About the service:

Holme Lea is a purpose built, two-storey building in its own grounds. It offers accommodation for up to 48 older people in single bedrooms, many of which have en-suite facilities. At the time of the inspection 44 people were living at the service.

The building is situated in a residential area of Stalybridge and is close to a main road offering public transport links and views across the foothills of the Pennines. Car parking is shared with the adjacent home, Stamford Court. The home is run by Meridian Healthcare Limited which operates several other care homes mainly in the North West of England.

People’s experience of using this service:

The service had an open and supportive culture. Systems were in place to monitor the quality and safety of care delivered. There was evidence of improvement and learning from any actions identified.

There were sufficient numbers of trained staff to support people safely. Recruitment processes were robust and helped to ensure staff were appropriate to work with vulnerable people.

People’s needs were thoroughly assessed before starting with the service. People and their relatives, where appropriate, had been involved in the care planning process.

Staff were competent and had the skills and knowledge to enable them to support people safely and effectively. Staff received the training and support they needed to carry out their roles effectively. Staff received regular supervisions and annual appraisals were planned.

Staff had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risk where possible.

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 supported people to access other healthcare professionals when required. Staff supported people to manage their medicines safely.

People’s outcomes were consistently good, and people’s feedback confirmed this.

Staff worked with other agencies to provide consistent, effective and timely care. We saw evidence that the staff and management worked with other organisations to meet people’s assessed needs.

We observed positive interactions between staff and people. Staff had good relationships with people and were seen to be caring and respectful towards people and their wishes.

People were supported to express their views. People we spoke with told us they had choices and were involved in making day to day decisions.

The provider and registered manager followed governance systems which provided effective oversight and monitoring of the service.

The premises were homely and well maintained. We observed a relaxed atmosphere throughout the home.

The service met the characteristics of Good in all areas.

Rating at last inspection:

At the last inspection of the service (published 04 April 2018) the home was rated Requires Improvement overall and there was one breach of regulations in relation to good governance. At this inspection the overall rating has improved to Good.

Why we inspected:

This was a planned inspection based on previous the rating. Prior to the inspection we were notified about a serious incident in which a person using the service died. We looked at risks associated with this. Further information is in the full report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

This comprehensive inspection took place on the 24 and 26 January 2018. The first day was unannounced. This meant the provider did not know we would be visiting the home on this day. The second day was announced.

Holme Lea is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided; both were looked at during this inspection.

Holme Lea is a purpose built, two-storey building in its own grounds. It offers accommodation for up to 48 older people. Communal rooms and dining areas are situated on both floors offering people a choice of areas to relax. There is a passenger lift between the floors.

As part of the homes registration conditions it is required to have a registered manager employed to oversee the day to day running of the service. 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. A manager had been in post at the service since October 2017 and registered with the CQC since January 2018. However, following the inspection visit we received a call from the registered manager to say they were no longer in post and it was their intention to de-register.

At the last comprehensive inspection on 01 August 2016 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to person centred care and treatment, this was because the service offered a limited programme of meaningful activities to people using its service. Following the inspection, we asked the provider to complete an action plan to show how they would ensure service compliance in the area identified and in what time frame this would be done.

At this inspection we found the service was now compliant in this area. We saw a detailed activities programme had been created and people we spoke with told us they could access a variety of activities each day if the wished.

During this most recent inspection we found the service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to good governance.

We found people’s care files lacked evidence of professional referrals such as GP and Dietician. Although the management team contacted the identified professionals and evidenced the referrals had been done this information was lacking from the services records. In addition to this people’s nutritional records were not always completed in full.

Approximately 10 weeks prior to this inspection the provider had identified areas of service improvement. This was identified through their own internal audit processes. The provider employed a, ‘turnaround manager’ and implemented an action plan in relation to the areas in need of development. A turn around manager’s role is to work alongside the management team to identify and support action plans highlighting non-compliance. In addition to this a new registered manager was also recruited. At time of inspection this action plan was embedded into the services practice and improvements had been made in areas, however we also acknowledged that this work was still in progress and the CQC will monitor this accordingly.

Safeguarding policies and procedures were in place to ensure people, staff and visitors were aware how to raise concerns and what abusive practice looks like. Staff received training in this area and a record of safeguarding referrals was kept securely.

Safe recruitment procedures were followed and new staff received a period of induction before being assessed as competent in their new role.

The service had recently transitioned through a period of change with a high staf

We last carried out an unannounced comprehensive inspection on 26, 28 January 2016 and 1 February 2016. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in us serving two warning notices and making six requirement actions. The overall rating for this service was requires improvement. The warning notices stated that the service must be compliant with these regulations by 13 May 2016. The service sent us an action plan informing us what action they intended to take to ensure they met all the regulations. They informed us they would be compliant with these by July 2016 and requested an extension until that date, which we agreed.

Holme Lea is a purpose built, two-storey building in its own grounds. It provides accommodation and personal care for up to 48 older people in single bedrooms, many of which have en-suite facilities. The service is divided into three units each having their own lounge area. The building is situated in a residential area of Stalybridge and is close to a main road offering public transport links. Car parking is shared with the adjacent home, Stamford Court. The home is run by Meridian Healthcare Limited which operates several other care homes mainly in the North West of England.

This was an unannounced comprehensive inspection which took place on 28 July 2016 and 1 August 2016 to check the required improvements had been made and to follow up on what action had been taken to address the warning notices and requirement actions.

During this inspection we found significant improvements had been made and the warning notice had been met.

There was a safe system of recruitment in place to help to ensure people using the service were protected from unsuitable staff. There were sufficient staff on duty to meet people’s needs and staff received the induction, training, support and supervision they required to be able to deliver effective care.

We found the home was clean, tidy and had no malodours. We saw that significant improvements had been made and a programme of refurbishment including re-decoration, new flooring and furniture had been undertaken. Care was taken to ensure effective infection control was maintained.

People had their health needs met and had access to a range of health care professionals. People at risk of poor nutrition and hydration had their needs regularly assessed and monitored thoroughly. The food within the service was nutritionally balanced and plentiful. All the people we spoke with told us the food had improved.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

People’s care records contained information about their interests and hobbies, but we found there were very limited meaningful activities regularly scheduled to provide stimulation for people who used the service.

The home is required to have a registered manager. Since our last inspection a registered manager had been appointed but was no longer working for the organisation. At the time of our inspection there was no registered manager in place at Holme Lea. 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.’ The home did not have a registered manager in post. The service had a relief manager in place. Everyone we spoke with was positive about the manager and the improvements they had made. We found the manager to be enthusiastic and committed to improving the quality of the service. They had only been at the service a short time, but we found they knew people well.

The service had notified CQC of

This inspection was carried out over three days on 26 and 28 January and 1 February 2016. Our visit on 26 January was unannounced.

We last inspected Holme Lea on 13 August 2014. At that inspection we found the service was meeting the regulations we assessed.

Holme Lea is one of 31 care homes owned by Meridian Healthcare and is situated in the Stalybridge area of Tameside. The home provides care, support and accommodation for up to 48 people who require personal care without nursing. Holme Lea is a 3-storey, purpose built care home and all rooms provide single accommodation, many of which are en-suite. Communal bathrooms and toilet facilities are available throughout the home. Bedrooms are located over the ground and first floors and they can be accessed via stairs, stairlift or passenger lift. The home is divided into three units, two on the ground floor and one on the upper floor; each unit consists of a lounge, dining area and kitchen facilities. The laundry and main kitchen are located in the lower ground floor. There is a conservatory and an enclosed garden and patio area at the rear of the building that is accessible to people who use the service. There is also a designated smoking room for people who wish to smoke.

At the time of our inspection there were 43 people living at Holme Lea.

The service did not have a registered manager in place. 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. A new home manager had been in post since December 2015 and had not yet submitted an application to register with the Care Quality Commission (CQC) as the registered manager for Holme Lea. The previous registered manager had moved on three months previously, but had not yet deregistered with the CQC at the time of our visit.

We identified 13 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People, their relatives, and staff spoke highly of the service; one person’s relative told us “It’s a lovely place” and “The manager is approachable, all the staff are.” Visiting professionals were also complimentary of the service and one person told us that they had seen a vast improvement in the home recently and told us “they are working with us a lot more”.

During this inspection we found that there were not always enough staff available to meet people’s needs. There was evidence of a dependency tool in place which should support the service to identify appropriate staffing numbers. However, whilst the dependency of residents was documented, this information was not used to calculate staffing numbers. Instead the staffing was based on a ratio of 1 staff to 8 people on day shift and 1 staff to 15 people on night shift. People did not always receive the care and support they needed in a timely way. Relatives and people using the service who we spoke with felt that there were not enough staff on duty during the day and night. One person told us, “There is nowhere near enough staff on at night.” Another person told us that they would like to have a bath, but staff say they do not have time.

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had not always been used to ensure that suitable staff were employed to care for vulnerable people.

Staff we spoke with were aware how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm.

Documentation at the hom

During our inspection we spoke with the manager and the care staff on duty. We spoke with people living in the home and some relatives who were visiting. We spoke with visiting professionals to ask them for their views of the service. We spent time observing the interactions between staff and the people who lived at the home. We looked at a sample of records which included care plans of people living in the home.

We considered the evidence collected under the outcomes we reviewed and addressed the following questions: Is the service safe? Is the service effective? is the service caring? is the service responsive? Is the service well led/

Below is the summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We saw staff supporting people and encourage them to do things for themselves. We saw that care plans identified people's care needs and provided care staff with the information they needed to meet people's needs in a caring and safe way. We saw through observations and through talking with staff that they had a good knowledge and understanding of individual care needs which meant that people could be confident that they would receive care and support in a safe and appropriate way.

During our visit we saw that there were sufficient staff on duty to meets people's needs and that monitoring systems were in place to regularly evaluate staffing levels to measure their effectiveness.

We saw that staff were provided with on going training and development opportunities to ensure that they had the right skills and knowledge to meet people's needs.

Is the service effective?

We found that care plans included risk assessments, and that all information was regularly reviewed and updated.

We saw staff used the care plans on a daily basis and referred to them whilst providing care and support to people. We saw that where appropriate the service would seek advice and guidance from other healthcare professionals so that people received the right care and treatment.

Is the service caring?

During our visit we observed staff supporting people in a kind and caring way. There was evidence to demonstrate that staff had a good knowledge and understanding of people's care needs. We saw staff engaging in meaningful conversations with people and that there were good relationships that had developed over time. People living in the home told us that they felt well cared for. One person said,"The staff are very caring. They will do anything they can for you."

Relatives we spoke with told us that staff were very kind and helpful to people living in the home. One person told us that staff kept them well informed about any changes in care needs.

Is the service responsive?

This service carried our regular service user surveys, and at the end of the process the results were analysed and used to inform and improve service delivery to people. One relative told us that the service had recently made improvements and listened to what people were saying.

Records showed that the service responded to changes in people's care needs and involved the appropriate healthcare professionals as required. Care staff supported people to attend appointments at local healthcare facilities such as hospitals.

Is the service well led?

The manager had recently been appointed to the post, however in the short time since her appointment she had made several improvements to management systems in the home. She was able to show us the on-going auditing and monitoring systems which were in place to assess how the service was performing and how well they were meeting peoples needs.

Relatives we spoke with told us that the manager was approachable and would listen to their concerns. When we spoke with staff they told us they felt well supported by the management team.

We saw evidence that consultations had been held with people and that the service was actively promoting the October service user survey to encourage service users and relatives to become involved in the consultation process.

We looked at records during our last review of Holme Lea in April 2013. At that time, we found that people's personal records including details on care plans were not accurate or up to date. This meant that there was a potential for people's care needs to be overlooked because staff did not have the correct information to provide care and support in a safe and appropriate manner.

During this visit we found that improvements had been made to care records. We looked at a sample of care plans and found that these were accurate and reflected the indivual needs of people living in the home.

The staff we spoke with had a good understanding of how to use care plans and of the importance of reviewing them regularly and keeping them updated. One member of staff told us that there were opportunities to access training and development and that they were supported in both formal and informal supervision sessions.

People living in the home expressed confidence that staff had the necessary information to assist them with their identified care needs in a safe and effective way. All care records were securely stored.

We used a number of different methods to help us understand the experiences of people using the service, including observing care and speaking to those people who could give their views on the home. We were able to speak with six people who lived in the home and four relatives who were visiting. We spoke with one health care professional who was visiting a person living in the home.

People we spoke with were very positive about their experience of living in the home. They told us that staff were kind and attentive and always willing to listen to them. Relatives visiting people told us that staff had a good knowledge and understanding of people living in the home. One visitor said," I feel the care is very good in this home. The staff work hard at providing activities that help keep people active. I like the way staff are flexible and treat people like individuals. If someone wants to stay in bed longer, or have their meal in their room the staff are able to arrange this." Another person told us that staff always appeared to have a good knowledge and understanding of how to meet people's needs.

During our observations we saw staff providing care and support to people in a kind and caring manner. We observed good interactions between the staff and people living in the home.

We used a number of different methods to help us understand the experiences of people using the service, including observing care and speaking to those people who could give their views on the home. We were able to speak with seven people who lived in the home. They were all very happy with the care they received. One person told us: "It's very comfortable here. Staff can't do enough for you. Everything's good". Another person said: "it is very nice and I'm not just saying that". People did comment that they would like more things to do during the day. We spoke with the manager about this.

We briefly spoke with one relative of a person who lived in the home. They were generally happy with the care their relative received commenting that "all staff are dead helpful".