Archived: Hollybush House Nursing Home

We found the following examples of good practice.

A separate unit was being used to support people who were self-isolating. This had clear signage and additional Personal Protective Equipment (PPE) stations. Specific staff were allocated to this area during the COVID-19 outbreak.

Staff wore PPE in line with guidance and were knowledgeable about what equipment was required for different tasks.

Enhanced cleaning schedules were in place which included high touch areas and an ‘exit cleaning’ process for staff leaving the room of a person who had tested positive for COVID-19. The Deputy Manager carried out weekly audits to identify any shortfalls in cleaning or IPC practice.

A separate bathroom allocated for visitors was located close to the home entrance. This supported visitors to maintain good hand hygiene when entering and leaving the home.

Areas used by staff had signs to indicate how many staff members could safely use the room whilst maintaining social distancing.

Staff had been given additional training so they could support tasks outside of their usual role. For example, carers had been trained in cleaning procedures.

At our last inspection in February 2016 we rated the service as good. At this inspection we found evidence that led the key question of Effective to be rated as Requires Improvement. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The inspection visit took place on 12 December 2018 and was unannounced.

There was an acting manager in post who had submitted an application to become the 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. The acting manager was not available on the day of inspection.

Training around mental health needs and deprivation of liberty was lacking for all staff, and staff did not have a high level of knowledge in these areas, although this did not affect the general care of people and they were supported by staff in the least restrictive way possible. People were supported to have choice and control of their lives. People were assisted to access appropriate healthcare support and received an adequate diet and hydration.

People continued to receive care that made them feel safe and staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to/follow. Safe recruitment of staff was carried out and adequate numbers of staff were available to support people. People received medicines as required.

The care people received was provided with kindness, compassion and dignity. People were supported to express their views and be involved as much as possible in making decisions. Staff supported people to have choices and independence, wherever possible. People’s diverse needs were recognised and staff enabled people to access activities should they so wish.

The provider had effective systems in place to regularly review people’s care provision, with their involvement. People’s care was personalised and care plans contained information about the person, their needs, choices and cultural needs. Care staff knew people’s needs and respected them. People were able to speak openly with staff and understood how to make a complaint.

The service continued to be well-led, including making detailed checks and monitoring of the quality of the service. People and staff were positive about the leadership skills of the acting manager. We were provided with information about the service where required.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were given appropriately. People were supported to take sufficient food and drinks and their health needs were met.

We observed there were a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs. People told us that they were kept safe.

People told us that they were able to raise any concerns they had and felt confident they would be acted upon. People and their relatives understood the complaints procedure.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. People were encouraged to make their own decisions. Staff interacted with people in a positive manner.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible. Social activities were carried out and people’s preferences acknowledged. The home had a friendly and welcoming atmosphere.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision, allowing staff to understand their roles, and responsibilities were in place.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective.

Quality assurance audits were undertaken regularly and the provider gave the registered manager support.

Notifications were sent to us as required, so that we could be aware of how any incidents had been responded to.

People told us that they had been involved in the compilation of their care plans. One relative said, 'They always ask me and get me to sign for treatment to be given.'

People we spoke with said they were happy with the care and support being provided. A relative said, 'Professionally I go to lots of homes, they can't touch this. It's excellent.'

Policies were in place in respect of safeguarding people from abuse. Staff had been trained and knew how to identify abuse and what the reporting procedures were.

Staff were well trained to provide care to people and received appropriate support and supervision from their management.

There was an established quality assurance system in place within the home. People were consulted about the quality of care.

People we spoke with told us positive things about the care and support that they or their relatives had received. We spoke to a relative who's job entailed visiting a number of care homes, they said 'my partner is very happy here they look so relaxed, this place is definitely one of the best I have to go into'.

Evidence we gathered indicated that staffing levels were adequate and people acting on behalf of persons using the service told us that there were enough staff to meet their needs.

There were systems and procedures in place for the safe administering, storage and disposal of medicines.

Systems and processes were in place to receive, handle and respond to complaints made by service users or persons acting on their behalf.