CQC report explained · a residential care home
What the CQC found at Holyrood House Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Inspectors found concerns about falls, staffing levels, equipment and incomplete medicine records. They made a recommendation about falls and the manager created an action plan for medicine-record issues.
- Effective?
- Good
- People's needs and choices were assessed and care plans were updated. Staff received training and supervision, and people were supported with nutrition, hydration, healthcare and consent.
- Caring?
- Good
- This question was not inspected during this visit. The report says the previous rating was used to calculate the overall rating.
- Responsive?
- Good
- This question was not inspected during this visit. The report says the previous rating was used to calculate the overall rating.
- Well-led?
- Good
- The home had quality checks, action plans and systems for gathering people's and staff members' views. Inspectors found the management team approachable and supportive.
What inspectors found, March 2022
Rated Good overall; inspectors found kind, effective care, but the safe rating Requires Improvement because falls information and medicine records needed improvement.
This was an unannounced focused inspection on 20 January 2022. Inspectors looked at Safe, Effective and Well-led. They spoke with people, relatives, staff and healthcare professionals, and reviewed care plans, risk assessments, medicine records and management records.
Overall, the home was rated Good. Effective and Well-led were rated Good. People were supported with food, drink, healthcare, consent and daily care. Inspectors saw positive relationships between people and staff, and found staff were trained and supported.
Safe was rated Requires Improvement, as it had been at the previous inspection. Inspectors found concerns about trends in falls, staffing levels and equipment used to manage falls. Some medicine records were incomplete, including records of when paracetamol was given, and some required-medicine instructions were missing or not followed.
The home had action plans to address the issues. The report says there was no evidence that people were at risk of harm from the concerns that led to this focused inspection. The previous ratings for Caring and Responsive were used to calculate the overall rating because they were not inspected this time.
Kind, person-centred care
Inspectors saw positive interactions between people and staff. People and relatives said they were satisfied with the care.
“People and relatives told us they were satisfied with the care provided.” from the report
Staff training and support
Staff received regular training, supervision, observations and appraisals. Relatives said staff had the knowledge needed to support people.
“Staff were provided with regular training to ensure they had the right skills and knowledge to support people.” from the report
Health and nutrition support
People were supported to eat and drink enough, and staff worked with healthcare professionals to meet their health needs.
“People received support to maintain good nutrition and hydration and their healthcare needs were understood, met and relevant records kept.” from the report
Good management systems
The home used audits, meetings and an action plan to monitor quality and identify improvements. Inspectors received positive feedback about the management team.
“The provider had several quality assurance systems in place.” from the report
Falls risks need closer review
needs fixingInspectors found patterns in people's falls. They recommended reviewing the information and checking that staffing levels and equipment were suitable and used effectively.
“We made a recommendation for the provider to review this information and ensure staffing levels were adequate and equipment used to manage people's risk of falls was used in an effective way.” from the report
Medicine records were not always complete
needs fixingSome records did not show when medicines such as paracetamol had been given. Some instructions for medicines given when needed were missing or not followed, and the home's audits had not found these issues.
“We identified improvements were required in some medication records. For example, times when paracetamol had been administered had not always been recorded.” from the report
Some incident recording was inconsistent
minorBehavioural incidents were recorded in people's care notes but not always in the central incident record. This reduced the home's ability to oversee and review patterns.
“Behavioural incidents were not always recorded in the incidents' matrix, these were recorded in people's care notes.” from the report
- 01What action has been completed to reduce falls, and what has changed about staffing levels and falls equipment?
- 02How do you now check that paracetamol and other medicines are recorded at the correct time?
- 03Are all required-medicine protocols now in place and followed by staff?
- 04How are behavioural incidents recorded and reviewed in one central place?
- 05What were the previous ratings for Caring and Responsive, and when will these areas next be inspected?
This was a focused inspection of Safe, Effective and Well-led only; the previous ratings for Caring and Responsive were carried forward when calculating the overall rating. This explanation was written from the published report of 9 March 2022 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 2018
Holyrood House is Rated Good overall; inspectors found kind, responsive care, but the Safe rating Requires Improvement because some medicine records and safety assessments were incomplete.
Inspectors visited without notice on 7 and 13 March 2018. They spoke with people living there, relatives, staff and managers. They observed care, looked around the home and checked care files, medicine records, staff files and other documents.
The home had improved since the previous inspection in January 2017. Medicines were better organised, staffing had increased and agency use had reduced. People said they felt safe and received medicines on time. However, inspectors found some medicine errors, one bed-rail safety assessment was missing and some care records were incomplete or contradictory.
The home was rated Good overall. It was rated Good for Effective, Caring, Responsive and Well-led. Safe was rated Requires Improvement, meaning inspectors found important areas that needed further improvement even though they also found many safe practices.
Kind and respectful staff
Inspectors saw staff treating people with dignity and building warm relationships. People looked clean, comfortable and well cared for.
“Staff were friendly, patient and kind in their interactions with people.” from the report
Staffing and response
Inspectors found enough staff during the visit and saw people receiving help without long waits. Staffing levels had increased and agency use had fallen.
“People and relatives felt there was enough staff to support people's needs.” from the report
Activities and choice
People could choose how to spend their time. Inspectors saw music, games and a themed event, and people said they enjoyed the activities.
“People told us they enjoyed the range of activities provided.” from the report
Medicine records
needs fixingMedicine management had improved, but inspectors still found missing information for two people and discrepancies in some tablet counts. These issues had been identified and addressed or discussed during the inspection.
“Medicine management was not always effective. However people received their medication on time.” from the report
Incomplete care information
needs fixingSome care plans did not fully describe people's life histories and there was some contradictory information. This could make it harder for records to reflect the person-centred care staff were providing.
“Care plans did not always reflect people's life histories.” from the report
Meal choices
minorThe home had pictures of meals to help people choose, but inspectors did not see them being used on either the residential or nursing floor during the visit.
“We did not see this on the residential or nursing floor at the time of inspection.” from the report
- 01What checks are now in place to make sure 'when required' medicine instructions are transferred correctly each month?
- 02How are medicine stock counts and administration records checked, and what happens when there is a discrepancy?
- 03Have all bed rails and other restrictive equipment now had a documented safety and capacity assessment?
- 04How have care plans been updated to include people's life histories and remove contradictory information?
- 05Are picture-based meal choices now offered at every meal, including on the residential and nursing floors?
This was an unannounced inspection across all five CQC questions, carried out over two days, and it included checks on concerns about staffing and moving and handling. This explanation was written from the published report of 26 April 2018 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 Holyrood House Care Home
5 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- March 2022Goodcurrent ratingstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2018Goodup from Requires improvementSafe: Requires improvementEffective: GoodWell-led: Good
- March 2017Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2016Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- June 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- January 2015
Registered with the Care Quality Commission on 20 January 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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