The Hollies Residential Home

Updated 18 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Hollies Residential Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Hollies Residential Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who commission the service. We also sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they had not visited the service or received any comments or concerns since the last inspection. A local authority commissioner told us they had carried out contract monitoring visit.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people who used the service about their experience of the care provided. We spoke with 2 people's friends and 2 relatives. We also received written feedback through our website from a further 2 relatives. We observed staff interactions with people and their care and support in communal areas. We spoke with 13 members of staff including housekeeping staff, kitchen staff, care staff, senior care staff, the deputy manager, the registered manager, the office manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 12 people's care records and multiple medicines records. We looked at 8 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, building related maintenance records and quality assurance records.

Updated 18 April 2023

About the service

The Hollies Residential Home is a residential care home providing personal care to up to 40 people. The service provides support to older people as well as younger adults. At the time of our inspection there were 30 people living at the service, some people lived with dementia, 1 person was cared for in bed.

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

People and relatives provided positive feedback about the service, the staff and the management. Comments from people included, “We are grateful to everyone at the Hollie's”; “I would, and have recommended here to other people”; “I feel very safe here”; “They are very friendly”; “When I want someone they’re here”; “I’m pretty happy” and “The girls (staff) are kind and caring.”

Although people and relatives were happy with the care and support, we found some concerns about people's safety. Improvements to safety had been made in relation to building related risks and risks relating to people’s assessed health needs. Some risks relating to skin integrity and constipation to people had not always been properly managed.

Medicines had not always been given as prescribed, however one medicine had not been given as per the prescriber’s instructions, as it had been given at the same time as other medicines. Medicated patches which can cause irritation to the skin if they are placed in the same position after removal were not always sited in a different place on people’s skin, which increased the risks of a reaction and discomfort. We found no evidence that people had been harmed. This is an area for improvement. Medicines were stored safely in a locked medicines room. Medicines had been stored at the correct temperature to ensure they were safe to use. Staff were trained to administer medicines and we observed good practice when staff were completing the medicines round.

Management oversight of the service had improved. The provider and registered manager had systems in place to check and audit the care and support as well as monitoring health and safety risks and building related risks. Actions were completed swiftly when the management team identified concerns. The provider had changed the electronic care planning system and this was mainly working well. However, some improvements were required to help the management team have better oversight of repositioning, constipation, medicines, and fluid intake.

Enough staff were deployed to keep people safe. Staff had been recruited safely to ensure they were suitable to work with people. People were supported by regular staff who they knew well. Staff were well supported by the management team.

The provider had improved the environment and further redecoration and renovation was taking place, during the inspection a new shower room was being installed. There was signage in place to support people living with dementia (as well as new people to the service) to orientate themselves.

People were assessed to check their capacity to make particular decisions when this was in doubt. Records showed how decisions were made in people's best interest. Mental capacity assessments were in place, these were decision specific, some had some conflicting information, which is an area for improvement. People told us they made choices about their lives. 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 provider had effective safeguarding systems in place to protect people from the risk of abuse. Safeguarding concerns had been identified and reported to the local authority appropriately. Staff knew and understood their role in keeping people safe.

The service was clean; the provider was promoting safety through the layout and hygiene practices of the premises. Staff used personal protective equipment when providing care to people in line with infection control guidance.

Prior to people moving into the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person.

Meals and drinks were prepared to meet people's preferences and dietary needs. People told us they liked the food.

People were treated with dignity and respect. People’s views about how they preferred to receive their care were listened to and respected. People and relatives told us staff were kind and caring.

People had access to a range of different activities throughout the week. People told us that they took part in these.

People received good quality care, support and treatment including when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians.

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 inadequate (published 26 August 2022). We served the provider warning notices in relation of breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also served requirement actions for breaches of regulations 9,11 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 9, 11, 17 and 20. The provider remained in breach of regulation 12 in relation to effective risk management and managing medicines safely. The service has been rated requires improvement.

At our last inspection we recommended that the provider considered current guidance on dementia friendly signage and take action to update their practice accordingly. At this inspection we found the provider had acted on any recommendations and had made improvements to dementia friendly signage around the service.

This service has been in Special Measures since 03 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

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

Enforcement

We have identified a breach in relation to effective risk management and medicines management at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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