Holme Farm is registered to provide accommodation and personal care for 30 older people, some of whom may be living with dementia. The home is a purpose built, single storey service which is situated in the village of Elsham and has access to all local facilities. On the day of the inspection there were 23 people using the service.

We undertook this unannounced inspection on 8 and 12 December 2016. At the last inspection on 2 and 7 October 2015, we asked the provider to take action to make improvements to risk assessing, care planning and the analysing of accidents and incidents. We received an action plan from the registered provider detailing how improvements would be made including a timescale; this action has been completed.

The service had a registered manager in post who was also the registered provider. A registered manager is a person who has registered with the 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.

We found improvements had been made in the way the service assessed and monitored risks to people's safety. We saw risks assessments were in place and these contained steps for staff to follow to help minimise the risks specific to people using the service. An analysis of accidents and incidents was undertaken regularly to identify any trends or patterns. This meant people’s needs could be reassessed if and when required. People who used the service received care in a person centred way with care plans describing their preferences for care. We found people’s plans of care were regularly reviewed, detailed and organised and had been updated following any changes in their needs.

At the last inspection we made a recommendation for the registered provider to find out more in relation to providing activities and meaningful occupation for people living with dementia. During this inspection we saw people were encouraged to take part in various activities if they wished to do so.

People told us they enjoyed the meals. People received a well-balanced diet and their specialist dietary needs had been assessed and provided for. One main meal was provided at lunchtime and alternatives were available on request. The meals provided to people were varied.

Staff contacted community health care professionals when required. Dieticians were contacted for advice and treatment when people lost weight or there were concerns about their food and fluid intake.

People we spoke with told us they felt safe living at Holme Farm. We found staff were recruited safely and there was sufficient staff to support people. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns. Staff provided people with information and spoke with them in a patient way. People's privacy and dignity was respected and their confidential information was held securely.

Staff received supervision, albeit not regularly, and we saw staff had access to training relevant to their roles which supported them to feel skilled and confident when providing care to people.

We found staff supported people to make their own decisions. When people lacked capacity for this, staff acted within the principles of the Mental Capacity Act 2005 and ensured important decisions were made within best interest meetings with relevant people present.

Plans were in place for emergencies like a fire or a flood and staff knew what to do in the event of an emergency. Safety equipment, electrical appliances and gas safety were all checked regularly.

The service had a quality monitoring system in place which ensured that checks were made and people were able to express their views. People told us the registered provider/manager was approachable and people who used the service felt they were listened to and their v

We saw that a person’s capacity was documented in the pre-admission assessment that was completed before a person moved into the home. Sections of the care plan, including personal care, medical health, night care and finances had been signed by the person to show their agreement with it.

Care files and risk assessments were reviewed and audited on a regular basis and a full review of a person’s needs was completed with the person twice a year.

Appropriate arrangements were in place for the safe ordering, dispensing and disposal of medication. The home utilises a blister pack system. Blister packs are prepared by the pharmacist and contain all of a person medication for each day. This minimised the potential for errors to occur.

During the inspection we looked at four staff files. We saw evidence of an effective recruitment and selection processes. Records showed that staff had appropriate checks undertaken prior to commencing work in the service such as confirmation of references and a Criminal Record Bureau (CRB) check.

A care worker explained, “People have little issues, of course they do but we fix them there and then so we don’t really get anyone complaining.” A person who used the service said, “I have no complaints at all but if I did I would just go and see Tony (the manager).”

The people we spoke with who lived in the home were not able to comment directly on the outcome areas we reviewed due to their complex needs.They did however tell us they were happy living in the home and felt well cared for. They were also very keen to talk about the extensive improvements made to their lounge area and were very complimentary about the décor and the new furniture which had been provided.

Comments from people living in the home were very positive and included ‘I am very happy with the care, I wouldn’t want to be anywhere else, they are brilliant here’, ‘I am well looked after and get up and go to bed when I like’, ‘the people who look after me are nice’, ‘I feel safe and am well looked after’ and ‘its nice here most of the time’. A person visiting the home and speaking on behalf of their spouse said ‘they are very well looked after, the staff come and are very patient, she is always clean and tidy. Another relative said my relative ‘is very well cared for and I am happy with the care’.

There were some negative comments about the activities available to people comments included ‘there’s not much going on’ and ’I like to do different things’.

We undertook this unannounced inspection on the 2 and 7 October 2015. The last full inspection took place on 9 April 2013 and the registered provider was compliant in all the areas we assessed.

Holme Farm is registered to provide accommodation and personal care for 30 older people, some of whom may be living with dementia. The home is a purpose built, single storey service which has been extended since it was built. It is situated in Elsham village and has access to all local facilities. On the day of the inspection there were 29 people using the service.

The service had a registered manager in post who was also the registered provider. 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.

People did not have risk assessments in place for specific concerns, such as falls and some of those in place lacked some important information to guide staff in how to minimise risk. Incidents and accidents had not been analysed to help find ways to reduce them. These issues meant the registered provider was not meeting the requirements of the law regarding keeping people safe from risks to their safety. You can see what action we told the registered provider to take at the back of the full version of the report.

Care plans needed to be more detailed and contain more information about how the person preferred to receive their care. Following the inspection the registered provider/manager confirmed they had obtained a new, more up to date, care recording system and had started to make improvements to the quality of the care records.

People had access to a limited range of activities. We made a recommendation that the registered provider/manager provided more training and support for staff based on current best practice, in relation to providing activities and meaningful occupation for people living with dementia.

We found the quality monitoring system had not been effective in highlighting some areas to improve and action had not been consistently taken in order to address shortfalls. Following the inspection the registered provider/manager confirmed they were updating the monitoring systems.

Staff understood their roles and responsibilities for reporting safeguarding or whistleblowing concerns about the service. Training had been provided to them, to ensure they knew how to recognise signs of potential abuse.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GP’s, hospital consultants, community mental health nurses, opticians, chiropodists and dentists. Systems were in place to ensure people’s medicines were administered safely.

People received a well-balanced diet and we saw specialist dietary needs had been assessed and catered for. Arrangements at lunchtime to provide one main meal and only offer alternatives on request, could limit some people’s choices. The choice of snack options between meals was limited. On some occasions, the monitoring of people’s weight had not always been carried out effectively so that changes could be highlighted and discussed with health professionals for advice. The registered provider/manager told us they would address this with staff.

Staff were provided in suitable numbers to ensure the needs of the people who used the service were met. Our observations showed staff were attentive to people’s needs and were always available. Recruitment checks were carried out on new staff to ensure they were safe to work with vulnerable people and did not pose an identified risk to their wellbeing. Staff had access to training relevant to their roles.

The Care Quality Commission [CQC] monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which applies to care homes. The registered provider/manager had followed the correct process to submit applications to the local authority for a DoLS where it was identified this was required to keep them safe. At the time of the inspection there was one DoLS authorisation in place and further applications were to be submitted.

Staff supported people to make their own decisions and choices where possible about the care they received. When people were unable to make their own decisions, staff mostly followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made. Improvements were needed with the recording of decisions about resuscitation.

There was a complaints procedure and people told us they would feel able to make complaints and these would be sorted out.