We carried out an unannounced inspection on 23 July 2018. Holmleigh 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.

Holmleigh care home offers accommodation for up to 44 older people with care needs. It is situated in the village of Navenby in Lincolnshire and offers accommodation on two floors. On the day of our inspection, there were 40 people living at the home.

At our last inspection in March 2016, we rated the service good. At this inspection, we rated the service as requires improvement overall and requires improvement in each domain.

There was 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.

Staffing levels were not always sufficient to meet the needs of people using the service due to vacancies and short term absence. People told us there were delays in staff responding to their needs and staff spoke about difficulties in providing the required levels of care, when planned staffing levels were not achieved. However, new staff were about to commence employment and the management team were taking steps to recruit additional staff. Safe recruitment processes were in place.

Systems were in place for the regular ordering and supply of medicines and people told us they received their medicines regularly. However, staff did not always stay with people to ensure they took their medicines. Processes to assess staff competency to administer medicines and to address gaps in the medicines administration record were not robust. We found some issues with the storage of medicines; however, following the inspection the management team took steps to address these issues. Systems were in place to maintain the premises and required maintenance and safety checks were completed. Staff had developed personal emergency evacuation plans for people to enable them to be evacuated from the building safely in an emergency. Most areas of the home were clean; however, we found some cleanliness issues in the kitchen and cleaning schedules were not being used to ensure a systematic approach was taken to cleaning the kitchen and catering trolleys.

People told us they felt safe. Processes were in place to keep people safe from abuse and avoidable harm. Staff reported incidents and accidents and a full investigation was completed following incidents and accidents to reduce the risk of reoccurrence.

Most of the people using the service were able to consent to the care and support provided and were able to leave the home freely if they wished. However, we identified instances when the principles of the Mental Capacity Act and consent legislation were not fully adhered to. The registered manager told us they would review the decision making in relation to these immediately.

Staff received an initial induction and training was provided, to ensure they were competent for their roles. However, the management team did not have full oversight of training to enable them to assure themselves that staff training was up to date. This was an issue which they had identified during their quality audits and they were in the process of developing a training matrix, to record all training completed and the dates of training.

People had access to healthcare services as they required. Staff were alert to signs people were unwell and sought medical advice when necessary.

The majority of people told us staff were kind and caring towards them; however, we received some feedback about poor staff interactions and comments which were uncaring. We observed

We inspected Holmleigh Care Home on 19 January 2016. The inspection was unannounced.

Holmleigh Care Home is owned and managed by Lincolnshire Licenses Limited. It is situated in the village of Navenby in Lincolnshire and offers accommodation for to up to 44 older people. It is registered to care for people who require accommodation with personal care.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection no-one who lived in the home had their freedom restricted. The registered manager demonstrated their understanding of how to identify restrictions to people’s freedom and apply for DoLS authorisations if this was required.

People felt safe living at the home. Staff knew how to manage any identified risks and they understood their responsibilities to report any concerns for people’s safety. People’s individual health and nutritional needs were managed effectively, in ways that met with their wishes and preferences. The registered manager and staff had developed good working relationships with other professionals involved in people’s care so as to ensure they had the full range of support they needed.

People were treated with kindness by staff who demonstrated genuine concern for their health and well-being. They were able to make their own choices and decisions about their lives and were consulted about the care they received. People were encouraged to express their views and opinions about the way the home was run. They knew how to raise concerns or complaints and were confident they would be dealt with appropriately.

Staff had the skills and knowledge to provide people’s care in the ways they needed and preferred. They had been recruited in a way that ensured they were suitable to work in the home. Sufficient staff were employed in the home to ensure people received their care in a timely manner. Training and support systems ensured that staff were kept up to date in their knowledge and could develop their skills.

The registered manager acted in accordance with their responsibilities as a manager who was registered with CQC. They had systems in place to regularly assess and monitor care practice and to ensure people received a good quality of care. The systems in place meant that any shortfalls in quality could be quickly identified and improvements made.

During our visit we spoke with four people, two relatives, a member of staff and the deputy manager. We observed the care people received and looked at records.

Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care and saw staff were responsive to people and interacted with them positively. During our visit we saw staff were caring towards people and responded to their wishes.

We saw from the care plans and observations people received care which was safe and appropriate to their needs.

People told us they were, "Very happy here" and said "Staff are caring."

We observed people received effective nutritional support. When we spoke with people they told us the food was good. We saw people were offered choices at mealtimes.

The provider had a process in place for reporting and recording accidents. However when we looked at the records we found there were two incidents which should have been reported to us as a serious injury. We spoke with the deputy manager who told us they would address this.

As part of our inspection we spoke with two people who used the service. We also spoke with staff, relatives,visiting professionals and looked at records.

Overall we observed that people were supported by skilled and experienced staff. We saw staff had received the appropriate checks before commencing employment and subsequently received training and support.

We saw people were treated with dignity and supported to make decisions about their care. Care records were up to date and we saw care reflected what was written in the care plans.

People told us they liked living at the home and they were well cared for. One person said, “Love it here,” and “Couldn’t have a better place.”

People said the food was good and were given a choice at mealtimes. They told us, “The food is very good.”

Relatives told us the home provided 'excellent' care.They told us if they had any issues they would be able to discuss them with the staff.

When we spoke with a nurse visiting the home they told us the home provided good care and they had a good relationship with the home.They told us care was carried out as they recommended for people.

People said they felt they were supported to be as independent as they were able to and they thought their privacy and dignity had been respected. One person said they had “total freedom of choice.”

Another person told us staff respected their privacy and always knocked and asked before entering their room. They also said, “Staff are polite and respectful.”

People told us they felt their needs were being met by the support they had received and this was provided in a way they wished. People said they were able to make the decisions they felt able to. One person told us, “If I go out with relatives and miss a meal they always make sure there is something for me to eat when I get back. The food is very good.”

We asked people if they felt safe in the home and they said they did. People also told us they did not feel they had ever been put at risk.

A visitor told us staff had been “outstanding” in ensuring their relative’s safety and putting a plan into place to ensure this from an identified risk.

We asked people if they felt they had been able to make comments about what it was like to live in the home. People said that they did, one person told us, “To be honest I get out more now than when I lived on my own. It’s a wonderful place and the staff are brilliant. The food is excellent and I’ve put on weight since I’ve been here.”

Other people told us they thought the home was friendly and homely. They said the food was good. A relative commented they appreciated the care staff took to ensure people were well presented. They commented,” Overall I would say the care is excellent. If it wasn’t they (their relative) would have been moved by now. This is the best place for them.”