Holland House

Updated 20 December 2019

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 Care Act 2014.

Inspection team

The inspection was carried out by one inspector. We visited the home on the 23 October and conducted telephone calls with relatives after the home visit.

Service and service type

Holland House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the service is small, and people are often out, and we wanted to be sure they would be at home to speak with us. We also needed to ensure the registered manager would be available.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with all four people who used the service about their experience of the care provided. We spoke with members of staff including the operations manager, the registered manager, a team leader and three care workers. We reviewed two people’s care records and medication records. We looked at one staff file 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

On the 8, 11 and 12 November 2019 we conducted telephone interviews with four relatives of people using the service.

Updated 20 December 2019

Holland House provides accommodation with personal care for up to four people. The service specialises in supporting adults with a range of complex needs and behaviours associated with Prader-Willi Syndrome (PWS) and learning disabilities. PWS is a genetic condition that means people with the condition will have an, insatiable desire for food, which can make the person eat excessively. This has the potential to result in life threatening obesity. There were four people using the service at the time of our inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People's experience of using this service

Without exception the care and support people received was specifically personalised to meet people’s specialist needs. All the people using the service and relatives spoke positively about the care and support they received and how it had greatly improved their lives.

The staff and management team were creative, committed and determined to supporting people to live independent lives and challenge the barriers people faced living with PWS. People were supported to achieve their dreams and aspirations. Staff spoke fondly of people and were proud of what they had achieved. There was a real ‘can do’ attitude.

A culture of being open and transparency was embedded in the service. The service worked closely with other healthcare professionals. The registered manager was extremely pro-active in encouraging ideas and feedback from people using the service, relatives, staff and other professionals, to continually drive up improvement. A robust system of quality monitoring checks and audits were used to continually review all aspects of the service.

People were supported to manage their weight and food choices. As a result, people had seen huge benefits to their health and wellbeing. People were educated about food choices and activity levels and how to control food cravings in social settings and when alone. People had made significant progress in losing a substantial amount of weight and they were immensely proud of what they had accomplished. This resulted in people experiencing huge physical and mental health benefits and leading healthy, active lifestyles. This had opened doors to people trying new experiences, making new friends and partner relationships.

Staff consistently went the extra mile to ensure people received all the support they required, when they needed it. People living at the home valued their relationships with staff and the commitment they provided, and this benefitted people immensely.

Staff worked as a close team and were driven in providing person centred support to enable people to become more confident and achieve as much independence as possible. People and their families were central to the care planning process and felt listened to. Each person was respected as an individual, with their own social diversity, values and beliefs. People received care and treatment that was delivered in line with up to date best-practice guidelines in relation to PWS.

Established systems were in place for receiving and responding to complaints and concerns. People, relatives and staff knew how to raise concerns and make a complaint if they needed. There were numerous forums where people could raise any concerns or complaints. For example, during house and one to one meetings with their named keyworkers. In addition, a suggestions box was available to post any concerns directly for the attention of the registered manager.

There was a clear management structure. Staff had the skills, knowledge and experience to perform their roles, and had significant experience in caring for people living with PWS. The provider had clear visions and values, and these were shared with the whole staff team. Staff followed the values, and this was evident in the way they provided care for people.

Staff received safeguarding training to enable them to recognise signs of abuse and how to report abuse. Established risk management plans were in place to protect and promote people's safety. Staffing arrangements ensured each person received the right level of staff support based on their assessed needs.

The staff recruitment procedures ensured people received care from staff that were suitable to work in a care setting. Staff received an induction process when they commenced work at the service and there was a strong focus on staff training and development.

People were supported to take their prescribed medicines safely. Systems were in place to ensure people were protected from the spread of infections. If any accidents or incidents occurred lessons were learnt, and action was taken to effectively manage known risks.

People's needs, and choices were assessed, and the care provided met their diverse needs. Each person's food intake was closely monitored to ensure they maintained a healthy weight in line with best practice guidance in relation to PWS. Staff supported people to access health appointments when required, to ensure people received continuing healthcare to meet their needs.

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.

Staff were caring and had built open and honest relationships with people. They demonstrated a genuine interest in people's wellbeing. People were happy with the care they received and felt valued by staff and the management team. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted.

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 Good (published 7 January 2017).

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 reinspection programme. If we receive any concerning information we may inspect sooner.