Holmes House Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed five quality statements in the Safe domain so we could assess if the provider had made the required improvements following our previous assessment. The provider had made sufficient improvement in relation to safe care, medicines, and the environment although some additional improvement was required. However, the provider was responsive and resolved these during and immediately following the assessment. People were protected from the risk of harm and abuse by effectively trained staff to carry out their role safely. Risks to people’s health and welfare had been assessed, monitored, and managed safely by staff who knew them well. Systems and processes for monitoring and responding to risk were robust. People’s health and well-being was promoted and guidance followed from external partners and other professionals to ensure people's changing needs were met.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us the service was safe. One person told us, “Yes I do think it's safe. The staff are brilliant here." A relative said, “[Family member] has been a resident here for quite a while, and has stayed in a number of care homes for many years. This [Holmes House] has been the best and safest place they have been." People had no unlawful restrictions placed upon them. Where people would be at risk of harm to themselves and/or others, continuous supervision was in place in line with their Deprivation of Liberty Safeguards (DoLS). DoLS protects people who cannot consent to their care arrangements in a care home and are protected if those arrangements deprive them of their liberty.

Staff knew their responsibilities of how to safeguard people from harm and abuse, and the requirement to report any concern to managers without delay. All of the staff we spoke with raised no concerns for people's safety. One told us, "My view is is that people are well looked after here."

Access to the safeguarding and whistleblowing policy was readily available to staff. Staff knew which agencies to report concerns to if a concern they raised wasn't acted upon by managers. Managers understood how to respond to allegations of abuse. They had a clear process of how to investigate, record and report these to keep people safe.

Staff were observed to respond promptly when people required assistance. Interactions were compassionate and protected people's dignity and privacy. Staff supported people safely, and in line with their corresponding risk assessments and care plans to protect them from harm.

Staff completed regular safeguarding training. The nominated individual and regional director told us they regularly review all safeguarding alerts across the service, and share any lessons learnt. Policies and procedures in place supported the prompt reporting of safeguarding matters. Records showed that any incident, accident or report of alleged abuse were promptly investigated and referred to the local authority safeguarding team where required. We reviewed 5 safeguarding matters prior to the assessment and found appropriate action had been taken which the local authority confirmed.

People and relatives feedback was overall positive which assured us people were well supported, and risks to their health and well-being were managed safely. One relative said “Honestly, I would chat to the manager if I was concerned but haven't had to. [Name] has multiple health issues that take a lot of managing and they do really well here."

Staff said information recorded in people's plans of care reflected the needs and risks to people to provide them with safe care. One staff member told us, "Care plans are reflective of people's needs. These are updated when people's needs change including people's mobility and what equipment should be used to support them safely. I support and encourage people to be as independent as possible."

Managers talked us through the assessment process, the development of the initial assessment and how care plans and risk assessments are formulated with people and their relatives. They added that where a change in need was identified, or a decline in a person’s independence was noted, they immediately contacted the relevant agency or assigned professional for advice and support.

Staff told us, and our observations assured us, they knew people well. When people required assistance staff responded promptly providing support and assistance to meet their immediate needs.

Care plans and risks assessments were detailed, reviewed, updated when people's needs changed together with regular auditing to ensure the information contained within them was current. Senior staff and managers had appropriate oversight of the process.

People and relatives raised no concerns over environmental safety. One person told us, "The home is kept lovely."

Leaders told us they had acted on concerns we identified at our previous inspection. They were open about a small number of further improvements, which were planned prior to our assessment.

Staff raised no concerns over the environment. One staff member told us,"Improvements have been made since you [CQC] last came."

At our previous assessment we identified a number of environmental concerns relating to the premises and equipment which exposed people to risk of harm. At this assessment our observations confirmed a number of improvements had been undertaken and the risk to people had been sufficiently reduced. These included a number of repairs and refurbishment across the service. Other environmental improvements were planned within the following 2 to 3 months of our assessment including replacing windows and frames.

There were processes in place to check the cleanliness, safety, and general condition of the service. These included daily walk rounds, and weekly and monthly checks. We did identify some minor shortfalls within this process as some crash mats, cushions and wheelchairs which which we brought to the attention of senior leaders.

They accepted our findings and were proactive in their response. During the assessment they undertook a whole home audit. They immediately replaced a number of items on the basis of our findings and strengthened the process for checking these items going forward.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us they had no concerns with cleanliness. One person said, "The home seems to always be clean and my clothes are laundered regularly. A relative said, "The home is fairly clean. Staff wear gloves and aprons when providing care."

Leaders told us they used regular checks and audits to ensure the service was cleaned effectively. This practice was supported by staff who had completed infection prevention and food hygiene training. Staff we spoke with confirmed they had received this training.

Staff told us they had access to personal protective equipment such as gloves and aprons. One ancillary staff member told us, “I have enough of the right equipment and products to to do my job.”

Whilst we received positive feedback from people, relatives and staff regarding the cleanliness at the service some of our observations did not always align with this feedback. For instance, we found some crash mats, cushions and wheelchairs were not cleaned to a good standard. When we brought this to the attention of leaders during the assessment they responded promptly by addressing these minor concerns by increasing the frequency of checks, cleaning schedules and audits.

Whilst processes and policies were in place to ensure the environment and equipment was kept clean and hygienic, we did find some minor shortfalls. Action was taken during the assessment. Processes were strengthened and immediately implemented.

People told us they always received their medicines at the right time including any 'as and when required' medicine such as pain relief. One person told us, "Yes I get my medicines on time. They [medicines administrator] has just been to give me my medication." A relative said, Yes 100%. I do not have any concerns in this area."

Leaders told us they had made multiple improvements to the safe management of medicines following the findings at our previous assessment where we found significant concerns.

We spoke with staff who administered medicines to discuss their practice of administration of medicines, and the processes and procedures in place. We observed a medicine round and found safe practice was followed. Processes in place for any administrative error and follow up actions such as contacting a GP for advice and recording and reporting of these events were robust. The medicines room and fridges were temperature controlled and were checked daily. Where controlled drugs were prescribed, national legal requirements were followed, such as being stored in a locked cupboard separate from other medicines and being recorded in a register which required two staff to sign for upon each administration. Staff who administered medicines told us they had received the requisite training to administer medicines safely.

Improvements had been made to systems and processes following our previous assessment where we identified a number of concerns. These improvements assured us medicines were now safely managed.