Holly Tree Lodge EMI Care Home

We found the following examples of good practice.

The home had a robust system in place to support relatives and friends to visit people living in the home during the COVID-19 pandemic. Government guidance was being followed and the home had supported visits to recommence safely within the home. Visits were pre-booked to ensure they were staggered and the number of visitors to the home was manageable at all times. Visitors were required to complete a COVID-19 test prior to entering the home and wear personal protective equipment (PPE) during their visit.

Staff were trained on how to keep people safe from the risk of infection and how to use PPE correctly. The provider ensured there was enough PPE available for staff at all times. We observed staff wearing appropriate PPE.

Tests for COVID-19 were being carried out in line with government guidance, for both staff and residents.

Appropriate checks were undertaken before people moved into the home to reduce the risk of infection being introduced to the home. This included obtaining evidence the person had recently tested negative for COVID-19.

The premises were clean. There was a cleaning schedule in place and suitable cleaning products were used to control the spread of infection.

There were clear procedures in place to help ensure staff knew what action to take if they or a person living in the service displayed symptoms of COVID-19 or received a positive test result.

Holly Tree Lodge is a residential care home that provides accommodation and nursing or personal care for older people and people living with dementia. The home can accommodate up to 41 people in one adapted building over two floors. At the time of this inspection there were 30 people using the service.

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

People were safe living at Holly Tree Lodge. There were enough staff available to keep people safe and meet their needs. People were supported by staff who had received training in how to safeguard adults from abuse. Risks to people were assessed and staff knew how to manage any identified risks. People were supported to take their medicines as prescribed, however we identified some minor improvements could be made to the way people’s medicines were stored. The home was clean and tidy, and people were protected from the spread of infection.

People were cared for by staff who were knowledgeable and skilled. Holly Tree Lodge had been refurbished to help ensure the environment was dementia friendly. People’s relatives provided positive feedback about the care their family member received at Holly Tree Lodge.

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 supported people to maintain their health by supporting people to access community health services. Staff worked alongside community health professionals to ensure people received effective care. People's nutritional needs were met, and people were satisfied with the food provided at Holly Tree Lodge.

People and their relatives were positive about the staff team. They told us staff were kind and caring. People were supported by staff who knew them well. Staff treated people with dignity and respect and people were supported and encouraged to remain involved in decisions about their care. People's privacy was respected, and their independence was promoted.

People's care plans were person-centred and contained information about their life history and preferences for receiving care. This supported staff to provide personalised care to people. Staff supported people to take part in activities in accordance with their preferences. They helped to ensure people were meaningfully occupied throughout the day. The provider had a suitable complaints procedure in place and we found complaints had been investigated and acted upon. The provider had systems in place to ensure people who received care at the end of their life were cared for in accordance with their expressed wishes and any pain was effectively managed.

The home was well-run. People were supported by a team of staff who were happy in their jobs and well-supported by their managers. An experienced manager completed a range of regular checks on the quality and safety of the service. The provider, manager and all staff demonstrated a desire to provide person-centred, high-quality care. People, relatives and staff had opportunities to express their views about the service.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 20 November 2018). At the last inspection we identified one breach of regulation in relation to medicines management.

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 any 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 ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides nursing and personal care for up to 41 older people, some of whom may have mental health needs and/or be living with dementia. Accommodation is provided on two floors with passenger lift access between floors. There are communal areas on each floor, including a lounge and dining room. There were 35 people in the home when we inspected.

At our last inspection on 6 March 2018 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We identified seven regulatory breaches which related to staffing, safe care and treatment, safeguarding, consent, dignity and respect, person-centred care and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection we found improvements had been made in all areas, although there remained a breach in Regulation 12 (safe care and treatment). This related to medicine management.

The registered manager who was in post at the last inspection in March 2018 left. A new manager started in post in April 2018 and has registered with the Care Quality Commission. 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 2008 and associated Regulations about how the service is run.

The environment had improved considerably following redecoration and refurbishment which was ongoing. This included making the home more dementia friendly with themed corridors providing different areas of interest such as a ‘woodland walkway’ with birdsong and open access to enclosed gardens with raised flower beds and seating areas. The home was clean and well maintained.

There were enough staff to meet people's needs and to enable them to engage with people in a relaxed and unhurried manner. Staff worked well together as a team communicating and supporting each other. Staff recruitment processes were robust.

Staff received the induction, training and support they needed to carry out their roles. Staff had been trained in how to manage behaviours that may challenge others. They knew how to recognise early signs of such behaviour and used distraction techniques effectively. Risks to people were well managed by staff, although this was not always fully reflected in people’s risk assessments.

Accidents and incident recording had improved and a monthly analysis considered trends and themes and looked at any lessons learned. Staff had a good understanding of safeguarding and the reporting systems and we saw incidents were recorded and reported appropriately.

Some aspects of medicines management had improved; however we also identified some shortfalls. Following the inspection the registered manager informed us these had been addressed.

People received personalised care although this was not always fully reflected in their care plans. All care documentation was being transferred onto a new electronic care recording system. Care plans that had been transferred were up to date, person-centred and reflected people’s needs and preferences. The registered manager told us all the care plans were being reviewed and would be inputted onto the electronic system within the next two months.

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 supported this practice.

People were supported to have sufficient food and drink and were involved in the decisions about the food they ate. Staff were familiar with people’s personal preferences, likes and dislikes. People had access to healthcare services and systems were in place to manage complaints.

Links had been made with the local community and people were going out more. The provider had opened an activity centre in the grounds of the home which offered a range of activities to people in the home and the local community. Staff were proactive in engaging people with individual activities of their choice.

Relatives and staff spoke highly of the new registered manager who, alongside the providers, had made significant improvements to the quality of the service. Quality audit systems had improved and were now effective in identifying and addressing issues. People who lived in the home, their families, staff and healthcare professionals were involved in developing the service and encouraged to provide feedback about the service provided. This was both on an informal basis speaking to the managers and through a quality assurance survey.

You can see what action we told the provider to take at the back of the full version of the report.

At our last inspection on 1 August 2016 we rated the service as ‘Requires Improvement’ and identified three breaches which related to staff training, safe care and treatment and recruitment. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in Safe and Effective to at least good.

Holly Tree Lodge 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 home provides nursing and personal care for up to 41 older people who may have mental health needs and/or be living with dementia. Accommodation is provided on two floors in single rooms with lift access between floors. There are communal areas on both floors, including a lounge and dining room. There were 38 people in the home when we inspected.

The home had a registered manager. 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 2008 and associated Regulations about how the service is run.

Staff had received training in safeguarding and understood the reporting systems, however we found safeguarding incidents were not always recognised or reported to the local authority safeguarding team. We found risks to people were not properly assessed or managed well, particularly in relation to nutrition, falls and behaviour which may challenge others.

Relatives told us they felt people were safe in the home. However, some relatives raised concerns about staffing levels. Duty rotas showed staffing levels the registered manager said were in place were not being maintained. However, following the inspection the provider told us staffing levels quoted by the registered manager were incorrect. The provider said they were reviewing the staffing levels. Staff recruitment procedures ensured staff were suitable to work in the care service.

Staff completed induction and were up to date with most of their training. However, they lacked the skills and knowledge in how to manage challenging behaviour which put people who used the service and staff at risk of harm and injury. Staff said they felt supported, although they were not receiving regular supervision.

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; the policies and systems in the service did not support this practice.

People’s care records were not personalised and did not reflect people’s needs or preferences. There was not enough detail to guide staff about the care and support people required. People’s nutritional needs were not always met, particularly those people who were low weight or had lost weight. People had access to healthcare services and systems were in place to manage complaints.

Medicines management was not always safe which meant people were at risk of not receiving their medicines when they needed them.

Relatives told us there were few activities which our observations confirmed. This had been raised in feedback from surveys people had completed in 2017 but not addressed. Relatives told us staff were friendly and caring. We saw some caring interactions but also practices which showed a lack of respect for people and compromised their dignity.

The provider’s systems and processes did not enable them to effectively assess, monitor and improve the service. They did not monitor and mitigate risk effectively. The provider had failed to notify CQC of incidents which are legally required to be reported.

We found shortfalls in the care and service provided to people. We identified seven breaches in regulations – staffing, safe care and treatment, safeguarding, dignity and respect, person-centred care, consent and good governance. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Holly Tree Lodge is a care home which is registered to provide accommodation and personal care, for people who may have nursing and dementia care needs. On the day of our inspection there were 36 people living in the home.

There was a manager at the service who was registered with CQC. 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 2008 and associated Regulations about how the service is run.

We last inspected Holly Tree Lodge on 4 June 2015 and found the service was meeting the requirements of the regulations we reviewed at that time.

One person told us, “It’s lovely here. I like it. The girls [staff] are so nice, I love them all, don’t worry about me.”

Relatives told us they thought the staff were competent to do their jobs and said they treated people, “Kindly” and with “Compassion.”

On the day of the inspection we observed two member’s of staff moving and handling a person inappropriately. This posed a risk to both the person and the staff member’s. The moving and handling technique used was not safe and was not in line with the person’s moving and handling risk assessment.

We looked at staff files and found some gaps in the information required to ensure people being employed were of good character. The staff had been employed prior to the provider taking over the service. Although the provider had taken some action to acquire further information about existing staff, some files did not include all the relevant information and documents required to ensure their suitability to work with vulnerable people.

Relatives spoken with said they thought their family member was safe living in the home. They did not raise any concerns about the quality of care and support provided to their family member. Staff had received safeguarding training and were confident the registered manager would act on any concerns.

There was a programme of training that staff were required to complete. The majority of staff had completed mandatory training in such things as health and safety and food safety. We found eight staff (in total) who had not completed training in moving and handling or fire safety since 2014. This training should be completed annually.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who were not able to make important decisions themselves.

We found staffing levels were sufficient to meet people’s needs. Staff received induction, supervision and appraisal relevant to their role and responsibilities.

Throughout our inspection we observed people were very comfortable and relaxed with the staff who supported them. We saw people living in the care home were free to move around the home. We saw staff advising and supporting people in a way that maintained their privacy and dignity.

People were provided with adequate nutrition and hydration. Where necessary staff assisted people with their food to ensure they had a sufficient and balanced diet. The mealtime experience was not a positive experience for everyone as there was insufficient space in one dining room for people to sit at tables.

Staff said that communication in the home was good and they always felt able to make suggestions. There were meetings held for all staff and additional meetings for groups of staff, for example, heads of departments. Minutes of these meetings showed this was an opportunity to share ideas and make suggestions as well as being a forum to give information.

The service had a complaints policy and procedure. People and relatives told us they could talk with staff and managers if they had any complaints or concerns.

We found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in regulation12; Safe Care and Treatment, 18: Staffing and 19; Fit and proper persons employed.

You can see what action we told the provider to take at the back of the full version of the report.