Hollywood Rest Home Limited

We found the following examples of good practice.

The registered manager and staff responded quickly when people tested positive for COVID-19. The first floor had been repurposed to support people who tested positive for COVID-19 to isolate. Designated staff were allocated to the first floor to minimise the spread of infection.

Social distancing was promoted through separate lounges and restrictions on the number of people who could access communal areas at one time. Staff were allocated to specific communal areas within the home to minimise the spread of infection.

Only essential health professionals visited the home at the time of inspection because people had tested positive for COVID-19. The temperature of all visitors was recorded, and all visitors were required to wear PPE including a mask, gloves and apron.

Relatives had access to their family members digital care records so they could see care plans and daily records. This allowed relatives to see how their family members were in real time.

Staff engaged people in activities such as singing and dancing, games that included 'play your cards right' and coffee mornings to promote people’s well-being. A blanket made of the pictures that had been sent in by family members had been arranged for one person.

Further information is in the detailed findings below.

People’s experience of using this service:

People were supported by staff that were caring, compassionate and treated with dignity and respect. Any concerns or worries were listened and responded to and used as opportunities to improve.

People received person centred care and support based on their individual needs and preferences. Staff were aware of people's life histories and individual preferences. They used this information to develop positive, meaningful relationships with people.

People told us they felt well cared for by staff who treated them with respect and dignity and encouraged them to maintain relationships and keep their independence for as long as possible.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role. People told us the atmosphere at the home was relaxed and homely.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

Where people lacked capacity, staff worked with the local authority to make sure they minimised any restrictions on people's freedom for their safety and wellbeing.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to management at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

Audits were completed by staff and the registered manager to check the quality and safety of the service.

The registered manager worked well to lead the staff team in their roles and ensure people received a good service.

More information is in Detailed Findings below.

Rating at last inspection: Good. (Report Published 03 July 2017)

Why we inspected: This was a planned comprehensive inspection based on the rating of requires improvement at the last inspection. We found improvements had been made and the service rating changed to an overall rating of good.

Enforcement:

No enforcement action was required.

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.

The care home accommodates up to 36 people in one adapted building and specialises in providing care to older people some of whom are living with dementia. At the time of our inspection 34 people were using the service.

We last inspected this service in June 2017 when we rated the service ‘Requires improvement’ overall. We identified breaches of regulations because the provider had not ensured staff were suitably deployed to respond promptly to people’s needs. The provider had not always notified the commission of incidents they were required to or taken effective action to identify and mitigate any risks to people who used the service. At this inspection, we found improvements had been made to meet all legal requirements although further action was required to ensure care records and systems to monitor the quality of the service were robust. This is the fourth consecutive time the service has been rated Requires Improvement.

The provider had strived to improve the quality of the service but further action was needed to ensure these changes were embedded in practice. Concerns from our last inspection about the lack of detail in people’s risk assessments had still not been fully addressed. Further guidance was required for staff to identify how to support people whose mental capacity may fluctuate and who could legally make decisions on their behalf. Although records were regularly audited we found some errors had not been identified. Audits had been carried out regularly however there was no formal process to ensure they would continue or enable the provider to check that audits had been carried out as planned.

There was a registered manager in place who was present during 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.

Since our last inspection the registered manager had taken action to protect people from abuse and avoidable harm. Staff knew how to recognise signs which could indicate someone was experiencing or at risk of abuse. Staff knew how to protect people from the risks associated with their specific conditions. Care plans were being reviewed to ensure they contained suitable guidance for staff about people’s care needs. There were processes in place to ensure the premises and equipment were regularly checked so they remained safe. Staff responded promptly to people's needs however there was no formal process to identify how much support people required. The provider had taken action to ensure people received their medicines appropriately and safely. There were systems in place to manage the prevention and control of infection and to review incidents and learning when things went wrong.

Staff were able to demonstrate they had sufficient skills and knowledge to support people who lived with dementia or could display behaviour which may challenge others. People received sufficient amounts of foods and drinks they enjoyed to meet their nutritional needs. We saw staff seek consent from people before providing personal care and respected their wishes. Staff demonstrated a knowledge of legislation which promoted people’s right to make decisions about how they lived their lives. There were effective processes in place to ensure staff communicated effectively between themselves and with other organisations. People were supported to live healthier lives and have access to other professionals to meet their needs. The premises were suitable to meet the needs of the people who used the service.

People told us that the staff were caring and staff spoke fondly about the people who used the service. The registered manager had taken action since our last inspection to ensure people were supported to express their views about the care they received. People were supported to be independent by staff who respected their privacy and dignity.

Staff responded promptly when people required support or asked for assistance. People were supported to follow their interests and hobbies. Details of the provider’s formal complaints policy were available in the reception. People’s concerns were responded to. There were processes in place to ensure people would receive appropriate care at the end of their lives. People who used the service and staff expressed confidence in the leadership of the care home.

At this inspection, we found that although these improvements were ongoing, progress had not always led to robust care planning and risk management to help ensure all people’s needs were always met and understood at the home. The registered provider and registered manager had not upheld all of their responsibilities to the Commission to ensure that all breaches of regulation were met.

Hollywood Rest Home Limited is registered to provide personal care and accommodation for up to 36 older people. At the time of our inspection, 30 people were living at the home.

There was a registered manager in place who was present throughout 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.

People told us that they felt safe living at the home. Staff told us that they had received safeguarding training and showed an understanding of how to report safeguarding concerns.

All people’s risks were not always managed effectively to help learn from incidents that had occurred and to promote people’s safety at all times. Health and safety checks were in place although they did not always cover all possible risks in the environment.

We could not be confident that staff were always effectively deployed to meet all people’s needs and wishes. The registered provider told us that recruitment processes were followed and overseen by an external service to help ensure that people were supported by staff who were suitable.

We identified some areas of positive practice in respect of how people’s medicines were managed. Audits had not always identified possible areas of improvements to ensure that people would always receive their medicines as prescribed.

People spoke positively about the support they received. Staff told us that they felt supported in their roles. Whilst we observed some areas of positive practice, we observed that staff did not always demonstrate a consistent understanding of all people’s needs. Care planning had not always provided clear guidance to help inform staff of people’s needs and how these should be met.

We observed that people’s consent was sought before they received support from staff and their decisions often respected. We found that processes were not always clear however to ensure that all people’s and rights would always be met in line with the requirements of the Mental Capacity Act (2005).

People had been involved in menu planning at the home to help meet their needs and preferences and we saw that people were given meal options. We observed that further improvement was required however to ensure that all people could enjoy mealtimes at the home. People were supported to access healthcare support when needed.

We observed some positive, caring interactions and relationships between people living at the home and staff. We found however that this was not always the consistent experience for all people living at the home. Shortly following the inspection, the registered manager told us that they were recommencing the keyworker system which would give all people and staff opportunity to spend time together and explore people’s care needs and wishes. Visiting relatives were welcomed at the home and we saw that they had a positive rapport with staff.

People often spoke positively about their care and support they received. Care planning processes however had not always ensured that all people would always receive care and support in line with their needs. We saw that people’s access to activities had improved although ongoing planned improvements would help ensure that this was a consistently positive experience for all people living at the home.

There was a complaints process in place and guidance about how to use this was on display at the home. Relatives told us that they would feel comfortable raising issues with the management. Some people had raised concerns which had been addressed although the home had received no formal complaints.

People and relatives had welcomed improvements they had experienced at the home and spoke positively about the registered manager. Planned improvements were ongoing and we saw that systems were being developed to help capture people’s experience of the home. Although we welcomed these findings and some ongoing improvements at the home, at the time of our inspection, audits and records were not always robust. We found that care planning and risk management processes had not always been effective to ensure that people’s needs could always be met. The registered provider and registered manager did not always uphold all of their responsibilities to the Commission.

You can see what action we told the provider to take at the back of the full version of the report.

We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hollywood Rest Home Limited on our website at www.cqc.org.uk.

This inspection took place on 19 December 2016 and was unannounced. During our last inspection, we identified a breach of three legal requirements. This was because systems in place were not effective to monitor and improve the quality and safety of the service that people received. People had not always been supported in line with the principles of the Mental Capacity Act (2005). We also found during our last inspection that people were not always supported in line with their individual care and support needs, including participation in activities of interest to them. During this inspection, we found that steps had been taken to improve these areas and the registered provider had met these regulations.

Hollywood Rest Home Limited is registered to provide personal care and accommodation for up to 36 older people. At the time of our inspection, 27 people were living at the home.

There was not a registered manager for the service. The registered manager had left the service in October 2016. A new manager had joined the service in November 2016 and was supported by a deputy manager who had also recently joined the home. The deputy manager had a lead role in monitoring and reviewing people’s care needs and providing support and guidance to staff. The registered provider, manager and deputy manager were present throughout our inspection.

The manager was in the process of completing their application to register. 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 were supported by staff who had a good understanding of their needs and preferences. We observed positive interactions between staff and people living at the home. Where some staff training was not up-to-date, this had been identified and was being addressed and further staff training plans were underway.

People were mostly supported in line with the Mental Capacity Act, the manager had recognised ways to improve practice to ensure that people were always supported in line with these principles.

People told us that that they did not always enjoy their meals at the home and they were not always offered choices that met their preferences. The manager told us that they were reviewing people’s experience of meals at the home and considering how to improve this. People told us that they were supported to access healthcare support as required. The deputy manager was responsible for maintaining oversight of people’s health and support needs and was taking action to ensure that people’s needs were always met.

People we spoke with told us that they were happy with their care. People received care that was responsive to their needs. People were involved in care planning and encouraged to engage in activities of interest to them.

People and relatives were comfortable raising concerns and confident that these would be addressed. Significant improvements had been made to people’s experience of the home since the new manager and deputy manager had joined. All feedback we received was positive and described an open, person-centred culture. Staff told us they felt supported in their roles and processes had been introduced to aid their development.

The registered provider, manager and deputy manager expressed a commitment to continuing to drive improvement at the home. They showed that they recognised areas that required improvement and had plans in place to address these. Records and systems in place were not always robust and did not always reflect the improved quality of care that people received. The registered provider and manager understood their responsibilities to the commission and assured us that they would address where these requirements had not been met.

Hollywood Rest Home is a care home that can accommodate up to 36 people. People living at the service had needs relating to their older age and some people were also living with dementia. At the time of our inspection there were 36 people living at the home.

There was not a registered manager at the service at the time of our inspection. The manager at the service had submitted their application for registration at the service. 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 last inspected the service on 23 October 2014 and found that the service required improvement and was in breach of regulations relating to gaining people’s consent to care and treatment. At this inspection we identified that whilst improvements had been made, some aspects of this regulation had not been met. Staff understanding of supporting people with limited capacity was in need of further development to meet this requirement.

People told us that they felt safe living at the service. However, people using the service told us that there were not enough staff to support people and this compromised people’s dignity and safety. We found that systems were not in place to investigate or reduce the risk of incidents and we saw that staff did not consistently follow risk assessments. We found that while steps were taken to maintain people’s health, incidents and risk assessments were not robustly recorded and learned from.

At our last inspection, we found that staff had little understanding of supporting people who lacked capacity in line with expected code of practice. We found that staff still had limited knowledge of this area and that the provider had not taken the necessary action to ensure that where decisions were being made, that these were as least restrictive as possible.

We found that people enjoyed the food at the service and that they received their medication safely. Some staff told us that they had received lots of training and helpful supervision, however we found that staff had not received training to equip them to meet the needs of people using the service. The medication training provided a good example of effective training being applied well in practice but staff had not been equipped with the skills required to support people living with dementia.

We saw that staff did not always interact with people outside of times that they provided care. While we saw some very caring interactions between staff and people using the service, this was not consistent practice within the staff group.

People and their relatives told us that they were not stimulated and we saw that people were not encouraged to pursue their interests at the home. People who were less independent and able to engage in their own activities had less opportunity to participate in activities which they enjoyed. People and relatives told us that they were not involved in the planning of people’s care, however the service supported people to have good access to health services as required. The manager had taken steps to introduce a complaints process and additional ways for relatives to share their feedback, and relatives had welcomed this improvement.

We found that while the manager had taken steps to introduce ways to receive feedback and monitor the quality of the service, this was not always effective. Some relatives and a professional told us that the manager was not always approachable. We found that systems were not in place to monitor and improve the quality of the service in order to keep people safe or to drive improvements to the quality of care provided. We also identified that the provider was operating outside of the conditions of their registration.

You can see what action we told the provider to take at the back of the full version of the report.

The home had a choice of suitable and nutritious food but procedures were not always being followed when fresh meat products were being frozen.

The home ensured that people were protected against the risks of unsafe or unsuitable premises.

There were systems in place to make sure that any risks to people's safety and welfare could be identified and improvements could be made. People's views were being sought and where concerns had been raised action had been taken to make improvements.