CQC report explained · a residential care home
What the CQC found at Holgate House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, June 2023
Rated Requires Improvement; inspectors found risks, record keeping and oversight were not reliable enough, although staffing and relationships were positive.
This was an unannounced focused inspection. Inspectors visited on 24 and 26 April 2023, spoke with people, relatives and staff, checked the home and reviewed care, medicines, recruitment and management records. The inspection was widened to include Effective after concerns about the Mental Capacity Act were found.
The home had enough staff and people generally had good relationships with them. People were supported to attend healthcare appointments, received training and supervision, and said they were happy with the food and support.
However, risks were not always properly assessed or managed. Some care plans and records were incomplete or out of date. There were concerns about medicines records, cleanliness, the environment, Mental Capacity Act decisions and restrictive house-wide practices.
The overall rating is Requires Improvement. Safe, Effective and Well-led were each rated Requires Improvement. This is a fall from Good at the previous inspection, published on 23 December 2019. CQC found breaches of regulations about safe care and treatment and good governance.
Staffing
Inspectors found enough staff with suitable recruitment checks. Staff said recent recruitment had improved the service and their wellbeing.
“There was sufficient staff to support people.” from the report
Relationships
People generally had positive relationships with staff and said they felt safe and supported.
“I am happy here, I get what I need.” from the report
Healthcare access
People were supported to attend healthcare appointments, including GP appointments.
“People were supported to access health care appointments, such as GPs.” from the report
Staff support and training
Staff received induction, ongoing training, supervision and appraisal. Staff described the management team as supportive.
“Staff received support through supervision and appraisal.” from the report
Risk management
seriousIndividual risks were not always assessed or reduced properly. Care plans and risk assessments did not always give staff enough detail, and lessons from incidents were not always recorded.
“Risks to people's safety were not appropriately assessed or mitigated.” from the report
Care records and legal decisions
needs fixingCapacity assessments and best-interest decisions were not always recorded. Information about Mental Capacity Act and DoLS arrangements was not always accurate, and some restrictions were applied as house-wide decisions.
“Capacity assessments and best interest decisions had not always been recorded.” from the report
Medicines
needs fixingSome handwritten medicines records did not contain full instructions. Patch instructions and some as-needed medicines protocols also needed updating.
“Medication administration records that had been hand transcribed did not always contain the full instructions on the leaflet.” from the report
Cleanliness and repairs
needs fixingSome areas were not clean, and repairs were needed to items including broken furniture, bedroom drawers and communal flooring. Inspectors also found environmental risks.
“Although the provider had employed a domestic staff recently, not all areas of the home were clean.” from the report
Weak oversight
seriousThe provider's checks did not identify or resolve several problems, including risks, records, cleanliness, medicines and Mental Capacity Act arrangements.
“The provider's quality monitoring processes were not robust and had not always identified concerns and improvements in the service identified during the inspection.” from the report
- 01What has been changed to make sure each person's risks and care plans are assessed accurately and reviewed after incidents?
- 02How are medicines records, patch instructions and as-needed medicines protocols checked and kept up to date?
- 03How do you record capacity assessments, best-interest decisions and DoLS reviews for each person?
- 04What repairs and cleaning improvements have been completed since the inspection?
- 05What evidence can you show that your quality checks now identify and fix problems promptly?
This was a focused inspection of Safe and Well-led, widened to include Effective; Caring and Responsive were not inspected during this visit and the overall rating used the relevant previous ratings where needed. This explanation was written from the published report of 2 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2019
Rated Good; inspectors found safe, kind and personalised care, with a few records and practice points to improve.
This was an unannounced, planned inspection on 3 December 2019. One inspector spoke with people living at the home, staff and a visiting social care professional. They reviewed care records, medicines records, recruitment files, training records, complaints and other documents.
The home supported 20 people, although it had places for up to 30. Inspectors found that all five areas were rated Good. People were treated kindly, involved in their care and supported to make choices, build independence and take part in community life.
The report also noted some improvements needed. These included obtaining employer references where possible, updating one epilepsy risk assessment and care plan, adding information to some as-required medicine instructions, and following correct infection control practice when giving medicines.
Personalised care
People were involved in developing and updating their care plans. Staff knew people's preferences and interests and used this knowledge to provide individual support.
“Care and support was tailored to each person's needs and preferences.” from the report
Kind and respectful staff
Inspectors found that people were listened to and treated with dignity. Staff understood how to support people's privacy, choices and independence.
“People were treated with kindness; they were actively listened to and their choices respected.” from the report
Choice and independence
People were supported to take positive risks, develop skills and become more independent. They were encouraged to spend time with friends and family and use the local community.
“People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.” from the report
Good management and feedback
People, staff and professionals described the management as approachable. The home collected feedback and acted on suggestions to improve the service.
“People had opportunities to be involved in developing the service.” from the report
Employer references
needs fixingThe provider needed to make sure references were obtained from previous employers where possible. The provider said this would be addressed.
“The provider needed to ensure that references were obtained from previous employers were possible.” from the report
Epilepsy records
needs fixingOne epilepsy risk assessment and one care plan needed updating. The registered manager later told inspectors this had been completed.
“One risk assessment and one care plan required updating in relation to epilepsy.” from the report
Medicine instructions and infection control
minorSome instructions for as-required medicines needed more information. Inspectors also gave feedback about following correct infection control practice when medicines were being given.
“Some protocols would benefit from further information adding.” from the report
End of life planning
needs fixingNo one was receiving end of life care at the inspection, so inspectors did not assess this in practice. The report says planning was not in place, although staff had received training.
“End of life care planning was not in place.” from the report
- 01What action has been taken to make sure employer references are obtained before staff start work?
- 02How was the epilepsy risk assessment and care plan updated, and how are these records checked now?
- 03What extra information has been added to the instructions for as-required medicines?
- 04How do you check that infection control procedures are followed when medicines are given?
- 05How would you plan and record end of life wishes if a resident needed this support?
This was an unannounced inspection covering all five CQC questions, and the report says the ratings in every area remained Good from the previous inspection. This explanation was written from the published report of 24 December 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Holgate House
5 rated inspections over 7 years: the service has improved, from Inadequate to Requires improvement.
- June 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- June 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2016Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedCaring: Inspected but not ratedResponsive: Inspected but not rated
- May 2016InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- November 2015
Registered with the Care Quality Commission on 18 November 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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Most charge £980 to £1,270 a week. 32 can care for a couple. 11 years' experience on average.
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