Holmlea Care Home 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, and both were looked at during this inspection. The home can accommodate 25 older people. When we inspected there were 22 people living at the home, some of whom were living with dementia.

At our last inspection in May 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good.

People and relatives told us they received very good care from kind and caring staff. We observed there were positive relationships between people, relatives and staff.

People, relatives and staff told us the home was safe. Staff had a good understanding of safeguarding and the provider’s whistle blowing procedure. They also knew how to report concerns if needed.

There were sufficient staff deployed to meet people’s needs. People confirmed staff responded quickly when they needed assistance.

Effective recruitment procedures were followed to ensure new staff were suitable to work at the service.

Medicines were managed safely. Accurate records were kept to confirm the medicines people had received from staff.

Incidents and accidents were logged and investigated. These were monitored periodically to identify trends and lessons learnt.

A range of checks and risk assessments were completed to maintain a safe environment.

Staff were supported well and received the training they needed, Records confirmed supervisions, appraisal and training were up-to-date.

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 meet their nutritional needs.

Care records showed people had access to external healthcare services when required. This included GPs, district nurses, chiropodists and dentists.

People's needs had been fully assessed to identify the care they needed and wanted. This included any preferences people had relating to religion and end of life. This was used as the baseline for developing personalised care plans. Mental health care plans required additional information. Care plans were reviewed regularly and amended as people’s needs changed.

There were good opportunities for people to participate in activities if they wanted. Activities were on-going throughout our time at the home.

People and relatives knew how to complain. Previous complaints had been dealt with effectively.

People, relatives and staff gave us very positive feedback about leadership and management of the home.

The provider had a structured approach to quality assurance, which was effective in addressing issues.

There were good opportunities for people and staff to provide share their views about the home. Staff told us their views were valued and listened to.

Further information is in the detailed findings below.

Holmlea is residential care home situated in North Shields close to local shops and community facilities. The service provides accommodation for 25 people, most of whom have physical care and support needs and/or, are living with dementia. At the time of our inspection 21 people were living at the service.

This inspection took place on 5 May 2016 by one inspector and was unannounced. An additional visit took place on 6 May 2016 by one inspector. We last inspected the service in October 2014 where we found the registered provider to be meeting all regulations we inspected.

The service has 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.

There were detailed safeguarding and whistleblowing policies in place which provided information about how to recognise the signs of abuse, and how to respond to any concerns people had.

Individual risk assessments were in place to support people with promoting their independence and safety. In addition to individual risk assessments, the service also had a range of environmental risk assessments. Regular health and safety checks had been carried out in relation to the premises to support with promoting a safe and clean environment.

There were enough staff to meet people’s care and support needs. Staff did not appear to be rushed and responded to people in a timely manner.

Records within staff files demonstrated proper recruitment checks were being carried out. These checks include employment and reference checks, identity checks and a disclosure and barring service check (DBS). A DBS check is a report which details any offences which may prevent the person from working with vulnerable people. They help providers make safer recruitment decisions. Staff were supported with regular training opportunities that linked to the care and support needs of people living in the service.

The service had safe systems in place to ensure people medicines were managed appropriately. Medicine administration was well ordered and audits of medicines were carried out to promote safe working practices.

The manager and staff were aware of their responsibilities relating to the Mental Capacity Act 2005. The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. People were supported with decision making and we saw that capacity assessments had been carried out relating to specific decisions.

People were positive about the food provided in the service. Menus were available which provided a choice of meals for each day. People living in the service were supported to have healthy and nutritious meals.

People and their relatives told us staff were caring and kind. We observed positive staff interactions during our inspection and the service had a homely atmosphere. Staff encouraged people to be involved with activities but respected their decision if they did not want to participate.

People’s care plans were specific and centred around their individualised care and support needs. There were a range of assessments in place to keep people safe. Care plans were up to date and were regularly evaluated. Staff were knowledgeable about people’s care and support needs.

The service had a complaints process in place. People living in the service and their relatives were provided with information to support them to raise any concerns or complaints they may have.

People, their relatives and staff spoke highly about the manager of the service. The provider

We carried out this inspection to check that shortfalls identified at our previous inspection on 16 May 2014, related to Regulation 12 of the Health and Social Care Act 2008 - Cleanliness and infection control, had been addressed. During this inspection we spoke with the provider, the newly appointed manager and care and domestic staff. We did not speak with people as we used other methods to assess whether the provider had rectified previous shortfalls and whether they were now meeting this regulation. We reviewed the provider's action plan which they had sent us to inform of how they were going to improve in this area, in line with procedures following our last inspection. We also inspected the premises and the systems that were in place to manage infection risks within the home.

We considered all the evidence we gathered and we used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found;

Is the service caring?

This was a follow up inspection to previous non-compliance against Regulation 12 of the Health and Social Care Act 2008 and we did not look specifically at this area.

Is the service responsive?

This was a follow up inspection to previous non-compliance against the Regulation 12 of the Health and Social Care Act 2008 and we did not look specifically at this area.

Is the service safe?

We found that improvements had been made since our last visit and people, staff and visitors were protected from the risk of acquiring an infection. The home was clean and procedural changes that had been introduced to monitor and manage the potential spread of infection and we found that systems in place were now appropriate.

Is the service effective?

This was a follow up inspection to previous non-compliance against Regulation 12 of the Health and Social Care Act 2008 and we did not look specifically at this area.

Is the service well led?

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

The manager at the service during this inspection was new to their post and not yet registered with the Commission in line with the requirements of the registration of this service. However, they assured us they had taken steps to commence the registration process and we will monitor that their application is made.

People told us they enjoyed living in the home and the staff were very helpful and caring. They said they could decide how to spend their time and were encouraged to make choices. They said they could decide when they wished to go to bed and when they wished to get up in the morning. They said their privacy and dignity was respected and the staff did not enter their bedrooms without their permission. They told us they enjoyed the food served to them and were able to request alternatives if they did not like the dishes on the menu. They said they would feel confident to make a complaint if they were unhappy about any aspects of their care and felt they would be listened to. However the people we spoke with said they had never needed to complain and were satisfied with the service they received.

During our visit we spoke with four people who use the service and one relative. Comments from people who lived at the home included, "I can choose when I want to get up and what I want for breakfast." "They wake me up at 7am. I always like to get up then." People said that they could make choices about their routines including what time they get up and go to bed. A relative spoke very positively about the care and support provided at the home she said, "It's top notch here. It's the staff that make it so good here. I always find them smiling and they're always around. There seems to be a lot of staff who do everything and anything. The home ticks all the boxes."

We did not obtain the views of people who use the service at this visit.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, staff supporting them and from looking at records.

Is the service caring?

We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people, for example by assisting them with mobility or eating. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required. People told us that they were happy with the care and support they received from the service. One person said, "I think it is very nice here" and "You get everything here, your meals and you get looked after".

People’s diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Staff were fully aware of people's care and support needs.

People told us and staff confirmed they pursued activities within the home and this was evident during our inspection where we saw people enjoyed time in the garden with staff and partaking in a quiz. The provider promoted people's well-being.

Is the service responsive?

People's care needs and any potential risks that they may be exposed to were assessed before they received care and support from the provider. The provider had arrangements in place to review people's care records regularly and we saw that amendments were made to people's documentation as their needs changed, to ensure this remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as occupational therapists or doctors, or where, for example, their weight or behaviours needed to be monitored, they received this care.

There was an effective complaints system in place and we found that people felt confident in raising concerns with the manager. Records showed that all previous complaints raised had been handled appropriately.

Is the service safe?

There were enough staff on duty to meet people's needs. Records showed that staff were appropriately trained to ensure that they were equipped with the correct skills and attributes to carry out their jobs effectively and safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager confirmed that one person who lived at the home was currently subject to a DoLS, which showed the provider understood when an application for a DoLS needed to be made, and how to submit one. We discussed the recent Supreme Court judgement handed down on March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The manager confirmed they would contact their local safeguarding team in light of this judgement, for further advice on their responsibilities and the arrangements they now need to put in place, for people in their care.

We found the building was well maintained and entry into the building was secure. People were accommodated in a safe environment.

The home was clean, tidy and well maintained. However, the infection control procedures in place for the cleaning of some equipment used in the delivery of care, did not follow national best practice guidelines. This was putting people and staff at risk of infection. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to following infection control.

Is the service effective?

People told us they were happy with the staff who cared for them and they met their needs. One person said, "It's quite decent here." Another person told us, "They look after me." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

People’s needs were taken into account with pictorial and written signage and the layout of the service enabling people to move around freely and safely.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. A district nurse that we spoke with told us they had no concerns about the care delivered by the provider.

An effective quality assurance system was in place which helped to ensure that people received a good quality service at all times, by monitoring care and addressing shortfalls promptly. The provider monitored care delivery by staff and gathered the views of people and their relatives about the service they received. One relative had commented in a questionnaire, "The treatment given to my mother is excellent".

Staff told us they were clear about their roles and responsibilities and they had a good understanding of the ethos of the home. The provider had a range of policies and procedures in place which gave direction and instruction to staff. Staff meetings were held monthly and a number of audits were carried out regularly, in addition to health and safety checks.