Archived: The Hollies Care Home Also known as holliescarehome@hotmail.com

The Hollies Care Home is a residential care home providing personal care to people aged 65 and over at the time of the inspection. The home is an adapted house situated in a residential part of Castle Cary and has accommodation arranged over two floors. There are stair lifts to enable people to access the floors. The service can support up to 18 people. At the time of inspection ten people were living at the service.

People’s experience of using this service and what we found

People and relatives were mostly happy with the service. One person said, “The staff are pleasant and helpful and kind.” However, we found the service did not have robust systems and processes in place to assess risk and ensure people were safe. Fire safety checks had not been completed to ensure people were safe in the event of a fire. This placed people at risk of harm.

People’s care needs had not always been appropriately assessed to ensure the service could provide the care they required. Staff told us they used inappropriate moving and handling techniques as they did not have the equipment to assist people. This had placed people at risk of harm.

We imposed urgent conditions to the provider’s registration to ensure people were safe. The registered manager shared a memo they sent to staff to cease poor moving and handling practices, arranged for moving and handling training and completed unannounced staff spot checking.

The service shared the procedures on what to do in the event of a fire with staff, arranged for fire safety training and purchased fire evacuation equipment. We contacted the local authority who visited the home with an occupational therapist to assess people’s moving and handling needs. We also informed the Fire and Rescue Service for the area of our concerns about fire safety. They arranged to complete a fire safety audit at the service.

Medicines were not stored and managed safely. This put people at risk of not receiving their medicines as prescribed.

We were not assured that the provider was promoting safety through the layout and hygiene practices of the premises. The service did not have a housekeeper in post and there were not enough staff to ensure people’s needs were met and that people were kept safe in case of emergency or incidents.

People were not always admitted safely to the service. A person had been admitted into the service without a proper assessment of their needs to ensure they could be cared for safely and effectively. Staff told us they were not aware of the person moving into the service and had no information as to how they should meet the person’s care needs.

We were not assured that the provider was making sure infection outbreaks could be effectively prevented or managed. Infection Prevention and Control audits had not been completed regularly and were not up to date.

The service lacked oversight and governance from the provider and the registered manager. This meant the quality of the service was not monitored. The lack of governance and oversight meant risks were not identified and managed and this placed people at risk of harm.

The registered manager told inspectors they were aware of the shortfalls at the service. However, they had failed to put any systems and processes in place to keep people safe from harm. The registered manager had been in post since March 2021 and told inspectors they planned on improving the service and felt the providers were supportive of this.

Staff and healthcare professionals told us the registered manager was often not available at the service. This meant healthcare professionals were not always able to provide important updates regarding people. Staff roles and responsibilities were not clear. One senior staff member told us they were often left in charge and told us, “I am not paid to run the care home, I am just a senior.”

One relative told us they were not informed when their loved one’s health deteriorated and did not feel listened to.

Staff knew how to safeguard people and had received up to date training.

Since our inspection the provider has supported the registered manager with spot checks to assess staff competency. The registered manager has re assessed people’s care needs and organised training for staff.

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 good (published 11 March 2020).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing levels, lack of governance, lack of moving and handling equipment and people’s care needs not being met. A decision was made for us to inspect and examine those risks. We inspected and found there were concerns with the management oversight, record keeping and cleanliness. We requested the registered manager to provide us with an action plan detailing how they would improve and mitigate risks to people. Following the action plan deadline date, we visited the service again and widened the scope of the inspection to a focused inspection to include the concerns we found on the first day in the key questions of safe and well-led.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the requirements relating to registered managers, safe care and treatment, good governance, staffing and notifications of other incidents, at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 overall rating for this service is inadequate and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Hollies Care Home is a residential care home providing personal and nursing care up to 18 older people. At the time of our inspection visit there were 13 people living in the home. The home is an adapted house situated in a residential part of Castle Cary. There are stairlifts to enable people to access all areas of the home.

People’s experience of using this service and what we found

The staff and registered manager were committed to supporting each other and promoting person centred care. There were systems in place to monitor standards and plan improvements.

People felt safe and spoke highly of the staff who supported them. The staff understood their responsibilities and how to protect people from abuse. There were enough staff to meet people’s needs and keep them safe.

There were organised activities, informal chats and entertainment which provided people with meaningful things to do some of the time. We received mixed feedback about the sufficiency of support with things to do and ways people could fill their time. The registered manager told us they would consider seeking focussed feedback and ideas from people about this. People were supported to maintain contact with friends and family members.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff respected people’s choices and preferences.

People were cared for by staff who knew them well and were kind and compassionate. Staff were committed to the home and wanted to provide the best care they could. People had built strong relationships with staff and appreciated the familiarity they had.

People were supported to eat and drink safely.

People received care and support in a way that met their personal needs and enabled them to live the way they chose to. The recording of some aspects of care was not detailed. The registered manager told us they would address this.

Rating at last inspection

The last rating for this service was good (published August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

The Hollies provides care and support for up to 16 older people. The home is located in the small ¿town of Castle Cary. It is not purpose built and has accommodation arranged over two floors; ¿there are two stair lifts, but no passenger lift. There were seven people living at the home during ¿our inspection; one person was on a short stay.¿

A registered manager was responsible for the service. This 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.¿

When we last inspected the service on 29 February 2016 and 2 March 2016 we found two ¿breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This

was because medicine administration records were not always accurate. Medicine audits were ¿not

completed thoroughly and checks were not always completed to ensure medicines were still safe ¿to use. People may have been deprived of their liberty without having their legal rights protected.¿

The provider sent us an action plan on 11 April 2016 which confirmed the action they were taking ¿in relation to these issues. At this inspection we found the necessary improvements had been ¿made. ¿

On both days of our inspection there was a homely, calm and relaxed atmosphere. Staff ¿interacted with people in a friendly and respectful way. People were encouraged and supported ¿to maintain their independence and to pursue their interests and hobbies. They made choices ¿about their day to day lives which were respected by staff. One person said, “I go out every ¿morning for a walk and have a coffee in the café. I go in the local shops. Nice to get out.”¿

People and their relatives said the home was a safe place to live. People spoke highly of the care ¿they received. One person said, ““The staff are caring. I would say they are excellent.” ¿

People were involved in planning and reviewing their own care. Staff respected people’s privacy ¿and were aware of issues of confidentiality.¿

People told us staff took the time to get to know them; staff asked them about their life history, ¿their interests, hobbies and preferred routines. There was a programme of activities in line with ¿people’s interests. People were involved in the local community. They had a choice of nutritious, ¿home cooked food. Each person we spoke with said they were happy with the food and drinks ¿served in the home. One person said, ““The food is good. You can ask for anything special. You ¿just say the word and they do it for you.” ¿

People had developed friendships with others who lived in the home; they kept in touch with their ¿other friends and relations. Friends and relatives could visit at any time. One relative told us, “I ¿usually come in every day. It’s lovely here; it’s like an extended family.” ¿

There was a stable staff team at the home. Staff were kind and caring. They had a very good ¿knowledge of people’s care needs. Staff received a thorough induction and ongoing training and ¿support. ¿

People were involved in decisions about the running of the home as well as their own care. ¿People knew how to make a formal complaint, but no one had needed to. One person said, “I’m ¿happy and I like it here. If I wasn’t I would talk to the staff about it. Nothing to worry about here ¿though.” ¿

The management structure in the home provided clear lines of responsibility and accountability. ¿People liked and trusted the registered manager. One person said, “[Name] the manager is very ¿nice and helpful. Very easy to talk to.” An improved system of audits and checks had been ¿introduced and now worked well to monitor people’s safety and the quality of care in an effective ¿and consistent way.¿

A registered manager was responsible for the home. 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 and associated Regulations about how the service is run.

This inspection took place on 29 February 2016 and 2 March 2016 and was unannounced. It was carried out by two inspectors.

At the last inspection on 11 November 2014 we found the provider to be in breach of Regulation 23 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because staff did not receive formal supervision or appraisals and there were limited opportunities to discuss issues or identify training needs in a confidential setting. We also found improvements were needed to make sure people received a healthy diet and had opportunities to make choices about the food served in the home and to make sure people who lived at the home and staff were fully involved in the running of the home. At this latest inspection we found the necessary improvements had been made.

Staff understood people's needs and provided the care and support they needed. People said the home was a safe place. One person said “Oh yes it’s safe. The staff make it safe.” There were organised activities and people were able to choose to socialise or spend time alone.

People interacted well with staff. There was a relaxed, homely atmosphere. There was laughter, chatter and friendly banter. People made choices about their day to day lives. They were part of their community and were encouraged to be as independent as they could be.

Staffing levels were good and people also received good support from health and social care professionals. Staff had built trusting relationships with people. People were happy with the care they received. One person said “The staff are wonderful, hardworking and dedicated. They are lovely.”

People, and those close to them, were involved in planning and reviewing their care and support. There was good communication with people's relatives. Relatives visited regularly and felt their views were listened to and acted on. One relative said “We have an annual survey; they listen and take it on board.”

Staff were well supported and well trained. Staff spoke highly of the care they were able to provide to people. One staff member said “I think the care is brilliant here.”

People liked and trusted the registered manager. All staff worked hard to provide the best level of care possible to people. The aims of the service were well defined and adopted by the staff team.

There were quality assurance processes in place to monitor care and safety and plan ongoing improvements but these were not yet fully effective. There were systems in place to share information and seek people's views about their care and the running of the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicine administration records were not always accurate. Medicine audits were not completed thoroughly and checks were not always completed to ensure medicines were still safe to use. People may have been deprived of their liberty without having their legal rights protected. You can see what action we told the provider to take at the back of the full version of the report.

We used the information to answer the five 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?

People told us they felt safe living at the home and with the staff who supported them. One person told us: 'I feel very safe here, there's nothing to worry about and I get all the help I need.'

There were systems in place for the safe administration, storage and recording of medication. Medicines were only administered by staff who had completed training in this area.

The home carried out regular health and safety checks to make sure that the building was maintained to a safe standard. These checks included testing the fire detection system and hot water temperatures.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. While no applications have been submitted relevant staff have been trained to understand when an application should be made, and in how to submit one. People's rights were therefore properly recognised, respected and promoted.

Is the service effective?

People's care and treatment was not always effectively planned and monitored to ensure they received appropriate care and treatment.

Although care plans gave some information about people's needs and preferences they did not always include details of how specific needs would be met. There were no nutritional assessments in place and therefore no plans of care to state how people's nutritional needs would be met or the assistance they may require.

People we spoke with said they had access to healthcare professional including doctors, chiropodists and community nurses. One person told us: 'They would certainly get the doctor if I wasn't well.' Another person told us that a community nurse visited them regularly.

The standard of decor in some areas of the home was poor and did not provide a suitable environment for people.

Is the service caring?

People who lived at the home and visiting relatives were very complimentary about the staff who worked at the home. One person told us: 'The staff are all lovely, if you want anything you only have to ask.' A visitor said: 'The staff are all very kind and very caring.'

Staff respected people's wishes about how and where they spent their time. Throughout the visit we saw that people were free to spend time in communal areas or in their personal rooms. One person told us they always liked to eat in their room. At lunchtime we saw that their meal was taken to them in their room.

Is the service responsive?

People were involved in decisions about their care and treatment which enabled them to express their views and wishes. Care plans gave evidence that they had been discussed with the person who lived at the home and/or their representative. One visiting relative we spoke with told us staff had gone through the care plan with them and their relative.

People told us they were able to make choices about their day to day lives. People were able to choose what time they got up, when they went to bed and how they spent their day.

People told us they would feel comfortable to speak with the registered manager or a member of staff if they had any concerns. One person said: 'The manager always comes to see me if I'm not happy about anything.'

Is the service well led?

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

There were some systems in place to monitor the quality of the service offered and ensure the safety of people who lived at the home. However these systems were not always effective in identifying shortfalls in the service and planning improvements.

There was sufficient staff on duty to meet the needs of the people who lived at the home. We observed that call bells were answered promptly and no one had to wait long for assistance.

People spent their time as they wished. Some people chose to watch TV, listened to music, read or joined in with activities. Regular activities were arranged which people could choose to attend. People liked the food served in the home. They chose where they wished to eat their meals. Most people preferred to eat in the dining area, but some chose to eat in their own rooms.

People we spoke with said they thought the home was a safe place for them to live. One person 'Yes, this is a safe place to live. I have never been upset here'. People said they would raise any concerns if they had any and would be happy to share these with staff.

People were cared for by friendly, competent staff. Staff members said they were well trained and well supported. They were never asked to carry out tasks they had not been trained to do safely and effectively.

The record keeping in the home was good. All of the records were kept securely and retained for appropriate periods of time.

We looked at five care files of people who used the service. We saw the manager used a dependency profiling tool which meant that people who used the service has their needs reassessed on a monthly basis. This allowed the manager to monitor the support people needed.

The people who used the service we spoke with said that they felt safe using this service and knew what to do if they had any concerns. We were told ' I feel very safe here, staff kept popping in to make sure I'm alright'.

We spoke to the manager about the improvements to the premises, for example, the new wet room being installed on the ground floor. We were told there had been a programme for improvement identified to benefit people who used the service.

We were given a copy of the last survey for the service. We read that the majority of comments made by people who had returned the survey were positive. For example, a visiting professional wrote ' I have observed good practise by the carers during assessments and customers appear happy and well cared for'.