Holly House Residential Home

Holly House Residential Home is a care home providing accommodation and personal care to up to 28 older people and people living with dementia. At the time of inspection there were 27 people living at the service.

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

People continued to be cared for safely and with compassion. Staff were appropriately recruited and there were enough staff to provide care and support to meet people’s needs.

Effective systems were in place to identify and manage risks to people. These included individual risks such as falls and pressure ulcers and environmental risks.

People were supported by sufficient numbers of staff who knew them well and understood how to meet their needs.

Medicines systems were well organised, there was effective oversight of medicines in place and people received their medicines as prescribed.

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 were protected from infection and the home was well maintained and clean.

The service had a positive ethos and an open culture. The management team were approachable, understood the needs of people, and listened to staff. People that used the service and their relatives had the opportunity to feedback on the quality of the support and care that was provided. There were effective systems in place to monitor the quality of the service and drive improvements.

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 15 November 2022).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of people’s skin and pressure ulcers and meeting people’s health needs. We undertook a focused inspection to examine those risks and reviewed the key questions of safe and well-led only.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has remained good based on the findings of this inspection.

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

Holly House Residential Home is a residential care home providing personal and nursing care to up to 28 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 22 people using the service.

Holly House Residential Home has accommodation on two floors in one adapted building. There are several communal areas for people to spend time in.

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

Some improvements were needed to ensure a wholly positive mealtime experience for people living with dementia or those who dined in their rooms. Assessments took place before people moved into the service and this process could be strengthened, along with daily recording of people's care and wellbeing.

Since the last inspection improvements were made to people's safe care. People were cared for safely. Health and safety checks were regularly carried out. Risk assessments were in place and reviewed regularly and as people’s needs changed. People received their medicines safely, in the way they preferred and from trained staff. Safe recruitment practices were followed to ensure staff were suitable for their roles.

Improvements had been made to staffing levels. There were consistently enough staff to meet people’s care needs. Domestic staffing hours had increased to ensure cleaning took place every day including weekends. This supported improved infection prevention and control practices.

We found improvements in documentation aided by an electronic care planning system. People’s care records contained clear information covering all aspects of their care and support needs. Staff knew people well and had a good understanding of people’s wishes and individual preferences. People’s personal histories, preferences and dislikes, diversity needs such as cultural or religious needs and links with family were all considered within the care plans. Staff received comprehensive training to meet people’s needs. People were supported to access health and social care services when needed.

People received support from staff who were kind and caring. Staff enjoyed working at the service and there was good communication and teamwork. Staff had positive relationships with people and their relatives. People were treated with respect. Staff maintained people’s dignity and promoted their independence.

Since the last inspection the provider had made improvements to embed personalised care which was responsive to people's needs. People were supported to do things they enjoyed and were important to them. People and their relatives knew how to make a complaint and felt they could raise any issues with the provider.

Significant improvements had been made to managerial oversight and quality assurance processes of all key aspects of the service. A range of audits took place and were clearly recorded and tracked. The provider used an improvement plan and regular engagement with an external consultant to drive continuous improvements of the service for the benefit of people living there.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 December 2021) and there were breaches of regulation. We took enforcement action and issued Warning Notices due to concerns about people receiving safe care and treatment (Regulation 12), staffing levels (Regulation 18) and management oversight (Regulation 17) of the service. We also requested an action plan after the last inspection due to a breach of Regulation 9 and concerns people did not always received person-centred care.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this unannounced inspection to check whether the Warning Notices we previously served in relation to Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked whether the Requirement Notice in relation to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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.

Follow up

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

Holly House Residential Home is a care home providing personal care and accommodation for up to 22 older people. At the time of the inspection the service was supporting 20 people in one building.

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

Risks to people had not consistently been assessed or mitigated. Care plans did not always contain the correct information within them. Staff had not consistantly recorded tasks completed to evidence people’s needs were being met.

Medicine management required improvement. Records did not evidence medicines were always given as prescribed and staff had not consistently recorded the required information when administering an ‘as required’ medicine.

People were at risk of infection. Infection prevention control measures were not all in place or effective. However, the home appeared clean during the inspection and staff and people took part in regular COVID-19 testing.

The environment was not always safe. Windows did not all have restrictors on them, hazardous substances were left accessible and fire exits were not always clear of obstruction.

Staffing levels were not always sufficient. People and staff told us at times staffing levels were too low to meet people’s needs. People told us they had to wait for care tasks to be completed or call bells to be answered.

People's nutrition and hydration needs were not correctly documented. We could not be assured these needs were being met.

Choices were not always given to people and feedback had not been requested from people living at Holly House Residential Home. Dignity and respect were not consistently promoted, and people did not always receive person centred care.

Systems and processes to ensure oversight of the service were not effective. Audits completed did not identify the concerns we found on inspection. Information was conflicting.

Staff were recruited safety and understood safeguarding and the providers policies and procedures.Staff had the required training to understand and meet people’s needs.

Peoples communication needs were documented, and the provider could format people’s care plans into an accessible format if required

People were not 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 did not support this practice.

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 17 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about coercive control from the management. A decision was made for us to inspect and examine those risks.

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 see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement.

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 risk assessments, medicines, infection control, staffing, oversight and person-centred care and 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 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.

We found the following examples of good practice.

There was a clear process for visitors to follow which included COVID-19 testing, temperature checks, a risk assessment and the wearing of personal protective equipment (PPE).

Staff had received training in the use of PPE. We saw this was accessible throughout the home and staff used it in accordance with the most up to date guidance.

Additional cleaning schedules had been put in place to ensure high touch surfaces were cleaned regularly with additional cleaning at night to maintain good hygiene standards.

There was a clear procedure in place, in line with national guidance, to ensure people were admitted to the service safely.

People living in the service and staff were being tested for COVID-19 in line with national guidance. Additional measures were in place such as regular temperature checks and other symptom checking to identify if people required further testing.

Staff were supported to isolate and shield where necessary. The provider had put in additional measures to keep staff safe such as providing transport for those who used public services to get to work.

The infection control policy was up to date and audits were in place to monitor cleanliness, handwashing and PPE use.

Further information is in the detailed findings below.

People’s experience of using this service:

¿ People experienced good care however statutory notifications were not always submitted in a timely way.

¿ People and their relatives told us they felt safe at the home.

¿ Potential risks to people’s health and welfare were assessed, effectively monitored.

¿ Safe staff recruitment practices were followed.

¿ Staffing arrangements were sufficient to meet the needs of people at the home.

¿ Medicines were safely managed.

¿ Staff received appropriate training and supervision to perform their roles.

¿ Mental capacity assessments were completed, and any best interests’ decisions were made with the involvement of people’s representatives and relevant health care professionals.

¿ A variety of nutritious meals were provided, and people were supported to eat, and drink sufficient amounts. People and their relatives told us that the food was excellent.

¿ People’s care was personalised to meet their individual needs. Their diversity, cultural and religious needs were promoted and respected.

¿ People’s privacy and dignity was maintained.

¿ Positive caring relationships had been developed between people and the staff team.

¿ People and their relatives were involved in all aspects of care planning where appropriate.

¿ People had opportunities to take part in activities that were of interest to them.

¿ The provider operated an open and transparent culture.

¿ People, relatives and staff were encouraged to ‘speak up’ if they had any concerns.

¿ Systems were in place for people to raise any concerns or complaints.

¿ Systems were in place for people, their relatives and staff to provide feedback and influence service development.

¿ Robust quality monitoring systems and processes were followed. Action was taken where any areas for improvement were identified and lessons learnt from incidents was shared with the staff.

¿ The provider, registered manager and staff team worked well with professionals and external organisations and they effectively used good practice guidance to enhance people’s quality of life.

¿ The service met the characteristics for a rating of "good" in four of the five key questions we inspected and a rating of "requires improvement" in one. Therefore our overall rating for the service after this inspection was "good".

Rating at last inspection: Good (published 18 August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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

The service is registered to provide care for up to 22 people. The service provides care to older people with a variety of needs including the care of people living with dementia. At the time of our inspection there were 21 people living there.

There was a registered manager in post at the time of our inspection. 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 saw that people were well cared for and the home had a relaxed atmosphere. People received care from staff that respected their individuality and were kind and compassionate.

There were appropriate recruitment processes in place which protected people from receiving care from people who were not suitable. People felt safe and secure in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

Staff were supported through regular supervisions and undertook training which focussed on helping them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments if people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People’s needs were assessed prior to coming to the home and individual care plans were in place and were kept under review. Staff had taken time to understand peoples likes, dislikes and preferences. There was a need to improve on the information about people’s life history and past hobbies and interests to enable the staff to develop individualised activities with people, which would enhance people’s daily experiences.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and engaged in conversations with them. Relatives commented positively about the care their relative was receiving and it was evident that people could approach management and staff to discuss any issues or concerns they had.

There were a variety of audits in place and action was taken to address any shortfalls. Management were visible and open to feedback, actively looking at ways to improve and develop the service.

We spoke with one person in the privacy of their room who said they received "very good care" from staff who were always kind. Some other people we spoke with said they were happy at 'Holly House' and they all confirmed they felt safe and "looked after".

We found that people's privacy, dignity and independence was respected and that as much as possible people were involved and encouraged by staff to make decisions about their care.

We found that people's needs had been assessed and were regularly reviewed. We saw there were care plans were in place to guide staff so they could meet people's needs.

We found 'Holly House' to be clean, comfortable, and free from odour.

Relatives told us they were always made welcome by staff when visiting their loved ones. One relative said, "When I visit the staff always offer me a cup of tea and a biscuit. Staff want friends and relatives to visit so people keep their links with the community and their families. I think that is very healthy and it certainly reassures me. I am able to see how people are being treated and I am very satisfied."