This inspection was carried out on 11 January 2017 and was unannounced.

Holmer Court provides accommodation and personal care for up to 33 people. At the time of our inspection there were 32 people living at the home.

There was a registered manager in post. 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 service provided person centred care that maintained people’s health and wellbeing. People were supported to maintain hobbies and interests and people’s skills and abilities were promoted by staff.

People were treated with dignity and respect. People had positive relationships with staff.

Staff were motivated and well supported with on-going training to enable them to meet the individual needs of people living at the home. There were sufficient numbers of experienced staff to ensure people were supported safely and people’s health needs responded to quickly. Medicines were managed safely and people received their medicines in line with their prescription.

People and relatives knew the registered manager and the provider. People were encouraged to be actively involved in the running of the home through regular meetings. They felt that if they had any concerns they were able to speak with the registered manager or provider. The provider welcomed people's views and opinions and acted upon them.

People felt safe and knew how to raise concerns. Staff felt comfortable to raise any concerns about people’s safety and understood about how to keep people safe. Risk assessments were in place and action taken to reduce any risks. Staff supported people to take positive risks. Where risks had been identified risk assessments were in place and action had been taken to reduce the risk of harm.

People enjoyed the food and had the support they needed to enjoy their food and drinks safely. People were able to make choices about the food and drink they wanted. There was a choice of freshly prepared nutritious food and where additional monitoring and support was needed this was provided.

People's health needs were monitored and changes were made to people's care in response to any changes in their needs. People had access to other health professionals and were referred to them by the registered manager if there were any concerns about their health needs.

There were a range of audits and checks to make sure that good standards of care and support were maintained. Feedback from the people and relatives was gathered on a regular basis and where any actions were identified these were actioned quickly.

This inspection took place on 9 January 2015 and was unannounced. Holmer Court provides nursing care for up to 33 people. There were 33 people living at the home when we visited and there was a registered manager in post. 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 last inspection was on 14 May 2014.

People told us they felt safe living at Holmer Court and the relatives that we talked with agreed. People knew who to talk to if they had any concerns. There were sufficient numbers of appropriately trained staff to meet the needs of people and keep them safe.

Assessments had been completed so that staff had the information they needed to manage identified risks to people.

People’s healthcare needs were met as they were supported to see healthcare professionals when needed. They received their medicines as prescribed.

People’s needs were met by staff who had the skills and knowledge to provide their care. People told us that the staff were kind and respectful. Relatives told us they were kept informed about their family member’s care. We saw that staff involved people in their care giving people explanations of what could happen so that they could make informed choices. We saw that people were treated with dignity and respect.

People were able to raise their concerns or complaints and these were investigated and responded to. People were confident they were listened to and their concerns taken seriously.

The provider acted in accordance with the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they receive. At the time of our inspection nobody was subject to DoLS. This meant that the provider had taken all steps necessary to protect the rights of people.

Staff meetings were held so staff could discuss the service provided to people. People and their relatives told us that the manager and the staff were approachable at all times. We saw that staff gave people choices and asked their opinions.

The provider had taken steps to assess and monitor the quality of the service which took account of people’s preferences and the views of relatives and other professionals. These had been used to make changes that benefitted the people living at the home.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describe what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

The people who lived in the home and their relatives told us they were pleased with the care provided. They felt that their views were respected and listened to.

People told us they felt safe. We saw that people were free to go about their daily routine. One person told us, “Care is superb”.

Recruitment processes showed that staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us that they were satisfied with the care they received. They told us that the registered manager and the staff had asked them what their needs were and how they would like them met. A relative said, “We talked about what dad needed and they made sure he got it”.

Care records confirmed people’s needs and preferences had been recorded and care and support had been provided in accordance with their wishes.

People and their relatives were involved in the assessment of their needs. One person said, “I talked with (registered manager) and arranged things how I wanted them to be”.

People told us they were happy to discuss their personal preferences with staff. They said that staff obtained help for them if they were ill. This meant people were supported to keep in good health, have access to health care services and received ongoing support.

We found that the staff received the support and training that enabled them to meet the needs of the people living in the home.

Is the service caring?

People we talked with told us their wishes were respected and they were able to live their lives as they wished. Staff took the time to find out about people’s background. Staff knew people’s needs well and how they wished to be cared for. This meant that staff cared about the person as an individual and were concerned about their well-being.

People and their relatives were encouraged to make their views known about their care. People that we talked with told us that they found the registered manager and the staff easy to approach about any issues they had. This meant that people were listened to and they felt that their views mattered.

Is the service responsive?

People had been assessed before they moved into the home so that arrangements could be made to meet their needs.

People and their relatives told us they talked with the registered manager and the staff about what was important to them. They talked the about activities they took part in and their meals. They told us that their care packages had been changed as a result.

Is the service well led?

The management and staff demonstrated values that included involvement, compassion, dignity, respect and independence. Staff we talked with showed they understood those values as they discussed their role and responsibilities in their work. This meant the service promoted an open culture that was centred on the individual and empowered them to take control of their life as much as they were able.

The provider had systems in place to assess and monitor the home so that potential improvements in meeting people’s care needs could be identified and put into place.

We did this inspection because we received information of concern. The main concerns we were told about were the management of medicines and how people with mobility difficulties were moved. We spent the majority of our time inspecting the arrangements for medicines. This was because it was the area in which people may have been at most risk.

During our inspection we identified a number of shortcomings in the arrangements for the management of medicines. These shortcomings meant that people were not protected from the risks associated with the unsafe use and management of medicines. The most concerning of these was that some people's medicines had been out of stock for up to 11 days. This meant that they had not received the medicines prescribed for them. Other concerns related to various aspects of the recording, handling, safe keeping, safe administration and disposal of medicines. Following our inspection we made a safeguarding referral to the local authority. This was in respect of three people where we were most concerned that they had not received their prescribed medicines.

We saw two occasions when care workers moved people in a way that is viewed as poor practice. We subsequently learned that one of these people should have been moved using a hoist. They had been moved by staff manually. This meant the person had not received the correct care and was put at risk of being injured.

We did this inspection because we needed to check the action taken since our last inspection to improve the management of medicines and the consistency of record keeping. We also checked whether people living at Holmer Court were respected and provided with care that met their needs, whether staff were carefully checked before they worked at the home and how the service monitors the quality of the service it provides.

During our visit to the home we watched to see what life was like for people who were living at the home. We looked at how staff provided care and listened to how they spoke to people. We spent time talking to people who live at Holmer Court, to a relative and to members of staff. We looked at some of the records kept to support staff in providing the correct care and also at recruitment, medicines and management records.

We saw that staff knew people at the home well and spoke with them in a friendly, respectful way. Throughout the day we noticed that staff were prompt to come to people who were upset or restless and spoke with them using a calm, reassuring and warm tone of voice.

We saw that people were rarely left for more than a few moments without a member of staff being in the room with them. Staff were watchful, for example they noticed when a person was looking anxious and when another felt cold because of the patio doors being open. The day of our visit was warm and sunny and at various times during the day people were helped to either go for a walk around the garden or to sit outside on the patio.

The relative we met told us they were very happy with the quality of the care their family member received. They spoke highly of the staff and described them as kind and caring. The staff we met and spoke with were positive about their work and talked about people who lived at Holmer Court in an understanding and caring way. One of them described making life at the home fun for people and giving them reasons to laugh as ‘joyous’.

We found that the arrangements for the management of medicines had been improved and we did not find any significant gaps in the records that we looked at. The service had recruitment processes that met legal requirements. There were various processes in place for checking and improving the quality of the service.

There was a calm, peaceful atmosphere in the home with classical music playing in one lounge. We saw that people were settled and staff spoke to them gently and kindly, asking them if they were comfortable. One person who lived at the home said that “it’s a good place to be”. Another person said that the staff were “kind and always cheerful. They look after me”. We spoke with relatives of two people who said that they were very happy with the standard of care given, and that they felt included by staff. They were welcomed at any time.

At our last inspection we were concerned about how the home managed people’s medicines and about how people with mobility difficulties were supported by staff when they needed to move. We wanted to check both of these things during this inspection. We also needed to look at how staff were recruited. A safeguarding investigation had identified that a care worker had been employed without suitable checks being made about them.

People were in general pleased with the home. One person told us, “I’m quite happy here, they are very good to me”. We saw that people had been supported to look their best. Staff were generally attentive and kind to people and gave them the time they needed.

Staff had been given additional training in how to support people safely if they needed help to move. The home's moving and handling policy had been updated. The required improvements to the arrangements for dealing with people’s medicines had been made.

The systems for recruiting new staff were not always effective. The home did not always carry out adequate checks on people’s suitability to work with vulnerable people.

The provider had systems for monitoring the quality of the service. Survey forms were used to give people the opportunity to give their views and opinions about the home. The provider told us that they had not received any complaints about the home.