Holgate House

Updated 2 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 2 inspectors. An Expert by Experience supported the inspection by making telephone calls to people and their relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Holgate House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. [Care home name] is a care home [with/without] nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 24 April 2023 and ended on 11 May 2023. We visited the location’s service on 24 and 26 April 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people who used the service, and 2 people's relatives about their experience of the care provided. We spoke with 9 members of staff including the registered manager, deputy manager and 6 members of care staff. We looked around the environment to review the facilities available for people and the cleanliness of the service.

We reviewed a range of records. This included samples of 5 people's care records, and multiple medication records. We looked at 3 staff files in relation to recruitment and training. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 2 June 2023

About the service

Holgate House is a residential care home providing personal care to people with mental health needs or learning disability. The service can support up to 30 people. At the time of inspection 23 people were using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Risks to people were not always effectively managed. This included individualised risks and risks in relation to the environment.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Work was required to ensure decisions were made on individualised basis rather than ‘house decisions,’ to ensure people received person centred care. Capacity assessments and best interest decisions had not always been recorded.

Right Care

People had good relationships with the staff. People were supported to access health care appointments.

The service had enough appropriately skilled staff to meet people's needs and keep them safe.

Right Culture

Staff felt supported by the registered manager and that it was good place to work.

The provider's quality monitoring processes were not robust and had not always identified concerns and improvements in the service identified during the inspection.

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

Rating at last inspection

The last rating for this service was good (published 23 December 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. We inspected and found there was a concern with Mental Capacity Act, so we widened the inspection to include the key questions effective.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holgate House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have made recommendations in relation to medicines and infection prevention and control.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.