Hollybush Residential Home

Hollybush Residential Home is a residential care service providing personal care and support for up to 14 people aged 65 and over. There were 14 people living at the service at the time of this inspection. The service is an adapted house, situated in a residential street in Newquay.

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

Records of people's care had been regularly updated. Five people were seen to be up and dressed, with four dozing in the lounge before 7am on the day of this inspection. Care plans were individualised and detailed most people’s needs and preferences. However, it was not always recorded when people preferred to get up or go to bed. This meant it was not possible to establish if people chose to be up, dressed and in the lounge before 7am in the morning.

People and their relatives told us that people had a choice about when they got up and went to bed.

Care plans included risk assessments and guidance for staff on how to meet people’s support needs. This meant any identified risks to people were minimised.

There were clear records to show, when assessed as needed, staff were monitoring specific health needs such as people’s weight, food and drink intake and the risk of skin damage. Where people had been assessed as requiring pressure relieving mattresses, to protect them from skin damage, these had been provided.

Some people living at Hollybush were living with dementia. Suitable pictorial signage was in place to support people to move around the service independently.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. People who wished to remain in their bedroom did so. Those spoken with confirmed this was their choice.

The service had suitable safeguarding systems in place, and staff knew how to recognise, and what to do if they suspected, abuse was occurring.

People told us the food was good. One person commented, “The food is really good here.”

Relatives were positive about the care and support provided. Comments included, “We are very happy with everything” and “The staff are lovely and it is always very clean.”

There were sufficient staff to ensure people’s needs were met. Staff told us they received appropriate support and training.

The building was clean and there were no malodours. There were appropriate procedures to ensure any infection control risks were minimised. Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Suitable visiting arrangements were in place for families to visit as per the current government guidance. The service had not experienced any positive cases of COVID-19 throughout the pandemic.

People received their medicines as prescribed. There were appropriate processes for ordering, recording and storing medicines. The temperature of the medicine refrigerator was monitored. However, staff were not able to monitor the maximum and minimum temperature of this refrigerator. This was immediately addressed by the provider during the inspection. Regular audits were carried out of the medicines records to help ensure any errors would be identified in a timely manner.

The service was managed effectively. Staff were working well together, and one staff member said, “I am happy here, we are well supported.”

Any changes in people’s health were escalated to the relevant professional and relatives were kept informed. One visiting healthcare professional told us, “We visit regularly and have no concerns.”

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 told us that people and their relatives had not recently been asked for feedback on the service’s performance. This was due to the impact of COVID 19. We were assured that a survey would be sent out in the coming weeks.

There was a stable staff team who knew people well and worked together to help ensure people received a good service. People, their relatives and staff told us the staff and management were approachable and listened when any concerns or ideas were raised.

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

Why we inspected

The inspection was prompted due to concerns received from one person. We received concerns in relation to people, living at Hollybush Residential Home, who were being woken up very early in the morning, being dressed and taken to the lounge. We were also told that people were asked to go to their rooms at 10pm and remain there. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this 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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We found the following examples of good practice.

Staff were following up to date infection prevention and control guidance to help people to stay safe. The registered manager had arranged for all staff to receive training in house on the appropriate use of personal protective equipment (PPE). Additional on-line infection control training had been made available to the staff team and updated regularly.

The service was clean throughout. There were appropriate procedures to ensure infection control risks were minimised. Seating in the lounge and dining area reflected social distancing guidance. Regular discussions took place between staff and people to ensure they understood the reasons for safe distancing. People who had limited capacity were sensitively encouraged to safe distance by staff.

People and staff were being regularly tested in accordance with current guidelines. Appropriate admission procedures had been developed and everyone who moved into or returned to the service from hospital had a negative test result on the day of their return. If a positive test occurred people would be supported in their room in isolation.

The service was closed to visitors following government guidance. There was an external room being installed as a temporary visiting room in the service garden, with separate entrances for people and their visitors. A permanently installed clear wall would minimise risks of infection to enable visits to be completed safely and comfortably.

Clear signage and sanitiser dispensers were in place around the service. They were informative and highlighted what PPE was required to protect people. On entry a staff member followed a checklist procedure, took the temperature and this was recorded in the visitor book to help track and trace. Visitors were encouraged to wash their hands on entry and exit to support infection control.

The registered manager communicated regularly with people, staff and relatives to make sure everyone understood the precautions being taken, and how to keep people safe.

Further information is in the detailed findings below.

Hollybush Care Home is a residential care home providing residential care for up to 14 people in one adapted building. At the time of the inspection 14 people were using the service. Some of the people who lived at the service needed care and support due to dementia, sensory and /or physical disabilities.

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

Staff understood their role in protecting people from harm and assessing avoidable risks. There were enough staff to provide care to people and they were available when people needed support. People received their medicines as prescribed.

Staff received training to enhance their skills and knowledge to provide the support and care people wanted.

People could choose how they wanted to be supported and how to spend their time. 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 were kind and compassionate and respected people’s privacy and dignity.

People’s needs were assessed, and care and support were planned and delivered in line with their individual care plan. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

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 quality of the service was monitored regularly through audit checks and receiving people’s feedback. There was system in place to handle and respond to complaints.

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 26 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We inspected Hollybush on 21 March 2017. The inspection was unannounced. The service was registered in May 2016, so this was the first inspection, for the service, when it was owned by this provider.

People told us they felt safe at the service and with the staff who supported them. We were told: “They are always watching over us to see if we are alright,” and “I feel safe here because all the staff are friends.”

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to a good standard, and staff received updates about important skills such as moving and handling at regular intervals. Staff also received training about the needs of people with dementia.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals.

There were enough staff on duty and people said they received timely support from staff when it was needed. People said call bells were answered promptly and we observed staff being attentive to people’s needs. Comments received included: “The girls are top notch, they certainly know how to look after me,” “The staff come around and ask us if we want a bath or do we want taking out to the shops, they’re wonderful,” and “There are really friendly staff that work here.” Staff said the team worked well together. For example, we were told: “Everyone knows what they are doing. Everyone pulls their weight.”

Care was provided appropriately and staff were viewed as caring. People told us: “I feel privileged to live here,” and “It’s just like living in a hotel.” Staff told us: “It is very homely here. Not many homes feel like that anymore.” “Care is brilliant,” and “We keep things as homely as possible.”

The service had some activities organised. These activities included quizzes, bingo, sing songs, craft activities and reminiscence sessions. Comments about activities included: “The girls do our nails, I really enjoy having them done,” and “My mum is being encouraged to take up knitting again, which she used to enjoy.”

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were happy with their meals. Everyone said they always had enough to eat and drink. Although there was not a formal choice of main meal, people told us they could have an alternative if they did not like what was on the menu. People said they received enough support when they needed help with eating or drinking. Comments received included: “You get a choice of food and if you don’t like something you can have something else and you can choose were you want to eat it,” and “You get good food here, it’s beautiful.”

People we spoke with said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint. However people told us: “I ‘ve got no complaints about this home, it’s very accommodating.”

People felt the service was well managed. The manager at the service had applied to the Care Quality Commission to be registered with us. Suitable processes were in place to check the service was providing a good service, and improve things should this be necessary. The change of ownership of the service had been viewed as positive. For example comments included that the new owners and manager were: “Brilliant,” “They are doing what they can to make the home better,” “The change has been good for the home. Fresh faces have spruced the place up.”