Holmes House Care Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We reviewed four quality statements in the Well-Led domain so we could assess if the provider had made improvements following our previous assessment. The provider had made sufficient improvement and is no longer in breach of regulations however, some minor shortfalls remained. Provider and managerial oversight had increased overall which meant the service was monitored more effectively reducing the risk of harm to people we identified previously, for example medicines and managing risk. Audits were now generally more robust overall but a small number still required more detail to allow prompt action to be taken when a concern was identified. The providers internal quality assurance process had identified some of minor shortfalls we found but these had not been addressed at the time of the assessment. The nominated individual informed us they were changing the systems and processes in place in relation to audits and quality assurance, and a date for implementation of these had been set.

Senior leaders and managers were open and transparent with the assessment process, accepting of our findings, and immediately acted to resolve the issues identified during the inspection. There was an inclusive and positive culture and leaders were visible in the service offering support and guidance to staff. Managers were accessible to people and their relatives. The service had positive relationships with other stakeholders and visiting health professionals who were complimentary about the leadership and their joint working arrangements. Staff said they received support from managers in their roles and could speak up if they had any concerns. People and relatives overall view and experience of the service was positive.

This service scored 54 (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 Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The culture at the service had improved. Senior leaders were open and transparent with the assessment process accepting our findings, taking immediate action where possible and informing us of future improvements in place. They were visible in the service and supported managers and staff. This was corroborated from the feedback we received from people, relatives and other professionals and stakeholders.

Staff were complementary about the current registered and temporary managers and commented on the improvements made since they were appointed. One staff member told us, “Things are a lot better here now since managers have changed.”

Changes were made to the managerial arrangements following our previous assessment, and a further enforced change made immediately prior to this assessment, where a temporary manager had been appointed. Whilst notable improvement followed these changes some shortfalls remained. Some had already been identified by the providers internal compliance team but an opportunity was missed in ensuring all of the issues and priorities were enacted, particularly in the context they were known, and the current temporary managerial arrangements. Senior leaders were visible and supportive to the service which managers and staff corroborated and further supported from the feedback we received from people, relatives and other professionals and stakeholders.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Leaders at the service told us the governance of the service had improved following our previous assessment and people, relatives, staff, visiting professionals and stakeholders were generally more positive about the service. The nominated individual was open and transparent about the audit process which had changed to an electronic version. They had identified some shortfalls with this system and, had prior to the assessment, taken the decision to revert to paper based auditing. This was due to be fully implemented following the assessment. The shortfalls leaders identified mirrored our findings.

In the absence of the registered manager the nominated individual and regional director told us they had increased the level of support to acting managers at the service to ensure the service had appropriate oversight in place.

Staff told us they felt supported and valued. They told us they knew their roles and responsibilities and felt the service was managed well.

Notable improvements had been made at the service in response to our previous inspection to governance and oversight. However a few shortfalls remained, predominantly with the auditing process. The provider had a new internal compliance process system in place to check the service was meeting expectations. Periodic visits were made to audit the service's performance and safety, and report areas where improvement was needed. We reviewed their previous report from September 2024 where some of the shortfalls we identified had been noted. In line with the provider's policy a follow up visit had been arranged shortly after our assessment to address these areas. The nominated individual provided us with a copy of the updated report. They told us, "Whilst I was disappointed all actions identified the report had not been completed I was satisfied that those you, [CQC] identified, the right progress had been made. In addition to this I am personally now undertaking 'spot checks' to ensure the progress made is sustained and to ensure the recently appointed acting manager received additional support."

The provider had quality assurance processes in place enabling people, relatives, staff, and professionals to share their experiences of the service. Leaders at the service understood their regulatory responsibilities and had submitted statutory notifications as required.

Feedback we received from other partners and health professionals assured us the service worked collaboratively with them to ensure people experienced joined up holistic care. For example, when people's needs changed professionals and services were contacted promptly.

Leaders told us they had had established good working relationships with stakeholders and health partners.

Staff told us they were informed of feedback from visiting professionals.

Feedback from partner agencies was positive. We spoke with a visiting health professional during the assessment who praised the management and staff on how they follow their recommendations and guidance. They told us, "Staff are proactive in terms of supporting people. I visit frequently to support a number of people at the service and relatives of people are complimentary about the service. I have no concerns at all."

The regional director explained they had recently worked in partnership with the local authority where a few recommendations had been made following a quality assurance visit from them. An action plan from this visit was compiled and the recommendations were subsequently implemented.

Leaders were open and transparent with the assessment process. They told us they had worked hard to make improvements to the service following our previous assessment and we found the majority of these had been implemented and embedded. The nominated individual acknowledged some further improvement in a small number of areas was needed. Most of the outstanding areas for improvement had already been identified with plans and timescales in place. However, given the timescale between this assessment and our previous one these would be expected to have been in place and embedded at the time of this assessment.

Staff told us the overall quality of the service had improved following managerial changes made following our previous assessment. Managers were reported to be more visible and supportive. We found the overall culture at the service had improved.

The service had learnt lessons and made improvements to a number of systems and processes including managerial arrangements following our previous assessment. However, there remained some shortfalls which meant not all of the required learning and improvement had yet been made. We were provided with future plans during and after the assessment which provided us with some assurances and we will review these at our next assessment.