Holehird Care Home provides care and nursing for up to 29 people with physical disabilities. The home is a detached period property that has been suitably adapted for the purpose. It is close to the town amenities of Windermere and the Lake District. Accommodation is provided on two floors and all areas of the home are wheelchair accessible. There are accessible outdoor areas and there are extensive gardens and a car parking area.

At the last inspection, in March 2015 the service was rated overall as Good. At this inspection we found the service remained Good.

Medicines were being administered and recorded appropriately and were being kept safely. We saw that improvements had been made in the recording of medications that were topically applied.

When employing fit and proper persons the recruitment procedures of the provider were robust in ensuring suitable people had been employed.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager or care manager to the appropriate authorities and we could see records of the actions taken by the home to protect people.

People’s rights were protected. The staff team was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body and was required to maintain their safety and welfare. We noted that four of these authorisations had not been notified to the commissions in a timely manner.

We have made a recommendation that the registered provider ensures the commission is notified in a timely manner when DoLs have been authorised by the local authority.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had completed training that enabled them to improve their knowledge in order to deliver care and support safely.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made.

There was a clear management structure in place and staff were happy with the level of support they received.

People living in the home were supported to access meaningful and individually tailored activities and pass times of their choice.

The in house physiotherapy services provided in the home positively impacted on people’s independence and physical movement potential. The on site physiotherapy service was available to people using the service as and when they required it. It also meant people had an individual postural management plan that supported intensive rehabilitation. A variety of facilities and specialised equipment was provided to support individual people’s levels of abilities that promoted their independence.

A variety of facilities and specialised equipment was provided to support individual people’s levels of abilities’ to promote their independence and ensured safe moving and handling.

Audits and quality monitoring systems were in place to allow the service to demonstrate effectively the safety and quality of the home.

Further information is in the detailed findings below.

This inspection took place on 2 March 2015 and was unannounced. Holehird Care Home provides care and nursing for up to 29 people with physical disabilities. The home is a detached period property that has been suitably adapted for the purpose. It is close to the town amenities of Windermere and the Lake District. Accommodation is provided on two floors and all areas of the home are wheelchair accessible.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our last inspection in September 2013 we found that the provider was compliant with all of the Regulations that we looked at.

At this inspection we found that appropriate arrangements were not in place in relation to the recording of medicines. We looked at medicines, records and care plans in detail and found that the records of administration of medicines taken by mouth were good. However, the records for the administration of creams were poor and we could not tell if people received them correctly.

We found care plans for the administration of medicines did not always reflect the risks associated with the medications. Where we saw good plans of care for the use of rescue medications in epilepsy these plans had not been consistently followed by staff.

This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 the management of medicines which correspond to regulation 12 (f) and (g) safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of this report.

The focus of physiotherapy services provided by the home positively impacted on people’s independence and physical movement potential. Physiotherapy ranged from informing a 24 hour postural management plan to intensive rehabilitation to improving mobility and to reduce reliance on equipment and carers for personal support.

A variety of facilities and specialised equipment was provided to support individual people’s levels of abilities’ to promote their independence.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety.

People were supported during their end of life to fulfil their wishes in the way in which they had identified.

There were meaningful and personalised activities made accessible to all people in the home and in the local community. These activities were supported by suitably qualified and experienced staff that could manage people’s complex needs.

There was a clear management structure in place and staff were happy with the level of support they received.

Innovative and creative ways had been established to enable people to express their views about the running of the home and to share information.

Following our last inspection in April 2013 we set some compliance actions for the provider to protect the interests of the people using the service. Some of these matters we needed to check did not necessarily relate to people's views and experiences. Therefore at this visit we did not ask people to comment on all of the outcomes we looked at.

The records we saw for assessing risks had been consistently reviewed. This meant that the information about the welfare and safety of people using the service was accurate and where changes in their needs had been reported the plans of care reflected them.

Senior managers in the organisation had carried out increased visits to assess and monitor the quality of the care and facilities provided to people. The manager told us that they had recruited more qualified staff which meant they were using less agency staff.

People who were able to talk to us told us they were happy living in this home and said they were provided with a range of activities which they enjoyed.

The people we spoke to told us they felt safe living in Holehird - Care Home with Nursing Physical Disabilities and said the staff employed in the home treated them with respect and encouraged them to maintain their independence.

A number of people living in the home were not easily able to express their views about the service or the care they received. We saw that the staff in the home provided people with care in a way which respected their rights and promoted their well being.

People who were able to talk to us told us they were happy living in this home and said they were included in decisions about the care they received and their lives in the home.

The people we spoke to told us the meals were generally good and said they were provided with a range of activities which they could choose to take part in.

We found some people who had limited verbal communication and who were not able to express their views had not been included in making decisions about their lives, nor had their families or other people who supported them. We found some people who had limited verbal communication had not received the care they needed.

People we spoke with were very happy with the care and support they received. One person told us, ''I’m looked after very well and get on very well with all the staff.’’

The records we saw for assessing risks were not consistently reviewed.

Staff we spoke with told us about their training in infection control. One member of staff told us,’’We refresh our training regularly’’.

Staff we spoke with told us about their induction programme. One member of staff said,’’The training was very thorough’'.

There was evidence that learning from incidents did not implement the appropriate changes required to risk assessments and care plans.

People using the service we spoke to told us they had no complaints about the service but would be happy to raise their concerns directly with the manager or staff.

Staff we spoke with told us the systems used to review assessments and care plans were being updated.