The Hollies

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked at 8 quality statements in safe and identified 2 breaches of the regulations. These were in relation to how the premises had not been kept clean and tidy, the poor management of records and staffing arrangements. There was no cleaner employed at the service. Care staff carried out cleaning duties when they had time but there were no consistent arrangements in place. On the day of the site visit many areas of the service needed cleaning. Records to monitor people’s care were in place. However, these were not always meaningful or lacked detail. Risk assessments and care plans had not always been developed to guide staff and help minimise risks. We did not see any evidence of harm. People and relatives told us they felt the service was safe. Staff knew who to raise concerns with and were confident these would be dealt with. Staff recruitment was safe and pre-employment checks completed. There were enough care staff to support people. Staff received training and told us they were well supported.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us about occasions when things had gone as well as expected and the service had made changes to how care was delivered to mitigate risk.

Staff told us they were able to raise concerns to either the registered manager or the owner.

Staff meeting minutes indicated staffing arrangements were changed when it had been recognised that falls were occurring more regularly at particular times of the day. Daily handover meetings were an opportunity to discuss any concerns and adjust how support was delivered accordingly. There was an appropriate Duty of Candour policy in place.

Relatives told us the registered manager spent time with them before their relative moved in, finding out what their family members needs were. This included information about their likes and dislikes and personality as well as their health needs. Relatives told us of occasions when their family member had needed to be admitted to hospital and staff had accompanied them to support the transfer.

Staff told us they had the information they needed to support people when they first moved into The Hollies. This included any information about people’s needs and preferences.

We sought feedback from professionals, however we received limited information in relation to this key question. One professional confirmed they worked with the service to support safe care.

The registered manager used information from commissioners and any previous providers to develop care plans which were further updated as staff got to know people. One member of staff commented; “The care plans are all being updated, they are quite good.”

Relatives told us they were confident people were safe living at The Hollies. One commented; “[My relative is] much safer than they were before [moving into The Hollies].”

Staff received safeguarding training and told us they would be comfortable raising any concerns to the registered manager or owner.

There was a pleasant and calm atmosphere. People were relaxed with staff who spent time chatting to them and offering support in an unhurried manner.

Care plans stated some people lacked capacity to make specific decisions and Deprivation of Liberty Safeguard (DoLS) applications had been made. However, no mental capacity assessments had been completed prior to the applications being made to evidence when people lacked capacity to make specific decisions.

Relatives told us they felt risks were known and staff supported people safely.

Staff and the registered manager were all confident they knew people well and had the skills to support people to manage risk and maintain their safety.

We observed staff reacting quickly when people with mobility difficulties attempted to mobilise independently. One person chose to sit out in the sun. Staff made sure they wore a hat and offered water regularly.

Processes to mitigate known risk were not robust. For example, there were monitoring charts in place to record how much fluid people had drunk during the day. There was no clear rationale for why these charts were in place. Staff recorded how much people had drunk but did not total it at the end of the day. There was no guidance on how much people should be drinking. Care plans were not always developed for people with specific health needs. For example, the registered manager told us one person had diabetes. There was no care plan in place specifically in relation to this need and it was not referenced in other care plans; for example, in care plans relating to eating and drinking. Five of the 17 residents did not have Personal Emergency Evacuation Plans (PEEPs) in place. The PEEP in one person’s room was for a previous occupant.

People told us they had access to the equipment they needed and felt confident with staff supporting them.

Staff did not raise any concerns about the safety of the environment.

The on-site assessment was prompted in part after the fire service shared concerns with CQC. We found the specific concerns had been addressed but there remained areas for improvement. One person had oxygen in their room, there was no sign on the door to alert first responders to this risk. The registered manager told us there had been one but that it must have fallen off. This had not been noticed and we could not be sure how long it had been missing. Action to follow up on the advice of external contractors was not taken in a timely manner. An oil tank was surrounded by combustible objects and material. This had been highlighted in a recent fire risk assessment and noted as an issue requiring immediate attention. Shortly after the assessment visit the registered manager sent photographic evidence to show the area had been tidied.

Audits had not identified the impact of having no cleaner in post.

People and relatives told us there were enough staff to meet people’s needs. One relative commented; “They might be a bit short sometimes, but they manage; they’re never in dire straits.”

There had been no cleaner in post since October 2023 and care staff were completing cleaning and cooking duties. Staff told us this impacted on the time they had to spend with people. One commented; “We can only clean when we are finished with the residents and we would rather spend time with the residents.” Staff told us they received the training they needed to help ensure they were able to provide care safely and confidently. Records confirmed training was in place.

We observed staff spending time with people and helping ensure they were comfortable.

Staff rotas had not been organised effectively. Staff numbers fluctuated; most days there were 5 care staff working in the morning. However, every week there was a day when the rota only planned for 4 staff. This meant there was additional pressure on staff to complete the additional cleaning duties. One member of staff commented; “Some days there are loads of us, others not so many.” During the week there were 3 staff on duty at night, this dropped to 2 at the weekend. There was no rationale as to why less staff were needed at this time of the week. Safe recruitment checks were completed.

Relatives were mainly positive about the cleanliness of the service although some did note it could be untidy at times. One told us it was, ‘untidy but not dirty.’ Another commented, “Must admit, since they lost the full time cleaner I sometimes think they need to put the vacuum round.”

Staff told us they did not always have time to complete deep cleans. One commented; “I have not done it for such a long time but on Fridays when you had staff you could go upstairs and do deep cleans but not for ages. It is embarrassing when families come in and people’s rooms are not up to scratch. It is really frustrating.”

There were not enough staff employed to ensure the home was kept clean and tidy at all times. There had been no dedicated cleaner in post since October 2023. Carpets throughout the service, and particularly in people’s bedrooms needed hoovering. Areas under kitchen workspaces had not been swept. Toilets did not always have toilet roll holders and these were kept on the back of toilets or on a chair next to the toilet which posed an infection control risk. In one toilet a soap dispenser had broken making it difficult to use.

Cleaning schedules were completed. These showed deep cleans of the kitchen were not occurring regularly. Bathrooms not always cleaned during the day.

People and their relatives did not raise any concerns about medicines. People told us they received their medicine on time and as prescribed.

Staff received training in the administration of medicines. This was now backed up by competency checks.

At our last inspection we found protocols for medicines to be used as required (PRN) were not always in place. At this assessment we saw the protocols had since been developed. However, guidance for staff was not always clear or detailed. We did not find any evidence of harm, but the processes did not support a consistent approach. One person self-administered a medicine. There was no reference to this medicine in their care plan. No risk assessment had been completed in relation to the practice of self-administration.