Archived: Holly Tree Lodge

The service was registered for the support of up to 14 people. This is larger than current best practice guidance. The size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home.

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

People living at the service were happy and liked the staff that provided their care and supported them.

People felt safe because staff knew what they were doing, they had been trained, and cared for people in the way people wanted. Staff assessed and reduced people’s risks as much as possible. There were enough staff to support people with their care and support needs. The provider carried out key recruitment checks on potential new staff before they started work to ensure they were suitable.

People received their medicines and staff knew how these should be given. Checks were in place to ensure that medicines were given safely and stored correctly.

Staff supported people with meals and drinks, ensuring that people had enough to eat and drink and were involved in making choices and helping to prepare them.

Staff used protective equipment, such as gloves and aprons to prevent the spread of infection. The service had gained advice regarding the use of face masks during the current covid-19 pandemic. We advised the registered manager to include these decisions in people’s risk assessments.

Staff followed advice from health care professionals and made sure they asked people’s consent before caring for them.

Staff were kind and caring, they involved people in their care and made sure people’s privacy was respected.

Staff kept care records up to date. Complaints and concerns were dealt with and resolved.

People, staff and relatives were asked their views of the service and action was taken to change any areas that they were not happy with. The provider had systems in place to effectively monitor and bring about improvements in the service. Concerns were followed up to make sure action was taken to rectify the issue.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. The service had implemented training on these principles to embed the values within the staff team

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 inadequate (published 23 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Holly Tree Lodge is a residential care home providing personal care to 10 people with learning disabilities at the time of the inspection. The care home is registered to accommodate up to 14 people, however, the home is no longer able to provide accommodation for more than 10 people. The building was spread across a main house and three additional and separate bungalows.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was registered for the support of up to 14 people. This is larger than current best practice guidance. The size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home.

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

People and relatives told us they felt safe. However, we found that systems and practices in the service meant people were not safe and at risk of harm and abuse. Risks to people had not always been identified and assessed.

Cleanliness in the communal areas of the home was not to acceptable standards which meant people were at risk of infection or disease or other illnesses. Medicines were not secure due to the keys being openly available to anyone and one person’s supply of emergency medicine had run out.

Staff recruitment process had not been completed as required which meant that staff were not suitably assessed to ensure they were safe to work with vulnerable people. Staff rotas were not well managed which meant staff were working excessively long hours and shift patterns that meant people were at risk or errors or harm due to staff not being fully rested.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were not always consulted about their consent before support was given and mental capacity assessments were not always completed or were not decision specific. This meant people’s rights were not supported and protected.

The service did not apply the principles and values of Registering the Right Support and other best practice guidance. People were not encouraged to do things for themselves or be involved in daily tasks.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, there was a lack of choice and control, limited independence, limited inclusion e.g. People did not have the opportunity for meaningful activities and staff did not promote their interests, social network, hobbies and cultural or religious needs.

People were not valued of respected as they were living in unclean environment which was also in need of repair and redecoration in many areas. Staff did not always talk with people when carrying out tasks and choices were not offered.

People were supported to access a variety of health and social professionals when required and actions suggested by professionals were put into place. Staff did ensure that people who were supported in bed due to their conditions were well cared for in relation to skin and pressure care. Records showed people were involved in reviews along with their relatives and social care professionals. People who could not communicate easily through talking, were supported to use symbols, gestures and sounds to communicate.

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 20 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to keeping people safe and assessing their risks and needs, poor hygiene practices, poor standards of the environment, safe recruitment processes, treating people with dignity and respect, lack of personalised care, lack of staff support and lack of good management of the service systems and practices.

We have imposed positive conditions on the provider's registration to drive improvement in the areas of concern highlighted above and promoting the principles of Registering the Right Support.

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.

Special Measures:

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 six 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 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.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed. Staff received an induction and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported with regular supervisions.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People were supported to access a variety of health professionals when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times.

People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place which was accessible to all. Complaint had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

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 support this practice.

Further information is in the detailed findings below

People experienced effective, safe and appropriate care. Care plans were well documented to promote continuity of care.

We found that people living in the home received their prescribed medication when they needed it and in a way that suited them.

We found the premises to be maintained to ensure the home remained safe for people using the service, staff and visitors.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

Suitable arrangements were in place to address people's comments and complaints, and ensure they were listened to.