Holmehurst provides accommodation and personal care for up to 21 people. Care is provided to older people, including people who live with dementia or a dementia related condition. At the time of inspection there were 18 people living at the home. Accommodation is in mainly single rooms but there are some rooms which can be shared by two people. Some of the bedrooms have ensuite facilities. There are two large lounges and a dining room on the ground floor.

This was an unannounced inspection carried out on 27 June 2017. We last inspected Holmehurst Residential Home in 17 March 2015. At that inspection we found the service was meeting all the legal requirements in force at the time and was rated as Good.

At this inspection we found the service remained Good.

A registered manager was in place. A registered manager (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, relatives and professionals consistently gave us positive feedback about how the home was personalised to meet people's individual needs. One person living in the home told us, “It’s very good indeed.”

People said they were safe and staff were kind and caring. Good relationships had been formed and people were treated as individuals. Staff knew the needs of the people they supported to provide individual care. People living in the home reported that staff all worked well together and many had worked at the home for many years, giving them consistency of care staff.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had received training and had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves.

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.

We have made a recommendation about support plans for people who at times may be challenging for the service.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

Risk assessments were in place to promote people’s independence. These accurately identified current risks to the person in order to minimise or appropriately manage those risks. The emphasis of the home was to support people to keep as much independence as possible.

The environment was well maintained with many areas that had recently been refurbished, such as a new lift and a garden make over that allowed people to comfortably enjoy time outside. The top floor had been completely refurbished in January 2017 to add an extra three bedrooms that were all en-suite.

People were very complimentary about the quality of the meals. They liked that meals were home cooked. Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for.

A variety of activities and entertainment were available for people and this was supported by a newly appointed activities coordinator.

People told us they felt confident to speak to staff about any concerns if they needed to. Staff and people who used the service said the manager and senior team were supportive and approachable

This inspection took place on 17th March 2015 and was unannounced.

Homehurst is two older properties that have been extended and adapted to provide care for up to twenty-three older people. The home is situated in a quiet residential street and is near to the centre of Carlisle and to the local amenities of the area.

Accommodation is in mainly single rooms but there are some rooms which can be shared by two people. Some of the bedrooms have ensuite facilities. There are two large lounges and a dining room on the ground floor.

The provider is also registered as the manager 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 and associated Regulations about how the service is run. The provider has delegated some management tasks to a care manager.

Staff in the home were aware of their responsibilities in relation to protecting people from harm or abuse. Staff had received training and there was suitable guidance in place about making safeguarding referrals.

The house was safe and there were good risk management plans in place for the environment.

Staffing levels were suitable for people’s needs. The care manager had increased staffing because the needs of people using the service had changed.

Staff recruitment was done correctly so that only suitable staff cared for vulnerable people. There were good disciplinary systems in place.

Medicines were managed correctly. Effective infection control systems were in place.

Staff were given good levels of support. Staff training was in place with any needs being identified and suitable training provided.

The staff understood their responsibilities under the Mental Capacity Act 2005. No one was being deprived of their liberty. Decision making was done correctly when people lacked capacity. Consent was sought for any intervention.

The food provided was of a good standard. Nutritional needs were understood by the staff team.

The house was being upgraded and improved to meet the needs of older adults.

We observed caring and sensitive care delivery. We saw that independence was encouraged. People told us the staff team were kind and caring.

People were given explanations and support and the staff team were able to pre-empt needs where people found it difficult to express themselves.

End of life care was managed appropriately with staff being supported by community nursing teams. Staff had received training in this and further updates were planned.

Assessment and care planning had improved in the service and the senior team were continuing to improve the way they planned care for people in an individual way.

Activities were being developed to meet individual and group needs.

Concerns and complaints were managed appropriately.

Good systems were in place so that people in the service would be supported if they had to go to another service. We saw that admission to hospital was well managed.

We judged that the home was being well managed. There was an open and inclusive culture in the home and people in the home and the staff were confident that their opinions were valued.

The provider had a team development plan and had changed the way that the tasks in the home were developed. A new senior team was being developed by the care manager.

A new quality monitoring system had been developed and staff were following this. We saw that routine matters were covered by this and that changes were made appropriately to allow for improvements.

This was a short responsive inspection because there had been problems with one aspect of record keeping when we had completed an inspection in November 2013.

At this visit we checked on a range of records again. At the planned inspection we saw that record keeping was being done correctly apart from the records concerning residents money. At this inspection we looked at a range of records and we saw that assessment and care planning, staff records and quality monitoring records were suitable and showed ongoing improvement.

We looked at the records specific to money management for people who needed support with this aspect of their lives. We saw that the records were now suitable, were checked weekly and monthly and that they reflected the spending on behalf of the person. Recording and safekeeping of residents' money was being done correctly. The service was therefore compliant with this outcome.

On the day of the visit we spoke to people in their own rooms and in small groups in the lounge. We also spoke to visiting relatives. We observed how people were cared for and spoke to the acting manager and to the staff team on duty.

People told us that they were satisfied with the care they received. Here are some of the things people told us:

"I'm quite happy here and I have no regrets about coming in. The staff are very nice."

"I am very well treated but I do get bored as there is not a lot going on."

"I am very settled. I don't spend much time in the lounge and don't join in activities but come down for meals."

We saw people being asked about their options and choices but we did judge that the staff team needed to record in a more formal way how they gained consent from some people.

On the day of the visit the home was clean and suitably equipped to meet people's needs.

When we spoke to people no one had any complaints and we had not received any complaints about the service. Minor changes were needed to the complaints procedure.

We looked at a wide range of records and saw that recording had improved considerably in the three months prior to the visit. We did however find some worrying errors in recording money kept on behalf of people who lived in the home. We made a compliance action about this.

We spoke to most of the people who lived in the home and they were mainly positive about their experiences:

" I settled in quite well...the staff are pleasant and the food is fine...".

"I have a lovely room with all my things around me...I come for meals but spend a lot of time in my own room and that is what I prefer".

"I have been here for a while and the staff are all right with me...and I am satisfied with what I am given...".

"They look after me and they get the doctor out if I am unwell...I have no complaints".

People confirmed that there had been improvements to the service since our last visit:

"Staff have been talking to me about what kind of care I need and also what I want and prefer".

In general people told us that they were satisfied with the care and services provided:

"I like my room...the food is OK..it is what I expect".

"The staff are great...nothing is too much trouble".

People told us they were quite satisfied with the care they received:

"The staff are lovely"

"We have a nice time...but we don't do many activities...we are supposed to but we don't."

"I don't know what they write about me...I don't think there are any plans written down for me...I haven't signed anything".

"We go out sometimes but not often...It is a bit quiet here at the minute...".

"The food is all right ...they wash my clothes properly and are nice to me...I don't have any complaints"