Holywell Park is a ‘care home’. People in care homes receive accommodation and 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. Holywell Park is registered to provide accommodation and personal care for a maximum of 60 people. The home specialises in providing care to older people and to some people living with dementia. At the time of our inspection there were 49 people living in the service. Holywell Park is located near to Sevenoaks and is arranged over three floors.

There was a registered manager at the service. 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 not always enough staff to meet all the needs of people living at the service. Staff were not always available for people using communal areas. People were protected from abuse. Staff knew how to identify abuse, and had received training and support from management to report concerns. Risks to people and the environment had been identified and action was taken to reduce the potential of harm. People were protected from the risk of infection and the environment was clean. People received their medicines from competent staff in a safe way. Accidents and incidents were analysed by the registered manager for trends and patterns and lessons were learned when things went wrong.

The design and adaptation for the premises did not always meet the needs of people living there, but the registered provider was acting to address the concerns. Staff received the training they needed to meet people’s needs. People’s needs and abilities were assessed before they moved into the service and care was provided in line with current legislation. People were supported to have a balanced nutritious diet. Staff worked together across organisations to help deliver effective care, support and treatment. Staff knew about the Mental Capacity Act and used it when supporting people to make decisions.

People were treated with kindness, compassion and respect. They were offered emotional support when they needed it. People and their relatives were supported to express their views about their care and to be actively involved in making decisions about their support. People’s privacy, independence and dignity were promoted and respected.

Not all people received the care they wanted or needed to meet their needs. Not all staff were aware of the needs of people because care records were not always accurate and up-to-date. People and their relatives were confident to raise concerns or complaints, but these were not always recorded accurately. We have made a recommendation about this. People were supported at the end of their life to have a comfortable, dignified and pain-free death. Staff worked closely with the local hospice and palliative care team.

Governance systems were not always effective in ensuring that shortfalls in service delivery were identified and rectified. Audits had not been effective in identifying the issues we identified during this inspection. The registered manager had an oversight of and reviewed the daily culture within the service, including the attitudes and behaviour of staff. The management team encouraged transparency and honesty within the service. People, their families and staff were encouraged to be engaged and involved with the service. The registered manager had developed links with the local community.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Full information about CQC's regulatory response to any concerns

The inspection took place on 17 and 18 May 2016 and was unannounced. Holywell Park is a large country house dating back to the 17th century, adapted to provide accommodation and nursing care for up to 60 older people near Sevenoaks, in 52 bedrooms and two flats. There were 48 people living in the home at the time of our inspection, ten of whom lived with dementia.

The service was last inspected in December 2014 where breaches were identified in respect of: recruitment procedures; care plans; quality assurance system and records; and the administration of medicines. We had requested the provider to write an action plan and take action within a specific time frame. At this inspection, we found that all action had been taken.

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

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

People, relatives and staff told us there was a sufficient number of staff deployed to consistently meet people’s needs. Staffing levels had been calculated taking into account people’s specific needs.

There were thorough recruitment procedures in place which included the checking of references and full employment history.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff had received essential training and were scheduled for refresher courses. All members of care and nursing staff received regular one to one supervision sessions. Staff reported feeling well supported in their roles.

Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions; meetings with appropriate parties were held and recorded to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect. People’s individual assessments and care plans were reviewed monthly or when their needs changed.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People were involved in the planning of activities that responded to their individual needs. People and their relatives’ feedback was actively sought at residents meetings, coffee mornings and through satisfaction surveys. Clear information about the service, the facilities and how

We used a number of different methods to help us understand the experiences of people using the service, because some of the people who lived there had complex needs which meant they were not able to tell us about their experiences. We observed how people spent their time during the day, how staff met their needs and how people interacted with staff. We spoke with five people and with two relatives.

People’s needs were set out in their care records which were up to date and detailed. The information in them provided staff with guidance about how to meet people’s needs in the ways they preferred and about how to promote people’s health and welfare.

There were safeguarding vulnerable adults procedures in place. Staff demonstrated that they knew what to do if they suspected abuse and that they understood the procedures in place.

The home had sufficient staff to meet people’s needs and people were comfortable and relaxed with staff. Staff were patient and respectful towards people, and were able to give us clear and up to date information about individual people’s needs.

People and relatives we spoke with told us they were very satisfied with the service. People told us “I like it very much” and “It’s very comfortable here”. Relative’s comments included “they look after him incredibly well” and “we have been very happy with the care here, they are doing a wonderful job”.

The service was provided within safe and well maintained premises. The manager and the

provider of the service carried out a range of quality and safety checks to ensure that people were receiving quality care and that their health and welfare were maintained.

We spoke with seven people living at the home as well as staff, and voluntary staff. People told us how much they enjoyed living at the home and spoke particularly about how caring and kind the staff were. Comments people made included “I get on with all of them, they are very good”, “I can’t fault them, I am very happy living here”.

Everyone we spoke with told us the food was excellent, and people also enjoyed the activities organised at the home.

When asked what the service could do better for them, none of the people we spoke with could think of anything. People said “I can’t find any fault” and “They do everything I want them to do”, and “If I don’t like something on the menu, I say what I want and they make it for me”.

People said that the laundry service was well run, that their clothes were “looked after well” and that the home was clean and tidy.

We observed the care of people who were less able to speak with us, staff interacted with those less able to communicate frequently and involved them in what was going on, reminding them of the day and time and what activities were planned that day and the next.

We observed a staff member holding hands and talking quietly with a person living at the home who had recently lost her husband, the person was clearly gaining support and comfort from the staff member.

Volunteers who ran some of the activities also spoke with us about how much they enjoyed helping at the home. One joked that she had booked her bed at Holywell Park.

The inspection was carried out on 15 and 17 December 2014 and was unannounced. Holywell Park is located on the outskirts of Meopham and provides nursing and personal care and support for up to 60 people.

Accommodation is set out over two floors with lift access to the first floor. On the day of our inspection there were 46 people living at the home, some of whom maybe living with dementia. Some people had sensory impairments, limited mobility and some people received care in bed.

Holywell Park is a family run home. The owner lives next door to the home and family members are involved in the day to day running of the home.

The home had 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 and associated Regulations about how the service is run.

People gave complimentary comments about the service they received. People felt happy and well looked after and safe. However, our own observations and the records we looked at did not always match the positive descriptions people and relatives had given us.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 came into force on 1 April 2015. They replaced the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The Provider had not always maintained adequate recruitment records to ensure that staff were suitable to work with people. Application forms did not always show a full employment history therefore it was not possible to identify if there had been gaps in employment.

Medicines had not always been administered and recorded in a safe manner.

Staff training records showed some staff had not attended training relevant to their job roles. The majority of staff had not received regular supervision and therefore did not get the support they needed.

Staff had limited understanding of the Mental Capacity Act 2005 (MCA) and how they apply this to their role.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager knew when to make DoLS applications to the local authority (the supervisory body) for other people who met the DoLS eligibility criteria.

Records were not accurate and up to date. Some people did not have care plans or risk assessments in place for staff to follow to ensure that they were supported and cared for in the way they wanted and needed.

The registered manager completed monthly quality assurance audits. However, these audits had not been robust to highlight concerns relating to care records, staffing records and medicines.

Staff had a good understanding of their responsibilities in relation to keeping people safe from abuse. Staff knew there was a policy in place and felt confident to raise concerns with managers.

The registered manager was visible around the home and knew people well.

The home was maintained, clean and suitable to meet people’s needs.

The provider had a detailed emergency plan in place, it provided advice and guidance to the registered manager and staff in emergency situations such as; electrical failure, flooding, lift failure and loss of heating.

People were supported to eat and drink adequate amounts of nutritious food and fluids. People were supported at mealtimes as required. Completed questionnaires showed that people were satisfied with the food.

Staff communicated well with people. Staff were respectful and kind when they communicated with people and they used people’s preferred names.

People were supported and helped to maintain their health and to access health services when they needed them.

People made their own choices on a day to day basis which included, what time to get up in the morning, what time to go to bed and where they wished to spend their time. Staff maintained people’s privacy and dignity. Staff knocked on doors before entering rooms and covered people up when they were providing assistance with their personal care.

Some people’s care files showed that people had been involved in making decisions about their care.

People’s information was treated confidentially. Files were kept in secure areas and not left unattended. Staff were discreet in their conversations with people, relatives and other staff.

The home worked closely with a local hospice to provide care and support for people who were at the end of their life. Some care staff had attended additional training relating to end of life care. End of life care plans were drawn up to detail people’s preferences and choices.

People’s call bells were answered quickly.

The management team conducted an assessment of people’s needs prior to people moving to the home to ensure that they have the right equipment, skills and staff to meet each person’s needs.

The home employed activities staff that had developed a monthly activities schedule. This was clearly displayed in the main hallway and a copy was delivered to each person’s room. Activities on offer included; cards, armchair exercises, cooking, arts and crafts, manicures, bible stories, quizzes, board games, singing (including external entertainers), darts, bingo and film nights.

Questionnaires were sent to people who lived in the home on a six monthly basis. The registered manager was in the process of collating the completed responses. Completed surveys showed that the feedback was positive.

People had a good understanding of who they needed to talk to if they had any complaints or concerns.

Staff felt confident if they raised concerns about practice it would be dealt with properly.

Appropriate action had been taken by the registered manager to investigate staff performance concerns. Decisions made were clear, support had been put in place to ensure change and improvement.

You can see what action we told the provider to take at the back of the full version of the report.