Holly Tree Lodge Residential Home Derby

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider ensured that people were at the centre of their care and choices. Partnership working with people and their relatives was not always effective in ensuring care needs were reviewed regularly and documented, which did not consistently support staff to respond to people’s changing needs.

Staff demonstrated a good understanding of the people they supported and a clear commitment to providing person-centred care. However, as described in this report, care plans were not consistently updated and risk assessments were not always in place. This meant some care records contained inaccurate or misleading information about people’s healthcare needs.

Relatives spoke positively about the consistent approach to care and the support their family member received. They told us their family member felt safe. People we spoke with told us that the staff treated their family member with dignity and respect.

A staff member said, “I have worked in lots of homes, the care here is very person-centred.”

People received support that was coordinated and delivered in a consistent way. Staff shared information verbally throughout the shift, which helped maintained some continuity even when written documents had not been updated. People told us the home ran smoothly and relatives said they were kept informed when concerns arose or when health advice was needed.

Staff worked well with external professionals and sought guidance when people’s needs changed. Relatives gave examples of staff contacting the GP or community teams promptly, which helped ensure the right support was put in place without delay. Staff were familiar with the advice provided and used this to adjust how they supported people.

A stable staff team meant people were supported by staff who knew them well and understood their usual routines and preferences. This familiarity helped staff recognise changes early and respond in a coordinated way.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Communication plans lacked detail and did not always describe people preferred information to be shared. For example, they did not include guidance for staff on taking time to explain information, breaking information down into smaller steps or checking understanding during conversations. However, we saw staff communicating with people in ways which met their individual needs.

The provider was aware of the Accessible Information Standards (AIS) and told us people could be provided with information in large print or easy read formats when required. However, information was not readily available in a suitable range of formats to meet people’s needs.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Review meetings were not always recorded to reflect people’s views and choices about the support they received. However, relatives told us they had regular conversations with the registered manager and staff. The provider assured us record keeping would be improved.

The provider had a complaints procedure in place, but this was out of date. However, we saw evidence that when concerns were raised, the registered manager took appropriate action.

One relative told us, “I would be happy to make a complaint, but I don’t want to risk [my relative] being moved.” However, these views were not reflected by other relatives we spoke with, but we reviewed these concerns as part of our assessment. Other relatives told us they were confident to speak with the leaders if they had any concerns. Comments included, ““If I was concerned, I would talk to the staff, I have the deputy manager’s phone number.”

The service made sure that people could access the care, support and treatment they needed when they needed it.

People were able to access the support available within the home and staff made adjustments, so no one was disadvantaged. Where people needed specialist equipment, the provider made appropriate referrals to obtain this. People were supported to understand choices available to them, including at mealtimes and in relation to activities. Although the layout of the home was not always accessible, staff understood how people preferred to move around the home and provided support with mobility when needed so people could reach communal areas and take part in activities. The home was not purpose built but adapted from a domestic dwelling. This meant opportunities for people with dementia who needed to walk and explore internally were more limited. However, the provider was refurbishing and was planning to make the home more accessible for people.

Overall, the premises were accessible. A lift was available to support people with mobility challenges to access upper floors and mobility aids were available in the bathrooms.

People had access to external health professionals on a routine and unplanned basis in response to their individual needs. This included primary care and hospital outpatient appointments.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored care accordingly. The provider and staff had completed equality and diversity training to support inclusive practice.

During the assessment, people’s experiences of the service were consistent. There was no evidence to suggest that anyone was treated less favourably, or that outcomes differed as a result of personal characteristics, background or support needs.

Relatives told us they were confident their family member was well supported, and staff demonstrated an inclusive, person-centred approach in their day-to-day practice.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

There was no evidence that people had been offered the chance to discuss end of life wishes ahead of time. Records did not always show what was important to people, their priorities or how they wish to be supported as their needs changed.

People were supported to discuss future care when specific decisions were needed, and staff sought advice from health professionals when needs changed. Staff explained they would talk with people around their wishes if their health deteriorated and involved others when appropriate. This helped ensure decisions made reflected what people wanted. However, this was not always reflected in their care plans.

Anticipatory medicines were prescribed for people should their health deteriorate suddenly. This meant people could access appropriate pain relief and comfort at the end of their life. Staff had received end of life care training.

The registered manager told us, “We always respect people’s beliefs and wishes, especially at end of life. For some residents, that’s included things like spiritual support or alternative therapies, and we’ve made sure those wishes are honoured so people feel comfortable and respected.” At the time of our assessment, no one was receiving end of life care.