The inspection took place on 11 January 2016 and was unannounced. We last inspected the service on 14 May 2014 and found the registered provider met the regulations we inspected against. Holly House provides care and support for up to eight people who have a learning disability and are on the Autistic Spectrum. At the time of our inspection seven people were using the service.
The home had a 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.
We found the registered provider had breached regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff had not received the registered provider’s expected number of supervisions or an appraisal.
You can see what action we told the provider to take at the back of the full version of the report.
Family members felt their relative received good care from skilled staff who knew their needs well. Family members commented: “Very well cared for. They are very supportive of [my relative] and the care she gets is very good to excellent”; “They really understand [my relative]”; and, “All of the staff we have seen are very well trained.” We observed warm and caring relationships had developed between people and staff.
People were supported to be as independent as possible. For instance, they were shown meal and drink options so they could choose what they wanted to eat and drink. One staff member said, “We encourage people to do as much as they can."
We received positive feedback about people's safety from family members. One family member told us, “[My relative] is definitely safe, they are very nice with [my relative]. I know [my relative] gets looked after and that makes me feel better. I have no worries at all about [my relative]. [My relative] seems content.”
People received their medicines safely from trained and competent staff. Medicines administration records (MARs) supported the safe administration of medicines.
Potential risks had been identified and assessed. Assessments identified the controls needed to reduce the risk and keep people safe.
Staff were appropriately recruited and sufficient to meet people’s needs in a timely manner. One family member said, “There seems plenty of staff on.” The home now had a settled staff team following the recruitment of new staff.
Staff had a good understanding of safeguarding adults and the whistle blowing procedure. They knew how to report concerns. One staff member said, “I haven’t used it [whistle blowing]. It is always in the back of my mind but never had to.”
Staff told us the environment was designed to be ‘autism friendly’ with neutral colours, heating and lighting controls and specific adaptations to meet individual people’s needs. Some family members felt the environment needed updating and was too noisy.
Incidents and accidents were recorded, including details of action taken to keep people safe. There were plans to deal with unexpected emergencies, including safe evacuation procedures for both staff and people using the service. Regular health and safety checks were undertaken to keep the building safe for people to live in.
The registered provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations were in place for all seven people. Staff had a good understanding of MCA, including how to support people with making their own decisions. Staff also understood people’s communication skills to help them make as many of their own choices and decisions as possible.
Staff were knowledgeable about how to manage behaviours that challenged. One family member told us, “Staff seem as if they know exactly what to do if people get anxious. If [my relative] gets anxious they go and talk to [my relative].” Physical restraint was used only as a last resort. One staff member said, “I have never had to use physical restraint. It would be the last resort and only if the person could hurt themselves or a member of the public.”
People’s nutritional needs were met. One family member said, “The cook is really good. He does lovely meals for them.” Another family member said, “They are watching how [my relative] eats and checking he has had snacks.” We saw people had their lunch in a quiet and calm environment.
People had access to the healthcare they required. One family member said, “They take [my relative] to the doctors and tell me when they have taken [my relative].” Care records confirmed people had regular input from a range of health professionals, such as GPs, behaviour specialists, occupational therapists and speech and language therapists.
People had detailed, personalised care and support plans which were focused around their individual needs. They included information about what was important for each person using the service and what people did not like or did not want to happen. The registered provider had assessed how autism affected each person using the service.
There were opportunities for people to take part in a range of activities. One family member commented, “They take [my relative] out a lot. [My relative] goes on holiday, they take [my relative] for walks and shopping.” Activities included outings, walks, bowling, visiting the hydro-therapy pool, trampolining, arts and crafts and one to one time with staff.
Family members told us they knew how to complain if they were unhappy with their relative’s care. One family member said, “I have been told [about the complaints procedure]. I would have a word with them.” None of the family members we spoke with raised any concerns with us about their relative’s care.
Family members told us the registered manager was approachable. One family member said, “Jason [registered manager] and [deputy manager] are lovely. As soon as I go in we have a chat.” They also said Holly House had a welcoming and friendly atmosphere. One family member said, “The kettle is on straightaway, it is very nice. It is just like visiting family.”
Family members had given positive feedback about the quality of people’s care during the most recent consultation. Management peer review checks were carried out to assess of the quality of the care people received. Recommendations following the last peer review had been implemented.