Hollywood Rest Home

We found the following examples of good practice.

• The provider was following the government's guidance on whole home testing for people using the service and staff.

• Arrangements were in place to ensure people were tested for COVID-19 before being admitted to the service. People who were admitted to Hollywood Rest Home were isolated for 14 days to prevent the spread of infection.

• Visiting arrangements at the service were in line with government guidelines. A booking in system was in place to stagger visitors and visiting times.

• Staff employed at the service had received training on infection prevention and the correct use of Personal Protective Equipment [PPE]. There was clear guidance and signage located within the service to help promote staff to safely work whilst minimising the risk of spreading infection including effective hand washing practices.

• The environment was visibly clean. Cleaning schedules evidenced the frequency of cleaning undertaken throughout the service.

• People living in the service were encouraged and supported to maintain social distancing in communal areas, such as the lounge and dining room.

Hollywood Rest Home 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. Hollywood Rest Home is registered to accommodate up to 46 older people. There were 34 people living at the service when we visited on the 16 and 25 January 2019.

Hollywood House is a large detached house situated in a quiet residential area in Grays, close to all local amenities. The building is set out on two floors, with lift access to the first floor. There are several communal areas throughout the building and a good-sized garden to the rear of the property.

At our previous inspection in March 2018, the service was rated ‘Requires Improvement’. We found breaches of Regulation 9 [Person centred care], Regulation 10 [Dignity and respect], Regulation 12 [Safe care and treatment], Regulation 14 [Meeting nutritional and hydration needs], Regulation 17 [Good governance] and Regulation 18 [Staffing] of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following our last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Is the service safe? Is the service effective? Is the service responsive? And is the service well led? to at least good. You can read the full report of our previous inspection completed in March 2018 by selecting the ‘All reports’ link for Hollywood Rest Home on our website at www.cqc.org.uk.

At this inspection, we found improvements had been made and the service is now rated ‘Good’.

The service 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 2008 and associated Regulations about how the service is run.

The registered manager and staff were committed to providing good quality care, improving and maintaining standards. Audits and quality checks were in place to monitor the quality of the service and drive improvements, however some aspects of the provider’s quality assurance processes required further improvements to ensure they were robust and thorough.

Individual risks to people had been identified, managed and reviewed to ensure their safety. There were adequate numbers of staff to meet people’s individual care and support needs. Effective recruitment procedures were in place to protect people from the risk of avoidable harm. Staff understood their responsibilities in relation to keeping people safe from harm and abuse. Systems were in place for the safe management of medicines. People were protected from the risk of the spread of infection.

Staff received an induction when they started work at the service. They received on-going training, supervision and support to fulfil their role and responsibilities. People were supported to maintain their health and well-being and were supported to access health care services. People’s dietary needs were met by staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with kindness, dignity and respect. Staff knew people well and were sensitive to their individual care and support needs. People’s independence was promoted and, where possible, they were encouraged to do as much as they can for themselves.

Care plans contained information and guidance to enable staff to support people in line with their preferences. Care plans were regularly reviewed to ensure they reflected people’s current care and support needs. An activities coordinator had been recruited to support people to participate in activities they enjoyed.

Further information is in the detailed findings below.

Hollywood Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 46 older people and people living with dementia in one building. At the time of the inspection, there were 36 people living at Hollywood Rest Home. Since our last inspection to the service in February 2016, the registered provider had varied their conditions of registration to increase the numbers of people living at Hollywood Rest Home from 27 to 46.

Hollywood Rest Home is a large detached house situated in a quiet residential area in Grays, Thurrock and close to all amenities. The premises are set out on three floors and there are adequate communal facilities available for people to make use of within the service.

At the last inspection on the 9 and 12 February 2016, the service was rated ‘Good’. At this inspection, we found the service was rated ‘Requires Improvement’. This is the first time the service has been rated ‘Requires Improvement’.

A registered manager was in post. The registered manager was also the registered provider. 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.

Improvements were required to the service’s governance arrangements. Not all information gathered was analysed to identify potential trends and the areas for improvement. The quality assurance arrangements had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements. The registered manager continued to have noticeable minimal involvement at the service and it was evident they relied heavily on the deputy manager and the service’s administrator. This lack of oversight had led to the shortfalls identified as part of this inspection.

Not all risks to people’s safety and wellbeing had been identified and suitable measures put in place to mitigate risk to keep people safe. Personal Emergency Evacuation Plans were not up-to-date and we could not be assured night staff employed at the service had participated in fire drills.

Medication arrangements at the service required strengthening and improvement, as not all people using the service received their medicines in line with the prescriber’s instructions or received their medication. Improvements were required to ensure that people’s care plan documentation reflected all of their care and support needs and how the care was to be delivered by staff.

Minor improvements were required in relation to the registered provider’s recruitment practices and procedures. Care had not always been taken to ensure a full employment history had been sought and gaps in employment explored. Not all newly employed staff had received a comprehensive induction or where staff had been promoted to a more senior role. Although the majority of staff’s mandatory training was up-to-date, not all staff had received practical manual handling training.

The dining experience for people living at Hollywood Rest Home was not always positive. Not all people received proper support from staff to eat their meals. Where people were at risk of poor nutrition and hydration, we could not be assured records to demonstrate what people had eaten and drunk were accurate and could be relied on.

Though people and those acting on their behalf told us they received a good level of support and were treated with care and kindness, interactions by staff and the way they communicated with people required significant improvement. The majority of exchanges were centred primarily on tasks and routines, rather than it being person-led and person-centred. Staff did not always listen to people or respond to non-verbal cues and there was an over reliance on the use of the television. The service had been without an activities coordinator since January 2018 and although there was an expectation that care staff would facilitate social activities, people did not routinely receive opportunities to engage in social activities.

People were protected from abuse and avoidable harm. People living at the service confirmed they were kept safe and had no concerns about their safety and wellbeing. Policies and procedures were being followed by staff to safeguard people. Comments about staffing levels from people using the service and staff were positive. The deployment of staff across the service was observed to be appropriate.

The service worked together with other organisations to ensure people received coordinated and ‘joined-up’ care and support. People’s healthcare needs were well managed and people had their healthcare needs met.

People were protected by the provider’s arrangements for the prevention and control of infection.

We have made recommendations about the management of risk.

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

Hollywood Rest Home provides accommodation and personal care for up to 27 older people and people living with dementia.

A registered manager was in post. 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.

People told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and others’ safety.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed to mitigate risks.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff demonstrated a good understanding and awareness of how to treat people with privacy, respect and dignity.

The dining experience for people was positive and people were complimentary about the quality of meals provided. People who used the service and their relatives were involved in making decisions about their care and support.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the Local Authority to make sure people’s legal rights were being protected.

Care plans accurately reflect people’s care and support needs. People received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns would be listened to, taken seriously and acted upon.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The registered manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service. They also told us that they felt able to talk to the staff because they were familiar to them and very kind.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Quality checking systems were in place to manage risks and assure the health, welfare and safety of people who received care at the service and the staff who supported them. We saw records which showed that the health and safety in the service was regularly checked.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated. This meant that staff were provided with up to date information about how people's needs were to be met safely and effectively.

We saw that the service had effective systems in place to ensure that people's nutritional well-being was monitored and supported.

The service recognised when people needed support from other professionals and took appropriate action to access services to meet their needs. A visiting professional said, 'This place is a dream. Staff are very aware. They staff ask for our support and chase others to make sure people here get what they need.'

Is the service caring?

People told us that they received the care they needed. One person said, 'They look after me very well.' Another person said, 'The staff are all very good; very kind, patient and caring."

We noted that staff were kind and caring towards people who used the service. Staff spoke with people by name and interacted with them in a friendly and respectful way. People who used the service also knew the staff by name.

A visiting relative said, 'The care is absolutely fabulous, you cannot fault it."

A visiting professional said, 'They have the right approach. The service is right up there in terms of good dementia care.'

Is the service responsive?

We saw that the service had acted promptly to protect a person who did not have the capacity to make decisions to keep them safe. The risk to their safety was considered in the least restrictive way to support and respect their human rights.

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to. Visitors confirmed that they were able to see people in private and that visiting times were flexible.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. This included weekly religious activities as well as noting people's preferences for their end of life care.

Is the service well-led?

The provider had procedures in place to support the deputy manager and to ensure that quality checking systems were in place. This was used to manage risks and to assure the health, welfare and safety of people who received care in the service.

Staff were well-led, trained and supported to enable them to meet people's needs. A visiting relative told us that they felt that staffing levels allowed for people, 'to be clean, tidy, fed, watered and loved every day of the week.' They also said, 'The care is so good because they employ people who care.'

As part of this inspection we spoke with the registered provider/manager and deputy manager. Documents relating to the service's quality assurance arrangements were viewed. Records were seen to be comprehensive and showed that appropriate arrangements were now in place to ensure that the quality of the service was assessed and monitored at regular intervals over a 12 month period. Where issues were highlighted for corrective action and action plan was completed detailing how this was to be achieved.

Throughout our inspection the atmosphere at Hollywood Rest Home was observed to be calm and relaxed. Staff interactions with people who used the service were noted to be positive and it was evident that staff had a good knowledge and understanding of people's care and support needs.

Each person was noted to have a care plan in place detailing their care needs and how they were to be supported by staff. Records also showed that people who used the service were supported with their healthcare needs.

Whilst we acknowledge that there were a lot of positives as detailed above and that improvements had been made to ensure that medication practices and procedures at Hollywood Rest Home were robust, and improvements made to cleanliness and infection control procedures; further work was required in relation to staff training, supervision and appraisal. Concerns were highlighted that little improvement had been made by the provider since our last inspection in November 2012, to ensure that there was an effective quality assurance system in place to assess and monitor the quality of the service provided.

We found that suitable arrangements were not in place to ensure the maintenance of appropriate standards of cleanliness and hygiene to protect people who use the service. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the recording and safe administration of medicines. Further improvements were also required in relation to staff undertaking a comprehensive induction and receiving regular supervision.