The Hollies Residential Home

We found the following examples of good practice.

Staff were following the current government guidance in relation to infection prevention and control. The provider had arrangements in place to ensure people and staff were tested for COVID-19 in accordance with current government guidance. The provider was working with their local infection control team to ensure they continued to follow current national guidance on best practice for infection prevention and control.

There were restrictions on visiting the service. There was a system for visitors in place to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing. All visitors were screened for symptoms of respiratory or other infections before being allowed to enter the home. The provider had made arrangements for relatives to visit that reduced the risk of any infection coming into the service.

The provider had arrangements in place to help prevent the spread of COVID-19 and other infections. All staff received training on the correct use of PPE and infection control. The management team audited all their infection control practices to ensure staff were following them.

The Hollies Residential Home provides personal and nursing care for up to 22 people across two floors. There were 17 people over the age of 65 using the service at the time of the inspection.

People’s experience of using this service:

Quality assurance processes were not consistently implemented to help the provider and the registered manager to identify and act on areas which could pose a risk to people’s safety. There was a lack of robust provider-led audits in place to hold the performance of the registered manager and other staff to account. Enough improvement had not been made since our last inspection. This was an ongoing breach of regulations.

There were not always enough suitably trained, skilled and experienced staff to support people at night. There was not a formal induction process in place and some staff had not completed all required mandatory training. Staff did not receive an appraisal of their work. This represented a breach of regulations.

Some further work was needed to ensure that 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. We did note there was an inconsistent approach to the assessment of people’s ability to make decisions. We also raised concerns about the low number of Deprivation of Liberty Safeguard applications that had been made for people. We have made a recommendation to the provider about this.

The risks to people’s health and safety were not always recorded within their records, although people told us they felt well supported and safe living at the home. Staff had a good understanding of how to identify and report any signs of abuse or neglect. The home was clean, although one communal room had a strong smell of urine and parts of the ground floor were cluttered. Action was taken after the inspection to address this. Improvements had been made to the way people’s medicines were managed. Accidents and incidents were investigated, but records used to record these investigations and subsequent actions taken were limited.

People’s needs were assessed prior to them moving to the home; however, this did not always result in detailed care plans and risk assessments to help to reduce risks to health and safety. Where people received support with their meals, staff did so effectively and in line with dietary requirements. Parts of the home required maintenance to ensure the home environment was safe for all. People had access to other healthcare agencies to help them to lead healthy lives. Visiting professionals praised the care provided by staff.

People liked the staff, they found them to be caring and respectful and they received personal care in a dignified way. People’s independence was encouraged and privacy respected. People’s care records were person-centred and contained guidance for staff to support them in their preferred way. Innovative methods had been used to provide people with information in formats they could understand.

People were supported to take part in activities to reduce the risk of social isolation. People felt able to make a complaint and were confident their complaint would be acted on. End of life care was not currently provided; however, more detailed care planning was required to ensure people could receive this care in their preferred way if needed.

The registered manager had a good knowledge of their regulatory requirement to report concerns to the CQC. People told us they would recommend the service. People’s views were requested and acted on.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was requires improvement (published 20 August 2018) and there were two breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Hollies accommodates up to 22 people in one building. On the day of our inspection, 14 people were living at the home, all of these were older people, some of whom were living with dementia.

A registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

During the home’s previous inspection on 07 December 2015, we rated the home overall as ‘Good’ During this inspection, we found some areas of concern and the overall rating has now changed to ‘Requires Improvement’. The details of the reasons why are explained in the summary below and in the body of the main report.

People were supported by staff who understood the risks people could face and knew how to keep them safe. Some risks to people’s health and safety were not being clearly identified and managed.

People were provided with their care and support when this was needed because there were enough staff on duty. People medicines were not managed safely and they may not receive these safely at the time they needed these. People were being protected from infection because safe practices were being followed.

People were being cared for and supported by staff who had been trained to do so. The provider was not following the Mental Capacity Act 2005 legal framework to ensure they made the least restrictive decisions in people’s best interest. People’s human right to make decisions for themselves was respected and they provided consent to their care when needed.

People were provided with the support they needed to have sufficient nutritional and fluid intake. Staff understood people’s healthcare needs and their role in supporting them with these. People lived in a building that had character which required ongoing maintenance due to this.

People were cared for and supported by staff who respected them and their privacy and dignity was respected. Where possible people were involved in planning their own care.

People received care that met their needs and they were able to participate in meaningful interaction and activities. Measures were in place to provide information to people in the most suitable format for them. People knew how to raise any complaints or concerns they had and felt confident that these would be dealt with. People approaching the end of their life were supported in a caring and sensitive way at that time.

People used a service that was responsive to their needs and views. They had confidence in the registered manager who was respected and supported by staff. However the systems to monitor the quality of the service and make improvements were not being used to achieve this.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

People were provided with a choice of suitable and nutritious food and drink. One person said, 'The food is fantastic, in fact it's top class. Nothing is too much trouble for them (care staff) I have no concerns at all.' Another person told us, 'I cannot grumble about the food. It's very nicely prepared and we cannot ask for anything better than that.'

We found that medication was managed effectively. One person said, 'My tablets are always provided and they (care staff) watch me taking them before they go.'

People told us they felt the staff had the right qualifications and skills. One person told us, 'We are all happy here, obviously we have our moments like anybody else but I feel that we are all happy'. Another person told us, 'All the girls (care staff) are beautiful, they all look after me. They are always there if I need them, at any time of the day or night, they are top class. I definitely feel safe here.'

We found effective recruitment process in place which adhered to current legislative requirements. We also found that the support staff had received a training package to ensure they were competent and confident in performing their duties.