Background to this inspection
Updated
22 December 2021
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.
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 team consisted of one inspector and one assistant inspector, a pharmacist specialist 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 Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. 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
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 and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with five people who used the service and five relatives about their experience of the care provided. We spoke with ten members of staff including the providers, registered manager, senior care workers, care workers and the chef.
We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at three 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 and quality assurance records. We spoke with two professionals who regularly visit the service.
Updated
22 December 2021
About the service
The Hollies Care Home is a residential care home providing personal care to people aged 65 and over at the time of the inspection. The home is an adapted house situated in a residential part of Castle Cary and has accommodation arranged over two floors. There are stair lifts to enable people to access the floors. The service can support up to 18 people. At the time of inspection ten people were living at the service.
People’s experience of using this service and what we found
People and relatives were mostly happy with the service. One person said, “The staff are pleasant and helpful and kind.” However, we found the service did not have robust systems and processes in place to assess risk and ensure people were safe. Fire safety checks had not been completed to ensure people were safe in the event of a fire. This placed people at risk of harm.
People’s care needs had not always been appropriately assessed to ensure the service could provide the care they required. Staff told us they used inappropriate moving and handling techniques as they did not have the equipment to assist people. This had placed people at risk of harm.
We imposed urgent conditions to the provider’s registration to ensure people were safe. The registered manager shared a memo they sent to staff to cease poor moving and handling practices, arranged for moving and handling training and completed unannounced staff spot checking.
The service shared the procedures on what to do in the event of a fire with staff, arranged for fire safety training and purchased fire evacuation equipment. We contacted the local authority who visited the home with an occupational therapist to assess people’s moving and handling needs. We also informed the Fire and Rescue Service for the area of our concerns about fire safety. They arranged to complete a fire safety audit at the service.
Medicines were not stored and managed safely. This put people at risk of not receiving their medicines as prescribed.
We were not assured that the provider was promoting safety through the layout and hygiene practices of the premises. The service did not have a housekeeper in post and there were not enough staff to ensure people’s needs were met and that people were kept safe in case of emergency or incidents.
People were not always admitted safely to the service. A person had been admitted into the service without a proper assessment of their needs to ensure they could be cared for safely and effectively. Staff told us they were not aware of the person moving into the service and had no information as to how they should meet the person’s care needs.
We were not assured that the provider was making sure infection outbreaks could be effectively prevented or managed. Infection Prevention and Control audits had not been completed regularly and were not up to date.
The service lacked oversight and governance from the provider and the registered manager. This meant the quality of the service was not monitored. The lack of governance and oversight meant risks were not identified and managed and this placed people at risk of harm.
The registered manager told inspectors they were aware of the shortfalls at the service. However, they had failed to put any systems and processes in place to keep people safe from harm. The registered manager had been in post since March 2021 and told inspectors they planned on improving the service and felt the providers were supportive of this.
Staff and healthcare professionals told us the registered manager was often not available at the service. This meant healthcare professionals were not always able to provide important updates regarding people. Staff roles and responsibilities were not clear. One senior staff member told us they were often left in charge and told us, “I am not paid to run the care home, I am just a senior.”
One relative told us they were not informed when their loved one’s health deteriorated and did not feel listened to.
Staff knew how to safeguard people and had received up to date training.
Since our inspection the provider has supported the registered manager with spot checks to assess staff competency. The registered manager has re assessed people’s care needs and organised training for staff.
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 11 March 2020).
Why we inspected
We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing levels, lack of governance, lack of moving and handling equipment and people’s care needs not being met. A decision was made for us to inspect and examine those risks. We inspected and found there were concerns with the management oversight, record keeping and cleanliness. We requested the registered manager to provide us with an action plan detailing how they would improve and mitigate risks to people. Following the action plan deadline date, we visited the service again and widened the scope of the inspection to a focused inspection to include the concerns we found on the first day in the key questions of safe and well-led.
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.
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 changed from good to inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to the requirements relating to registered managers, safe care and treatment, good governance, staffing and notifications of other incidents, at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is inadequate and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.