Holly Cottage

Updated 15 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection. It took place on 24 and 25 July 2018 and was unannounced. Before the inspection, the registered provider had completed a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

The inspection was carried out by one inspector. We also looked at previous inspection reports and any statutory notifications sent to us. Notifications are information we receive when a significant event happens, like a death or serious injury.

We spoke to the new manager, the quality and compliance manager, the deputy manager, four support staff and two families. Two people gave us their views of the service and we contacted a range of professionals to gain their perspective of the service.

We looked at a range of support documents including, risk assessments and care plans, medicine administration records, staff files, supervision records, minutes from meetings, policies and procedures and the business continuity plan. We also asked the provider to send us a range of documents including the development plan and follow up actions from internal audits after the inspection, which they did.

Updated 15 September 2018

We carried out an unannounced comprehensive inspection on 24 and 25 July 2018.

Holly Cottage is home to five people with a learning disability and at the time of the inspection there were no vacancies. The single story premises provides good access for people with low mobility. The service is set on Highlands Farm near the village of Woodchurch, Kent. Each person has their own personalised bedroom, there is a communal bathroom and additional wet room. To the rear, there is a fenced garden with a large summer house.

Holly Cottage 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. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service good and we found that the evidence continued to support the overall rating of good with no evidence of serious risks or concerns. However, since the last inspection the service had not remained well-led. The registered manager had not worked at the service for over six months and had now left. During the interim period, the service had been managed by a deputy manager with oversight from the quality and compliance manager, however, staff development and service planning had decreased over the period leaving the team feeling less supported. A new manager had been appointed and had been in post for three weeks it was their intention to apply for registration, but during their induction they were being supported by the registered provider. Following the inspection, the manger provided an action plan with a focus on supervision and staff support.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

People had continued to receive a good service from the provider and the deputy manager praised the support and dedication the team had shown over the six-month period, when the service was without a registered manager.

People were protected from abuse by trained staff who understood how to keep people safe from situations that might harm them. Safeguarding procedures and personalised risk assessments provided staff with clear information to reduce and manage risks. There were sufficient numbers of staff rostered to ensure the flexibility to support people’s activities and appointments.

People received their medicines on time from staff that had been trained to administer medicines safely and the service worked closely with their local pharmacist to ensure that medicines were delivered, stored, recorded and audited regularly.

The service had remained clean and people had been protected from the risk of infection and cross contamination. Incidents had been recorded and appropriate measures put in place to ensure learning and follow up.

Staff had assessed and reviewed people’s needs holistically. Care plans were updated regularly to reflect changes to people’s choices and wishes in line with national best practice guidelines

Statutory checks and robust recruitment procedures ensured that staff had demonstrated the required level of suitability for the role. Staff received induction training along with ongoing monitoring and support from the experienced staff.

People were supported to eat and drink regularly throughout the day. Staff encouraged people to take an active involvement in planning and preparing their meals and assisted them to maintain a balanced diet and stay healthy.

People’s changing health needs were reflected in their care plans. Staff had supported people to attend routine and follow up appointments and made referrals to specialist services as required. Some information about medical procedures had not been provided in an accessible format. We have made a recommendation about this in our report.

People were happy and relaxed with staff and there was a clear sense of mutual respect. Staff used their detailed knowledge of each person to support them to express their views and be as independent as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems supported this practice. People’s consent had been sought and access to independent advocacy was available. However, the provider had not consistently recorded decisions in line with the principles of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty. Safeguards (DoLS). We have made a recommendation about this in our report

People had continued to receive responsive care based around their individual needs and wishes. Activities, and interests were actively supported and people encouraged to maintain regular contact with their relatives. Staff understood when people were unhappy and supported them to resolve concerns and issues. They also had a complaints process in place if required.

People’s end of life wishes had been discussed and agreed with support from families.

The new manager was supporting the team to develop. Both the new manager and deputy manager, acknowledged that that the lack of day to day leadership had limited the support and development of the staff. However, the impact on people had been minimised through the hard work of the staff team who had united under a clear vision for positive person-centred care.

Further information is in the detailed findings below.