CQC report explained · a residential care home
What the CQC found at Holmehurst Residential Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors were assured that the home had systems to prevent infections, used protective equipment effectively, admitted people safely and carried out regular testing.
- Effective?
- Good
- People's needs were assessed, staff had the training they needed, meals supported people's nutrition, and staff worked with health professionals. Records about decisions made for people lacking capacity had improved.
- Caring?
- Good
- Caring was not covered by this focused inspection. The report says relatives described staff as friendly and care as personalised.
- Responsive?
- Good
- Responsive was not covered by this focused inspection. The report says staff knew people's preferences and relatives felt involved and kept informed.
- Well-led?
- Requires improvement
- Management systems had improved, but oversight was not strong enough to make sure identified actions were completed. Medicine audit findings were not clearly followed up, and there was uncertainty about future management arrangements.
What inspectors found, October 2020
Rated Good overall, but inspectors found the home still needed to improve its management checks and leadership.
This was an announced focused inspection, carried out on 19 and 28 August 2020. Inspectors checked whether the home had completed its improvement plan after a previous breach about management systems. They also looked at infection prevention during the coronavirus pandemic.
The home was rated Good overall. Effective was rated Good. Inspectors found that people's needs were assessed, staff were trained, meals supported people's nutrition, and health care was arranged well. Infection prevention arrangements were also judged reassuring, although Safe was inspected but not rated.
Well-led remained Requires Improvement. Management records and audits had improved, but some actions were not followed through. Medicine audits identified gaps without a clear record of how errors or trends were dealt with. The provider was also recruiting for stronger on-site management. The previous Regulation 17 breach had been addressed and was no longer in place.
Effective care
Inspectors found that care was based on assessed needs and current guidance. Relatives felt staff were capable and competent.
“Staff received essential training to undertake their role.” from the report
Food and nutrition
Catering staff understood people's special dietary needs and had improved records showing the meal choices offered.
“The catering staff were very knowledgeable about people's special dietary requirements and made sure people got enough to eat and drink.” from the report
Health support
The home worked with health professionals during lockdown and kept relatives informed about health care and coronavirus testing.
“The service had worked well with health services to support people's health care.” from the report
Infection control
Inspectors were assured that the home had suitable infection prevention arrangements, enough protective equipment and regular testing.
“We were assured staff had sufficient supplies of PPE and were using these effectively.” from the report
Personalised atmosphere
Relatives and staff described the home as homely and family-orientated. Inspectors found support was flexible and personalised.
“People received support that was personalised and flexible to meet each person's needs.” from the report
Audit actions not completed
needs fixingSome management checks still needed strengthening. The provider did not have enough oversight to show that actions identified through audits were completed.
“There had not been sufficient oversight by the provider to make sure that any identified actions were addressed.” from the report
Medicine audit follow-up
needs fixingMedicine audits found gaps, but records did not show how errors or patterns were dealt with to improve practice.
“There was no demonstrable record of how identified errors or trends were addressed to improve practices.” from the report
On-site leadership
needs fixingThe registered manager had not been available during the pandemic, and staff were concerned about the lack of consistent senior leadership on site. The provider was recruiting for this role.
“Staff praised the support they had received during the pandemic but were concerned that there was not a registered manager on site to provide consistent senior leadership and direction.” from the report
- 01Who is currently providing day-to-day senior management on site, and has the registered manager vacancy been filled?
- 02How do you make sure actions from audits are completed and checked by the provider?
- 03What medicine errors or trends have been identified since the inspection, and what changes were made in response?
- 04How are relatives kept informed about people's health, treatment decisions and coronavirus testing?
- 05How do you record and review decisions made in the best interests of people who may lack capacity?
This was a focused inspection of Effective and Well-led, with infection prevention checked under Safe; the other ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 2 October 2020 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, April 2020
Rated Requires Improvement; the home provided kind and safe care, but records, best-interest decisions and quality checks were not reliable enough.
This was an unannounced inspection on 26 and 28 February 2020. One inspector spoke with people, relatives, staff and a visiting care professional. They also checked care, medicine, staff and management records.
People generally felt safe and praised the kindness of staff. Inspectors found enough staff, clean surroundings, safe medicine support, good meals, activities and help to access healthcare. Care was personalised and people were treated with dignity.
The main weaknesses were in management systems and recording. Best-interest decisions and some checks were not recorded clearly. Two Deprivation of Liberty Safeguards authorisations had expired without clear evidence of follow-up. The home was rated Requires Improvement overall, down from Good at the previous inspection.
Kind and respectful care
People and relatives spoke positively about the staff. Inspectors saw friendly interactions and support for people's dignity and choices.
“People and relatives spoke positively about the care and kindness of staff.” from the report
People felt safe
The home had enough staff, risk assessments and equipment to reduce risks such as falls. People received their medicines as prescribed.
“People said they felt safe at the home. There were enough staff to support them whenever they needed it.” from the report
Good health and food support
Staff worked with health professionals and followed their advice. Catering and care staff communicated about dietary needs, and people praised the meals.
“Catering and care staff communicated well to make sure people got enough to eat and drink.” from the report
Personalised daily life
Staff knew people's routines and preferences. People could choose activities, eat in their rooms and maintain contact with family and friends.
“People received a personalised service that met their needs and preferences.” from the report
Weak quality checks and records
seriousAudits and records did not always show what checks had been completed or what action followed. This was a breach of Regulation 17 and could place people at risk.
“The provider's governance systems of the service were not fully effective.” from the report
Best-interest decisions not recorded
seriousThe home could not show who had been involved in some decisions about restrictive equipment or how the least restrictive option had been chosen.
“There was no records of best interest decisions, who had been involved or how the outcome was considered the least restrictive option.” from the report
Expired authorisations
seriousDeprivation of Liberty Safeguards for two people had expired 8 to 12 months earlier. The provider said it had reapplied, but there was no record of this or of chasing the local authority.
“The DoLS for two people had lapsed between 8 – 12 months earlier and the management team said these had been reapplied for.” from the report
Policies were out of date
needs fixingSome policies referred to old laws and standards. The provider said after the inspection that it was addressing the shortfalls.
“The provider's policies and procedures were out of date.” from the report
Some care records needed more detail
needs fixingOne care plan did not contain enough detail to ensure staff took a consistent approach. The provider planned to revise it.
“One person's care plan would benefit from more details to ensure a consistent approach by staff.” from the report
- 01What has been done to make sure quality audits identify gaps and record the action taken?
- 02How are best-interest decisions now recorded, including who was involved and why the option was least restrictive?
- 03Have the two expired Deprivation of Liberty Safeguards applications been followed up and documented?
- 04Have all policies been updated to reflect current law and guidance?
- 05Who is now responsible for managing the home each day, and has the planned full-time manager been appointed?
This was an unannounced planned inspection that assessed all five CQC questions and found the overall rating had fallen from Good at the previous inspection. This explanation was written from the published report of 4 April 2020 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 Holmehurst Residential Home
4 rated inspections over 5 years: the service has held its Good rating throughout.
- October 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2020Requires improvementdown from GoodEffective: Requires improvementWell-led: Requires improvement
- August 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 24 December 2010.
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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