outstanding overall. The key questions for safe and responsive were rated good and the key questions effective, caring and well-led were rated outstanding. At this inspection of 12 March 2019, we found the evidence continued to support the rating of outstanding. The continuous improvement in the service had resulted in a further outstanding rating for the responsive key question.

¿ People told us that they were extremely happy with the service they received. They were highly complimentary about the caring nature of the staff and management team.

¿ People were supported by highly motivated and caring staff who knew them well.

¿ The service was led by a highly motivated and compassionate registered manager who continued to strive to continuously improve the service and provide high quality care to people at all times.

¿ There were systems designed to keep people safe, including from abuse. Risks to people in their daily lives were assessed and plans in place to reduce these. People’s medicines were managed safely.

¿ There were enough highly trained and skilled staff to meet people’s needs effectively. Recruitment processes continued to be safe.

¿ Infection control procedures in place helped protect to people from the risks of cross infection.

¿ People had access to health care professionals when needed.

¿ People were supported to maintain a healthy diet. Meal times were extremely social occasions and people had choices of meals. Without exception people were complimentary about the provision of food.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

¿ People shared very positive relationships with staff. People’s privacy, independence and dignity were always respected.

¿ People were listened to in relation to their choices about how they wanted to be cared for. These choices were highly valued.

¿ There was a complaints procedure in place and people’s concerns were addressed.

¿ There was an extremely open culture in the service. People using the service, their representatives and staff were asked for their views about the service and these were valued and used in the ongoing improvement in the service.

¿ The service had systems to continuously monitor, assess and improve the service provided.

Rating at last inspection:

¿ At our last inspection of 6 April 2016, which was published 9 August 2016, the service was rated outstanding.

Why we inspected:

¿ This inspection took place as part of our planned programme of inspections, based on the rating of outstanding made at our last inspection.

Follow up:

¿ We will continue to monitor this service according to our inspection schedule.

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

The inspection took place on 6 April 2016 and was unannounced.

Holmwood residential home provides accommodation and personal care for 32 older people, some who were living with dementia. At the time of our inspection there were 30 people living in the service.

There was a registered manager in post. 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 provided outstanding care to people which was continually reviewed to ensure the best possible outcomes. People, staff, relatives and professionals were extremely complimentary about the service and what it provided.

The registered manager was inspiring and dedicated to providing care which met the highest of standards. They strived for excellence through consultation, research and reflective practice. They were passionate and dedicated to providing an outstanding service to people. They led with a dynamic approach and continually reflected on how to improve the service further. They demonstrated a strong and supportive leadership style, seeking feedback in order to further improve what was offered. The provider's vision and values were understood and shared across the staff team, and they were fully supportive of development plans.

We observed staff providing care which was dignified and respectful. Staff were highly motivated to provide kind, compassionate and effective care to people, and had taken on specific lead roles to further enhance their knowledge and skills. ‘Champion’ roles were established within the service which resulted in people receiving care which was in line with best practice guidance, and which demonstrated a positive impact on people’s health and well-being.

Systems were in place which safeguarded people from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe and actions were taken when they were concerned about people’s safety.

Care plans provided an exceptional level of detail relating to people’s needs and preferences, incorporating personal wishes and views, how people liked to live, past histories and current preferences. Risk assessments were reviewed regularly to reflect changes, and also guided staff thoroughly on how to minimise risks, including action plans on what steps to take if a person became unwell.

Medicines were provided safely and when required. Staff carried out regular audits to ensure processes were reviewed and monitored for effectiveness.

The service were highly responsive to people’s nutritional needs. Staff were allocated dedicated time to support people to eat and drink sufficiently to optimise health. Nutritional risks assessments were used effectively and monthly reports were compiled to identify people most at risk.

Staff and management worked in partnership with people. People were encouraged to be involved in the interviewing and recruitment of new staff, ensuring people’s views were used to inform decisions.

People’s capacity to make decisions was regularly reviewed and amended. The registered manager was highly knowledgeable in this area, referring to current best practice, legislation and process.

Complaints received were responded to thoroughly, and solutions put in place when possible.People were encouraged to share their opinions informally through comment cards in reception. Results of surveys were shared and actions they had taken in response to questionnaires and comment cards. People, their relatives and other health professionals were encouraged to share their opinions to ensure their views drove improvement. Planned improvements were focused specifically on improving people's quality of life.

Robust quality assurance reports had been developed, incorporatin