The Hollies

The Hollies is a care home without nursing registered to provide accommodation and care for up to 20 people. People living at the service are older people, some of whom may be living with dementia. At the time of our inspection there were 16 people using the service.

The home is currently providing support to some people living with a learning disability, however, people’s primary need for admission was their dementia and personal care. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting maximised people’s choice, control and independence. Staff supported people to make choices about their daily lives and engage in activities, that were tailored to their individual needs and promoted their independence. People were supported to maintain and develop relationships.

People were supported by enough staff on duty who had been trained to do their jobs properly. People received their medicines in a safe way.

People were protected from abuse and neglect.

People's care plans and risk assessments were clear and up to date.

Right care:

People received good quality person-centred care that promoted their dignity, privacy and human rights. Staff knew people well and demonstrated an understanding of people’s individual care and communication needs. This helped ensure people’s views were heard and their diverse needs met.

People were treated in a dignified manner and staff were aware of people’s support needs. Staff were observed talking to people in dignified and respectful way. Staff delivered personal care needed and gained consent prior to providing any support. Care plans informed staff of any specific ways to best communicate with the person.

Right culture:

People led their life that reflected their personalities and preferences because of the ethos, values, and attitudes of management and care staff ensured people led confident, inclusive and empowered lives. Staff created an environment that inspired people to understand and achieve their goals and ambitions.

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

We last inspected the service in September 2021. At that time, we had concerns regarding the management of the service and The Hollies was rated Requires Improvement. We identified checks and monitoring had not always been completed. At this inspection we found that whilst improvements had been made, we have made 2 recommendations in this report.

At the previous inspection we found the management of medicines was not always safe. We found improvements had been made and that medicines administration records (MAR) were now stored securely, records were now maintained and no gaps were found in MAR. However, we have made recommendations over the use of ‘as required’ protocols and staff competency check and handwritten entries on MAR.

At the last inspection we found issues over the level of detail in peoples care plan was limited and that individual risks were not always presented in care records in enough detail to support staff. We also found the registered manager had not always notified CQC of incidents in line with regulation. At this inspection we found these issues had been resolved.

The environment was safe and there was equipment available to support staff in providing safe care and support. We did find 2 windows without restrictors in place. The maintenance person fitted these immediately. Health and safety checks of the environment and equipment were in place. However, we had been informed by the fire department that the service was required to replace all the internal fire doors. This work had already started.

Medicines were ordered, stored and disposed of safely. However as mentioned above in the previous inspection staff competency checks and ‘as required’ medicines still did not have a protocol in place.

We have made recommendations about the management of medicines. The report highlights the actions the provider had taken at the inspection.

People told us they were happy with the care they received, and people said they felt safe living there. Comment from one person was, “Very safe here!” People looked relaxed, happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service. A relative told us, “My relative is safe here and well looked after.”

Records were accessible and up to date. The management and staff knew people well and worked together to help ensure people received a good service.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and there was a designated activities staff member to assist people. Staff knew how to keep people safe from harm.

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.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. One visiting professional said, “The staff are very quick to ask for advice and support.”

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.

Staff told us the registered manager and provider were available and assisted them. They went onto say how they were approachable and listened when any concerns or ideas were raised. A staff member said, “We are like one big family.”

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

Rating at last inspection and update

The last rating for this service was requires improvement overall (published 2 November 2021).

Why we inspected

We carried out this inspection to follow up on the breaches of regulation from the previous report.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Hollies on our website at www.cqc.org.uk

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Hollies is a residential care home providing personal and nursing care for up to 20 people. At the time of the inspection the service was supporting 16 people.

The service is a two-storey detached property in the centre of Roche. There was a range of equipment to support people with mobility issues. Some bedrooms had en-suite facilities and people shared communal lounges.

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

We last inspected the service in February 2020. At that time, we had concerns regarding the management of the service and The Hollies was rated Requires Improvement. We identified checks and monitoring had not always been completed. At this inspection we found that whilst some improvements had been made not enough had been done to meet the breaches of regulation.

At the previous inspection staff recruitment processes were not always safe. At this inspection, the provider had improved the recruitment process and met the breach of regulation.

At the previous inspection we found the management of medicines was not always safe. Records were not accurately maintained and included gaps which meant it was not possible to establish that people had received their medicines as prescribed. Auditing was not effective. At this inspection we found improvements had been made. However, the service was required to make further improvements.

Medicines administration records were not stored securely in a way that maintained people’s privacy. The storage of these records had the potential to be accessed by other people.

At this inspection we found the service identified and responded to individual risk. However, we noted the information was not always presented in care records in enough detail to support staff.

Care plans were reviewed, and staff understood people’s current needs. However, the level of detail in reviews was limited.

The registered manager had not notified CQC of incidents in line with the regulations. For example, they had not notified us of falls or when a person required medical attention.

There were processes in place to prevent and control infection at the service, through regular COVID-19 testing, cleaning procedures and safe visiting precautions.

People using the service consistently told us they felt safe and that staff were caring and respectful. Comments included; "Staff are fine. It’s OK here” and “I feel safe living here and much more relaxed than I was at home.”

We observed many kind and caring interactions between staff and people.

Staff spent time chatting with people and knew the people they supported well.

There were enough staff to meet people's needs and ensure their safety.

Staff told us that they had received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training, and this had ensured all staff received the training and updates needed to provide safe consistent care.

The provider had safeguarding systems in place and staff had an understanding of what to do to help ensure people were protected from the risk of harm or abuse.

Peoples dietary needs were understood by staff and met. Meals and the choice of food provided by the service was enjoyed by people.

The management team engaged well with health and social care professionals.

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 27 February 2020)

Why we inspected

We received concerns in relation to staffing, medicines, the environment and the quality of care people received. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 have found evidence that the provider needs to make improvements. Please see the Safe, and Well Led sections of this full report.

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

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 remains requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Hollies on our website at www.cqc.org.uk.

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 monitor the service.

We have identified three breaches in relation to governance systems and processes and medicines. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an updated action plan from 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 is a residential care home providing residential care for up to 21 people in one adapted building. At the time of the inspection 19 people were using the service. Some of the people who lived at the service needed care and support due to dementia, sensory and /or physical disabilities.

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

Recruitment process did not ensure staff had the necessary information in place to ensure ‘fitness checks were effective. For example, full employment histories were not available and gaps in employment had not been explained. . There was no photographic identity documents available and limited evidence of meaningful checks of staff performance in previous care roles. There were no interview notes demonstrating applicants had the skills for the role applied for. This was a breach of the requirements of the regulations.

The management of medicines was not always safe. Records were not accurately maintained and included gaps which meant it was not possible to establish that people had received their medicines as prescribed. There were no protocols in place to record why medicines that were offered if required, were administered. Medicines being checked into the service were not signed for, therefore there was no clear audit trail as to who had been responsible. There were no current systems to identify the concerns found at this inspection. This was a breach of the requirements of the regulations.

Governance systems had not identified the inconsistencies in relation to the service’s recruitment processes and the support people received with their medicines. This meant the services leadership were unaware of these failing prior to this inspection. This failure meant the service was in breach of the requirements of the regulations.

The environment of the service was in the process of being modernised at the time of our inspection. In two rooms malodours were identified which were evident on entry and in close vicinity to the rooms. The service’s refurbishment plan had identified these rooms needed replacement flooring and these works were planned in the near future.

People lived in an open, friendly, family atmosphere where they felt safe and well cared for. People had good relationships with staff and other people living at The Hollies. During the inspection we saw people engaging happily with laughter and good-humoured banter.

People received care and support from staff who knew them well. Staff were trained and competent in their roles and monitored people's health and wellbeing. When needed, referrals were made to other healthcare professionals. Staff responded to advice given to ensure people received the care they required.

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.

Care plans were personalised and reflected people’s individual needs. The service supported people to engage in a range of activities suitable to meet their needs. People's communication needs were being met and complaints were acted upon.

People were supported to maintain relationships that were important to them. People socialised together during meals and activities. Relationships with family and friends were supported and encouraged.

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

Rating at last inspection and update

This service was registered with us on 05/03/2019 and this is the first inspection.

Why we inspected

This was a planned inspection.

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.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report. We found no evidence during this inspection that people were at risk of harm from this concern.

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

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