This inspection took place over two days on 12 and 13 December 2017. The first day was unannounced, which meant the service did not know in advance we were coming. The second day was by arrangement.

Holmfield is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Located in Didsbury, South Manchester, Holmfield is registered with the CQC to accommodate up to 29 people. At the time of this inspection there were 21 people living in the home. The home is converted from two adjacent houses with a link between them. There are three adjoining lounges and a dining area.

The previous inspection took place in place in September 2016. At that time the home received an overall performance rating of ‘Requires Improvement.’ However, the issues we found at that time were low level and there were no regulatory breaches. At this inspection we found continued improvements had been made to attain an overall rating of ‘Good.'

People living at Holmfield told us they considered the home to be a safe place to live. This was underpinned by effective systems and procedures which sought to protect people from abuse.

Where people experienced an accident or untoward incident, such as a fall, these were reported and recorded in a timely manner and management took appropriate action to reduce the likelihood of such events occurring again in the future.

Where a particular risk had been identified, information was provided in people’s care records which sought to ensure care and support was delivered as safely as possible. Reviews of risk were also completed in a timely manner.

People’s medicines were ordered, administered, stored and disposed of safely. Staff responsible for the management of medicines were suitably trained and competent to do so.

Staffing levels at Holmfield were sufficient to meet people’s needs and the home benefited from a stable workforce.

All relevant health and safety and building maintenance checks had been completed and safety certificates were up to date. Equipment used for moving and handling people had been serviced and maintained in line with regulations and was deemed safe to operate.

People living at Holmfield are cared for by staff who were well trained and competent to carry out their roles. The home benefited from an in-house trainer and all new staff were required to complete the Care Certificate.

Staff supported people to have maximum choice and control of their lives and in the least restrictive way possible; the policies and systems in the service reflected? this practice.

People were well supported to eat and drink and to maintain a balanced diet. A senior care assistant had lead responsibility for nutrition and they worked well with the chef.

The outside space at Holmfield had been transformed to create a wonderful sensory garden that was now accessible to all.

Staff treated people with compassion and dignity and respected their privacy. We saw people were afforded time to express their needs and communication was at an appropriative level and was not rushed. Staff talked to people with kindness and encouragement and this clearly brought out the best in people.

Everyone living at Holmfield was allocated a keyworker. Their role was to get to know the person particularly well and to ensure their day-to-day needs were met. The keyworkers were full time members of staff who each had a maximum of three people they were responsible for. This meant they had the opportunity to get to know those people well.

Holmfield is a well managed home and people spoke highly of the management team and wider staff group.

Holmfield Care is a residential care home in Didsbury in south Manchester. It does not provide nursing care. It is registered to accommodate up to 29 people. At the date of this inspection there were 26 people living in the home. Three people were single occupants of the three double bedrooms, which meant there were no vacancies. The home is converted from two adjacent houses with a link between them. There are three adjoining lounges and a dining area.

This inspection took place over two days on 27 and 28 September 2016. The first day was unannounced, which meant the service did not know in advance we were coming. The second day was by arrangement.

The previous inspection took place in November 2013. At that inspection we found minor breaches of three regulations. These related to infection control, safety of the premises, and the Statement of Purpose not being updated. The provider submitted an action plan in February 2014 stating actions had already taken to remedy the breaches. At this inspection we checked and saw that those issues had been rectified.

Holmfield had a registered manager who had been in post for two years. 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. There were also two assistant managers and there was always at least one manager on site during office hours and at weekends.

People living in the home told us they felt safe and the building was designed to minimise the risk of falls. There had been no serious injuries so far during 2016. Falls were recorded and analysed with a view to improving safety.

People were protected against the risk of fire. Individual evacuation plans needed to be improved to give a summary of people’s mobility. This was done during the inspection. The building and equipment were serviced regularly. The home was clean and smelled fresh.

Staffing levels were adequate. Agency staff were never used. Recruitment methods were robust to ensure that suitable staff were employed, but there were a few points of detail to attend to. The registered manager used effective disciplinary procedures.

Staff were trained in safeguarding and knew what procedures to follow. There had been no safeguarding incidents within the past 12 months. Risk assessments were carried out. Medicines were managed safely.

People enjoyed the food. Daily pictorial menu sheets were produced. Meetings were held at which people could express their views about the food. There was a nutrition lead who together with the chef ensured that people got the food they needed and wanted.

People’s weight was monitored and action taken when required. People’s health needs were met.

Training was thorough for both new and established staff. A variety of training methods was deployed. There was regular supervision of staff, and annual appraisals took place.

The service was complying with the Mental Capacity Act 2005 and ensuring that consent to care interventions was obtained. The registered manager understood the legislation relating to the Deprivation of Liberty Safeguards (DoLS). Applications were made when needed. However, the registered manager had not notified the CQC about four DoLS authorisations. This was done immediately during the inspection.

The environment had some adaptations for people living with dementia.

People living in the home were happy with the care provided and with the staff. Families also expressed satisfaction with the home.

Staff were patient and thoughtful when helping people with physical tasks, and they showed empathy with their emotional needs. We observed kind and considerate interactions.

Staff maintained people’s dignity, and respected their privacy. Care records were kept confidentially.

Staff were

During our visit to the home we spoke to four people living in the care home and three visitors. The people who lived in the care home chose to spend time in the privacy of their room when they wanted to. Staff told us that they and could also have a key to lock their door if they choose too. The people using the service decided upon their daily routines and whether they wanted to take part in planned activities and outings.

The staff and carers were observed to be unhurried and respectful with the people who lived in the home. Arrangements were made for people to practice their faith and faith representatives also visited the home. Visitors told us that they were made welcome and felt well involved in the care of the people they visited. The manager has introduced meetings for people who lived at Holmfield to try and improve the service users’ involvement in the running of the home.

The care plans were completed by the assistant managers and the carers were involved in helping to update them. Staff were supported with training and the home was working towards gaining accreditation for The Gold Standard Framework for end of life care.

We found areas on non-compliance with a moderate impact on people using the service in relation to the safety and suitability of the premises, cleanliness and infection control. The statement of purpose needed updating to reflect the developments at Holmfield. The statement of purpose is a document that the provider must update and make available to the Commission. It should include the aims and objectives of the service provider in carrying out the regulated activity, the kinds of services provided, contact details of the service provider and any registered manager, the legal status of the service provider and details of the registered locations.

People who used the service said: "my number one carer makes sure I get what I need"; "I can relax especially at night when I lock my door I know I won’t be disturbed”; "there always someone about"

We visited Holmfield Care in February 2012 and found moderate concerns around how peoples care and welfare was being met. We found that improvements were needed in care plan documentation, to reflect the actual care provided and to detail what action care staff were taking to meet peoples care needs. We made a compliance action and asked the providers to look at ways of improving care plan documentation and outcomes for people living at the service. We also had minor concerns around the way in which the provider was maintaining and monitoring the service. We followed up on compliance actions during this inspection.

We received information of concern in May 2012 that parts of the building were not safe and were not being maintained. We followed up on these concerns during our inspection on the 29 June 2012.

We spoke to people living at the service. Some people were able to comment on the care and treatment they received at Holmfield Care and other people were unable to comment because they had varying degrees of dementia. In light of this we spoke with peoples relatives to find out what they thought of the service and how their relatives were being cared for. We also spoke to care staff, observed care practices and observed people who used the service.

We spoke to four relatives who were visiting Holmfield Care at the time of our inspection. They told us they liked the home straightaway when they first visited. This was because they had found care staff to be friendly and very welcoming. One person told us, “We watched staff speaking to people in a nice way and having appropriate fun with them.”

Other relatives said, “We came here because we liked the friendliness and openness of the care staff. The home is always clean and it never smells.”

Relatives told us carers were friendly and approachable and they could speak to staff and the manager if they had any concerns or just wanted to know how their relative was progressing.

Relatives told us they were satisfied with the care provided and they felt their relatives were safe and well cared for.

One relative said, “My relative always looks well. Dress has always been important to him and staff always make sure he’s got a shirt and tie on.”

People living at the care home told us they were happy with the care they received. People told us that care staff treated them well and they felt safe.

During our visit to Holmfield Care Home we spoke to five people living in the home and two visitors, which included a district nurse.

One person living in the home told us: "When I came to live here I spoke to the staff about the care I needed and the staff also chatted to my family. We talked about the care I needed and also what would help me to stay as independent as possible."

Another person told us: "The food here is good and there is plenty of choice. I like living here."

One person living in the home told us: "The staff know what they are doing and they are very kind. If they don't know something they find someone else who does, you can't ask for more than that."

Other comments from people living in Holmfield Care Home included: "I have not had reason to complain but if I needed to say anything, I feel I could, or my family could, the staff are very approachable, as are the managers." and "The staff are all very kind, they always try and do the best for you."