Hollybank Residential Home

We found the following examples of good practice:

The provider was following best practice guidance to prevent visitors to the home spreading COVID-19 infection. The provider kept in touch with family members and people's friends through regular phone calls and emails.

The provider had arrangements for visitors to meet with people virtually through video conferencing and physically in visiting areas. The provider had arrangements for visitors to meet with people in a visiting pod (designated area for visits) which was a purpose-built visiting area in their garden with a giant transparent screen separating the pod. They also had a conservatory where visitors could meet with people. All visitors have to had had their temperature checked and show proof of negative lateral flow test on arrival; in addition, visiting professionals had to show proof of their COVID-19 vaccination.

In order to control the spread of infection the provider promoted social distancing in the lounge and had two sittings at mealtimes. Each floor in the care home had dedicated staff and staff had staggered break times. The provider informed us that staff used Personal Protective Equipment (PPE) including gloves, mask and apron when providing personal care and when social distancing was not possible.

All COVID-19 positive service users were isolated according to Public Health England Guidelines. The provider informed us if a resident tested positive, they were isolated and were allocated a dedicated carer to cater their needs.

The provider had an admissions process in place. The provider informed us that newly admitted service users had to have had undertaken a COVID-19 PCR test 24 to 48 hours prior to being admitted into the service. A lateral flow test was undertaken on the day of admission into the service and they were isolated according to latest government guidance. The provider informed us that some service users found it difficult to isolate in their rooms and they were allowed outside their rooms if they had a negative lateral flow test; however, they were asked to maintain social distancing in communal areas.

The home had five PPE stations for staff to don and doff (put on and take off) Personal Protective Equipment (PPE). The provider informed us that they had prepared individual packs of PPE including gloves, apron and masks and used these packs with residents who were isolated due to COVID-19.

Our observations during the inspection confirmed staff were adhering to PPE and social distancing guidance.

The provider informed us that all staff had received the infection prevention and control and personal protective equipment training.

The provider informed us that all staff undertook COVID-19 lateral flow tests three times a week and PCR tests once a week. Lateral flow tests were undertaken on a daily basis during an outbreak. The provider confirmed to us that all staff working at the service had received their booster dose of COVID-19 vaccine. The provider informed us that all residents except one had received their booster dose.

The provider informed us that they had an open-door policy and had regular meetings with staff. The provider informed us that one of the care staff was a mental health wellbeing officer who helped residents and staff. The provider informed us they supported the wellbeing of staff by having open discussions, regular virtual meetings and being flexible with their rotas. The care home manager indicated they were supported by the management.

Further information is in the detailed findings below.

Hollybank is a residential care home providing personal care and accommodation to 17 people aged 65 and over at the time of the inspection. The service can support up to 17 people.

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

People were protected from the risk of harm and abuse. There were safeguarding policies and procedures in place and staff were aware of this.

Comprehensive assessments of people’s needs were in place. There was evidence of improved safety of people, including reduction of falls and pressure ulcers. This showed risks were being managed properly.

Staff had been recruited safely. They underwent appropriate recruitment checks before they commenced working at the service.

Medicines were administered safely. All staff members had undergone relevant training for medicines administration.

There was an infection control policy and measures were in place for infection prevention and control. There was a system for managing accidents and incidents to reduce the risk of them reoccurring.

The service carried out comprehensive assessments of people’s needs and developed person-centred care plans. People had agreed goals of care which were delivered in line with standards, guidance and the law.

People’s nutritional needs were met. They had been involved in drawing up the menu plans, and choices were regularly adapted in line with their preferences.

The environment had been adapted to meet the specific needs of people with dementia. People received co-ordinated input from a range of specialist services, such as psychiatrists, allied health professionals and community pharmacists.

There was evidence of on-going and relevant staff training. Relatives confirmed that staff had skills to support people safely.

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. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People were supported and treated with dignity and respect. People’s relatives confirmed that staff were kind and caring. People’s care records contained information about their choices and independence.

Specific needs in relation to equality and diversity issues were recorded in people’s care plans and addressed. The menu plans fully catered for different cultures and cuisines.

The service recognised people’s rights to privacy and confidentiality. Confidentiality policies had been updated to comply with the new General Data Protection Regulation (GDPR) law.

People received individualised care that met their needs, preferences and interests. People were supported, if needed, to express their views and preferences in relation to their care and support. The service identified and recorded how people wished to communicate and their communication needs.

There was a complaints procedure, which people and their relatives were aware of. The procedure explained the process for reporting a complaint

There were methods of monitoring the quality of the service in place. Regular checks and audits had been carried out in areas related to maintenance of the premises, health and safety, medicines management, infection control and management of accidents and incidents.

Rating at last inspection:

At our last inspection, the service was rated "Good". Our last report was published on 13 December 2016.

Why we inspected:

This was a scheduled inspection based on the previous rating.

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.

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

Hollybank Residential Home is a privately owned care home for up to 17 older people who require residential care and may be living with dementia. Accommodation is arranged over three floors and there is stair lift access to one floor. Communal areas include a lounge, conservatory, kitchen and dining room with bathroom and toilet facilities throughout. There is also an enclosed rear garden with sloping lawn and paved area for people to access. At the time of our inspection there were 17 people using the service.

Under the conditions of registration the home is not required to have a registered manager as it is owned by an individual provider. There was an established manager who had worked at the service for over twenty years. The registered provider was in the home each day and was actively involved in how the home ran.

People using the service and their relatives told us they felt safe and well cared for. Staff knew how to recognise and report any concerns they had about the care and welfare of people and how to protect them from abuse and harm. Where risks were identified, there was guidance on the ways to keep people safe in their home and in the local community.

The environment was safely maintained and people had the equipment they needed to meet their assessed needs. Individual bedrooms were personalised and furnished to comfortable standards.

The provider followed an appropriate recruitment process to check staff were suitable to work in a care setting. Staff received an induction and relevant training to support people with their care needs. This was followed by ongoing refresher training to update and develop their knowledge and skills. Staff also undertook training courses specific to people’s needs such as dementia awareness, diabetes and understanding depression.

The staff team had worked at Hollybank for a number of years and knew people well. There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Staff treated people who used the service and their guests with respect and courtesy. They were caring, patient and maintained people’s privacy and dignity.

People's needs were assessed and planned for and staff had accurate information about how best to meet people's needs. People's wishes, preferences and beliefs were reflected in their care plans. There was information about people’s social links and relationships with family and friends. Staff were responsive when people's support needs or circumstances changed and care records were updated appropriately.

People’s rights were protected because the provider acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This legislation is intended to ensure people receive the support they need to make their own decisions wherever possible. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Where people lacked capacity to make decisions, staff were aware of how to support them in line with the law. Families and professionals were consulted about people’s care so decisions could be made in the person’s best interests. Appropriate applications had been made to the supervisory body to restrict people's liberty where required.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were provided with homemade, freshly cooked meals. When people were at risk of poor nutrition or dehydration, staff involved other professionals such as the GP or dietician.

Medicines were managed safely and people received their medicines as prescribed. The service worked closely with external professionals to promote people's health and wellbeing and meet their needs. Appropriate referrals were made when people became unwell or required additional services.

The manager had been in charge at Hollybank for a long time. She knew people and staff well and had good oversight of everything that happened at the service.

People and their relatives felt involved in the way the home was run and were encouraged to express their views and opinions. They knew how to complain and make suggestions, and were confident their views would be acted upon.

Management and staff completed regular audits to check the quality and safety of the service. Where improvements were needed or lessons learnt, action was taken.

We found areas within the home that could be decorated and equipped more suitably for people living with dementia. We have made a recommendation about improving the environment to provide more engagement and stimulation.

As part of this inspection we spoke with six people using the service, two visitors, three members of staff, the registered provider and home manager. We also toured the premises and reviewed records relating to five people using the service and the management of the home.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were sufficient numbers of suitable staff to meet people's needs. Staffing levels were flexible to meet any changing needs.

A safeguarding policy and procedure was in place to advise staff what they should do if they suspect abuse and staff received regular training in safeguarding. We spoke with two members of staff who both demonstrated a good understanding of types of abuse and how to protect the welfare of vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The manager had been trained to understand when an application should be made, and how to submit one. We saw that there were plans for other care staff to attend refresher training. We saw where people no longer had capacity to make specific decisions, the staff acted appropriately and decisions were made in people's best interests.

People were cared for in an environment that was safe, clean and hygienic. We saw that equipment was available to enable people to mobilise safely around the home.

Is the service effective?

We saw that there was good liaison and communication with other professionals and agencies to ensure people's care needs were met. The service had made timely referrals for health and social care support when they identified concerns in people's wellbeing. Records showed that staff had followed the advice and guidance provided by health and social care professionals.

The staff we spoke with had a clear understanding of the care and support needs of the people living in the home.

People spoke positively about the quality of the food and choices available.

Is the service caring?

We saw that people were at ease in the presence of staff and staff knew people well, and were able to talk and share experiences. Those people who were able to talk with us said that they were supported by kind and attentive staff. Comments included, 'It's the best here', 'Everyone is so lovely' and 'I'm very happy with the staff and care.' A visitor told us, 'They are all very caring here.'

Staff assisted promptly and we observed that people were relaxed and comfortable in the company of staff. We saw they were kind, attentive and supported people at their own pace. People we spoke with told us they were well looked after. They described the staff as 'very good', 'kind' and 'they will have a chat with you if you need one.' One person told us 'they are only too willing to help if you want something.'

Staff we spoke with knew the importance of treating people as individuals and maintaining their dignity when giving personal care.

People were able to provide feedback about the quality of the care and support provided through regular meetings and annual satisfaction surveys.

Is the service responsive?

Care records were person centred and clearly described people's needs and risks and how these were to be managed. People needs and risks were regularly reviewed and changes made to the support provided as and when required.

People were supported to access health and social care services such as GPs, dietetic services, chiropody, community nursing and mental health support. Staff members we spoke with told us how they monitored people's general well-being and health needs, which was reflected in their care plans.

Is the service well led?

There was a long standing manager who demonstrated a good knowledge of their role and responsibilities and how to effectively lead the team of staff. The registered provider was in the home each day and was actively involved in how the home ran.

The staff team had also worked at Hollybank for a number of years and knew people well. Staff told us that they had the training and information they needed to care for people and that the manager was always available to offer guidance and support.

Staff felt there was good teamwork and one told us, 'It works well here as the home is organised.'

The service worked in partnership with key organisations, such as the local authority, to support care provision and service development.

The manager undertook a range of quality audits to ensure risks to people's health, safety and welfare were identified and managed.

There were systems in place to make sure the staff learnt from events such as accidents and incidents. These meant risks to people were reduced and there was evidence that the provider used this to improve and develop the service.

The provider notified us, the Care Quality Commission (CQC), of any incidents that occurred as they were required to by law.

We observed staff engaged with people in a supportive and sensitive manner. A person who spoke with us said 'The staff are friendly and caring." Another person said 'the staff respect my privacy."

We looked at the home's medicines administration practices. We found that people received their medicines in a safe way. Two people who spoke with us said they always received their medicines at the right time.

We found that the home had not always informed the Care Quality Commission of all incidents they were required to notify us about. We also found that prompt action had not been taken to report two potential safeguarding matters to the local authority.

We found that before staff commenced employment at the home checks had been completed to ensure they were safe and fit to do their job.

The service had systems in place to ensure that people's comments and complaints were listened to and acted upon. A person who spoke with us said 'The staff are very good at sorting out problems and requests.'

People who used the service told us they were happy living at the home and they were well looked after. Comments included, 'this is the best home I've been in', 'The staff are good to me, the food is nice', 'we are very lucky here and well fed!' and 'I'm very happy, we have a laugh.'

People knew who to talk to if they had any worries or concerns, and felt assured that staff would respond to these in an appropriate manner.

There was a stable staff team who have worked at Hollybank for a number of years. Staff told us that they had the training and information they needed to care for people and that the manager and provider were very supportive.

All the people we spoke to complimented the staff and described them as 'very caring', 'helpful', 'friendly' and 'very patient.'

There were systems in place for ensuring that the service was operating effectively. We saw evidence that when improvements had been identified at Hollybank they were acted upon.