Archived: Hollywell Court Residential Home

Hollywell Court Residential Home is a residential care home, providing personal care for up to 12 people aged 65 and over. At the time of the inspection 8 people were using the service. Accommodation is provided over the ground and first floors with some rooms having access to en-suite facilities.

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

There were informal systems in place to monitor the quality and standards of the service, however these had not always been effective at identifying areas for improvement

Formal staff supervision and appraisals were no longer taking place and the registered manager confirmed they no longer held staff team meetings, residents and/or relatives meetings. In addition, they told us they were no longer sending out satisfaction questionnaires to people and their relatives to gain their views about the service.

People received safe care and support and they told us they felt safe living at Hollywell Court. Staff understood safeguarding procedures and were confident in reporting any concerns. Risks to people's safety were assessed and well managed, and people’s care plans detailed current risks and individual needs.

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.

There were sufficient numbers of staff who were safely recruited to meet people's needs. Staff received training in relation to the safe administration of medicines and their competencies were checked to ensure safe practice. Infection control measures were robustly followed, and staff had access to sufficient PPE.

An activities programme was in place, and care plans were personalised to each individual detailing their likes, dislikes and personal preferences. People and their family were involved in the care planning process as much as was possible.

A complaints system was in place and was used effectively. There had been no complaints in the last 12 months.

There was no one receiving end of life care at the tie of our inspection. However, there were systems in place to care for people at the end of their life with support from other health professionals.

Staff felt well supported and said that communication was effective. One staff member commented, “We are small and like a family. We have regular communication every day and we always know what's going on.”

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 07 November 2019)

Why we inspected

We received concerns in relation to the management of people’s end of life care needs. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holywell House Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿The service was small, but setup and prepared to manage any COVID 19 outbreak should it occur, although nobody using the service had been diagnosed with COVID 19 throughout the pandemic. Systems were in place to ensure people could be isolated if required, with staffing arrangements ensuring the potential of any infection spreading would be low. Regular cleaning took place from dedicated staff.

¿Arrangements were in place to isolate any new people moving in to the service. There was a person new to the service, and staff found isolation arrangements were difficult to manage due to the person’s understanding and potential behaviours which may challenge. The registered manager was seeking further support from the local authority, and this was being dealt with in as safe a way as possible.

¿Staff had access to sufficient supplies of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser. The registered manager had been pro active in ensuring stock levels remained good for the staff.

¿Staff followed guidelines with the donning and doffing of PPE, and had an area within the service where this could be done safely.

¿Processes in place for any visitors were clear, and included questions around COVID 19, a temperature check, and appropriate PPE. Family members were able to visit using a side entrance, directly in to a dedicated room for visiting. Time slots were booked by visitors, and protective screens were in place during the visit, followed by thorough cleaning.

¿Staff followed clear procedures to ensure good practice with infection prevention and control. They received additional training and support. This reduced the risk of cross contamination.

¿People and staff received regular COVID19 tests, to ensure action could be taken promptly if required.

¿Regular checks and audits around infection control were completed to ensure the registered manager had oversight on the service, and could address any issues promptly if found.

Further information is in the detailed findings below.

Hollywell Court is a residential care home, providing personal care for up to 12 people aged 65 and over. At the time of the inspection 6 people were using the service. Accommodation is provided over the ground and first floors with some rooms having access to ensuite facilities.

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

All the people and relatives we spoke with praised the home. People felt safe and well cared for. People's preferences were respected, and staff were sensitive and attentive to people's needs. Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well.

There were sufficient numbers of staff employed to ensure people's needs were met. We saw staff had time to sit and engage people in conversation.

Recruitment practices were safe and staff received the training they required for their role.

Risks to people's health, safety and well-being were assessed and care plans were in place to ensure risks were mitigated as much as possible.

Staff were aware of their responsibilities to safeguard people and the home had robust procedures in place.

People's care plans contained information detailing how people wanted their care to be delivered. However, they could have contained more person-centred information such as people’s life history.

Staff were keen to ensure people's rights were respected.

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.

People received their medicines safely and as prescribed. Medicine management practices were safe

The service was provided in a homely and clean environment.

Consideration was given to providing a variety of leisure and social activities for people to enjoy.

Quality assurance systems were in place to assess, monitor and improve the quality and safety of the service provided.

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 (report published 21st January 2017)

Follow up

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

Hollywell Court Residential Home is registered to provide residential care and support for up to twelve older people. At the time of our inspection there were eleven people using the service. The service is located within a residential area and provides accommodation over two floors.

Hollywell Court Residential 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.

People’s safety and well-being was promoted through the management of risk. This was achieved through the sharing of information and through the promoting of people’s choices and independence in their day to day lives. Where necessary equipment was used to enable people to move around the home safely. People’s safety was further supported through the robust procedures in the recruitment of staff and by their being sufficient staff to provide the support people required.

People’s medicine was managed safely and people were involved in decisions as to whether they wished to take their medicine. Audits were undertaken on a range of topics, which included medicines and maintenance of the environment to ensure people’s safety was promoted and maintained.

People told us that staff had had a positive impact on their lives due to the care and support they received. Staff told us that they undertook training which enabled them to provide good quality care. Staff received continued support by working alongside the registered manager and through supervision, which provided opportunities for staff to discuss their professional development.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were committed in their approach to supporting people to make informed decisions about their care. People’s capacity to make informed decisions was considered with regards to all aspects of their day to day lives.

People were encouraged to make decisions about their day to day lives. People’s care plans provided information for staff as to what the support people required, so that people’s independence was recognised and not undermined by staff.

People’s health and welfare was promoted through a range of assessments and the development of care plans which were regularly reviewed. People with the support of staff accessed the services of a range of health care professionals who monitored and promoted their health. People’s nutritional needs were assessed and met and were regularly reviewed. People spoke positively about the homemade meals and how they were regularly offered and encouraged to eat and drink well.

People spoke positively about the attitude and approach of staff towards them, stating staff were friendly and helpful and provided care and support when they needed it. We found people were consulted about their care and their views and needs were recorded within a care plan which was regularly reviewed.

People considered Hollywell Court to be their home and took pride in the environment in which they lived, its friendliness and homely atmosphere. People were relaxed within the home and spent their time as they chose, watching television, listening to music and reading.

The provider had quality assurance systems, which included a range of audits that were carried out by the registered manager, which meant the provider could assure themselves people received a high quality service. People’s views about the service were sought and used to provide information to people who used the service and their relatives.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People told us they felt safe. A relative we spoke with also said they thought their relative was safe in the service.

An unlocked bathroom had been used as a storage area which could have caused trips and falls. This meant that people had not been fully protected from the risk of accidents. Fire systems had not been fully followed. There was therefore a greater chance of risks to peoples' safety.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing a homely and safe environment.

Is the service effective?

People or their families had been involved in writing their care plans. People's needs had been included within care plans and care staff told us that they had read and followed care plans. Information the home had was able to support staff consistently to meet people's needs.

People's mobility and other needs were taken into account in relation to building adaptation, enabling people to move around freely.

A relative we spoke with confirmed that they were able to see their relative in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'staff are always there to help you. They do it in a nice way.' A relative told us; 'staff are excellent. I could not fault them. You feel part of the family here.'

Is the service responsive?

Records showed that people's preferences, interests and needs had been included in care plans. This meant that the service was informed about people's needs.

A relative told us that the manager was very proactive in making sure people's needs had been met.

Is the service well-led?

Staff said that if they witnessed poor practice they would report their concerns. They knew which agencies to contact to protect people from abuse.

There was evidence that the service worked in partnership with key organisations, including specialist medical personnel to support care provision and service development.

People were asked for their consent before they received care. The service had excellent support from a local geriatrician, Dr Wong, to record people's decisions about their end of life care.

People told us they were supported to take the right medicines when they needed them. We found the provider did not have appropriate arrangements to protect people from risks associated with medicines. This was because care workers did not follow the provider's procedures for administering and recording medicines. Arrangements for disposing of medicines were not appropriate.

Staff were well trained and skilled. People told us: 'I can't fault them.' When we asked for their views about staff, they told us: 'Wonderful.' and 'We have a laugh.'

Although people were not formally asked for their views, people using the service and visitors were confident their views were taken into account. The manager was continuously making changes to improve the service.

We spoke with three people using the service about abuse. They all told us they felt safe using the service. They were all confident that staff and the manager would take appropriate action if they reported concerns to them. We found that staff had training in safeguarding people from abuse and had a basic understanding of the risk of abuse. Care workers did not know enough about how to report concerns about possible abuse.

We found the provider had put secure storage arrangements in place for care records. These were not being used effectively to ensure confidential personal information was secure. The manager agreed to take immediate action to address this.