About the service: Holmewood is a residential care home that was providing personal care for up to 25 people. At the time of the inspection there were 20 people living at the home. The period property had been adapted for its current use with accommodation in single rooms with ensuite shower or bath facilities with suitable shared facilities.

People’s experience of using this service:

People told us they were very happy with the care provided, especially the caring nature of the staff team and the homely feel that had been created. One person summed this view up by telling us, “It’s home from home here, you can do what you like. I couldn’t wish for better, the staff are very kind. I kept falling and getting poorly but since I came here I haven’t had one fall, they’ve seen to that. My health is good now as staff are on the ball.”

People felt safe living in Holmewood and with the staff who supported them. Staff knew them well and were focussed on promoting their independence and well-being. Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.

Staffing levels were suitable for people’s needs. There was a stable staff team who had the skills and knowledge to meet people's needs. The home’s programme of training and staff supervision had improved which ensured staff were up to date with the latest guidance and information for their roles.

People received the support they required to maintain good health. Medicines records were accurate and supported the safe administration of medicines.

Meals were of a good quality and nutritional value and people told us the meals were very good and home-cooked.

The home worked in partnership with external healthcare professionals. Healthcare professionals gave positive feedback on the care and of the monitoring of peoples changing health needs. A relative told us that the end of life care of their loved one had been exemplary.

People were involved in planning their own support and the activities they wanted to take part in. There was a programme of activities for people to take part in and people were also supported to follow individual interests and hobbies.

The home had undergone improvements to the environment; and to care planning and staff induction and training since the last inspection. The registered manager and owner had developed an improvement plan for the home which included the next phase of improvements, such as continuing to replace furniture and carpets and developing a dementia-friendly garden space.

The home was clean and well maintained; checks were carried out on the premises and on the quality of the service. Good measures were in place to prevent the spread of infections. Concerns and complaints were managed appropriately and staff and people in the home felt able to speak to the manager and owner of the home.

More information is in the Detailed Findings below.

Rating at last inspection: Requires Improvement (report published 18 January 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had been rated as Requires Improvement and we asked the provider to submit an improvement plan. On this inspection we saw improvements had been made since our last inspection and we have now rated the service as Good.

Follow up: We will continue to monitor as part of the re-inspection programme for a Good service. If any concerning information is received we may inspect sooner.

We inspected the service on 6 & 14 November 2017. The first day of our inspection was unannounced. At the last inspection, October 2015, the service was rated Good. At this inspection we found the service needed to make some improvements and was rated as Requires Improvement. This is the first time the service had been rated Requires Improvement.

There was a registered manager in post on the day of our inspection visit. 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.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were around risk assessments and ongoing assessments when people’s needs changed; staff induction, training and development; and the quality assurance systems to check the quality of the service.

We found assessments of people’s support needs did not always contain all the information needed to meet their current needs.

We found that the provider and the service did not have effective quality assurance systems in place. For example, for ensuring that the care given in the home was up to date best practice. Staff carrying out audits did not have the appropriate qualifications and skills to analyse and understand the significance and impact. The service was not always effectively seeking and acting on feedback from relevant persons, including people in the home, to improve the service.

People made informed choices and were enabled to be involved in decisions. Some of the records in people’s care plans were not clear on the support they needed to make decisions.

We made a recommendation about how people’s capacity was assessed and recorded.

We found some infection control measures were not in place and the home was not following national best practice guidance in this area. We have made a recommendation about improving infection control in the home.

Staff received basic training required to undertake their roles. Staff were given supervision and attended staff meetings. Staff received informal induction when they began working in the home.

We have made a recommendation about introducing a more formal structured programme, with more detailed training on the issues for people living with dementia.

Systems were in place for the safe storage, administration and disposal of medicines. Records showed people received their medicines as prescribed and in their preferred manner.

We made a recommendation about developing care plans to manage ‘as and when’ medicines.

There was a programme of entertainments in the home and people went out on day trips. People’s preferences to meet their social and recreational needs was not always recorded. Some people spent all their time in their bedrooms and they maybe at risk of being socially isolated.

We made a recommendation about seeking people's views on day to day activities and then ensuring these are in place with appropriate staff support.

People were supported by sufficient numbers of staff who knew them well. Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.

The environment was well maintained and the atmosphere was relaxed and homely.

Staff worked with external professionals to promote people's physical and mental well-being. People were well supported to have a dignified end of life and a pain free death.

People were supported to have a balanced diet that met their and health needs and told us of the good quality and range of the meals provided. Their visitors were made welcome in the home and people were able to maintain relationships that were important to them.

Safeguar

This was an unannounced inspection that took place on the 5th October 2015.

Holmewood is a period property set in its own extensive grounds. The home has car parking facilities and is served by public transport. The home is located on the outskirts of Cockermouth and has its own transport. The building has been adapted and extended provide care for up to 26 older people.

Accommodation is in single rooms with ensuite shower or bath facilities. There are suitable shared facilities with a large lounge, a quiet lounge and a large dining room.

The home has a registered manager. 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 in the home told us they felt safe. The staff team had received training in the protection of adults. We judged that people were suitably protected from harm and abuse. Staff said they could talk to the registered manager and the provider if they were concerned.

The registered manager had suitable plans in place to deal with accidents and emergencies. There were risk assessments and management plans in relation to the premises.

Staffing levels were suitable to meet the needs of people in the home. Staff told us that there were enough staff to deliver good levels of care and services.

Recruitment and disciplinary matters were managed appropriately.

Medicines management was done correctly. People told us they were encouraged to deal with their own medicines where possible.

The home was clean and orderly and good infection control measures were in place.

Staff received supervision, appraisal and training. We saw evidence to show that members of the staff team were supported to develop in their role.

The registered manager understood her responsibilities under the Mental Capacity Act 2005. She judged that no one was being deprived of their liberty. People were asked for consent for care interactions. Restraint was not used in the service.

People enjoyed the food provided. Staff understood the need for good nutritional planning if people were underweight.

People in the service were supported to get health care support. The community nursing team and the local G.Ps visited on a regular basis. Specialist intervention was sought where necessary.

The house had been suitably extended and adapted to meet the needs of older people.

We observed a staff team who had a caring and sensitive approach to their work. People told us they were treated respectfully and that staff supported them to retain their dignity when care was delivered.

We had evidence to show that people’s privacy and confidentiality were protected. Independence was encouraged.

End of life care was being managed well.

We saw good assessments of need on file and detailed and up to date care plans in place. People told us that they were asked about their needs and preferences.

People in the home were keen to talk to us about outings, activities and entertainments. We learnt that people went out to church, went to Cockermouth and joined in exercise classes in the home and enjoyed the entertainments on offer.

The home had an easily accessed complaints procedure in place but there had been no formal complaints received.

The home had an experienced and suitably qualified manager who was registered with the Care Quality Commission.

We observed a kind, friendly and caring culture in the home. Independence was encouraged and people felt their wishes were respected. People told us they were consulted.

Regular questionnaires went out to the people in the home, their relatives and visiting professionals. The results were analysed and changes made.

Quality was monitored by regular checks on all aspects of the service.

People who lived in this service told us that they were happy with the care and support they received.

"The staff are excellent… Nothing is too much for them."

"I think I made a good choice coming here because everyone is very pleasant."

"I am given plenty of support but I can be as independent as I want."

The home was clean, tidy and fresh on the day that we visited. It was well furnished, freshly decorated and all of the equipment was up to date and well maintained.

The home was appropriately staffed with skilled and experienced team members. We spoke to the staff on duty and they were enthusiastic, well trained and knew the people who lived in the home very well.

No one in the home had any complaints about the care or services. People knew how to make a complaint but said that they have never had to do this. There was a minor change needed to the home complaints policy and the provider agreed to do this.

There was efficient record keeping systems in place. There were some minor changes needed and again the provider was happy to improve the way records were managed.

We spoke to everyone in the service during our visit and their comments were very positive.

"I am pleased that I decided to come here...I was finding things very hard to manage...I can now enjoy my life again as I don't have to worry about being alone and looking after myself...".

"I am quite settled...I have a lovely big room with a bathroom. I enjoy my food and I like having company or being private when I want".

"The staff are wonderful...they look after me well. I am well fed and cared for. I enjoy the music activities we have".

"I am very well looked after...rooms are clean, my laundry is beautiful and the food is very good".

We had lengthy conversations with individuals and with groups of people and overall people were very satisfied with the care and services provided.

"I have been here for a few weeks and I am enjoying being here...plenty of friends and we enjoy each others company, watch TV together, join in activities, go out on outings and I have been talking to staff about my future and I think I will stay here as I have a good life here."

"My relative has been here for some time...she found it hard to settle but is now more relaxed and treats it as her home. Staff are very pleasant and the food is good...her room is beautiful and always clean."

"I love the Jacuzzi bath and staff will give you as many baths as you want...".

"My clothes are well cared for and I wear all my best things to come down for meals...I dress up, eat well and have a jolly time...quite happy".

"I have no real complaints but if anything isn't quite right the staff do their very best to put it right."

"I like to look nice and the staff need to dress me as I am quite elderly now but I still choose what I wear and like my hair done...I still like my food and it is really lovely here and I get what I want and a sherry or two if I want."