Archived: Hollow Oak Nursing Home Limited

Hollow Oak Nursing Home (Hollow Oak) is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Hollow Oak provides nursing care for up to 27 older people and is an established family run business. The home is in a period house that has been adapted and extended for its present use, including two conservatories and a modern extension. The bedrooms in the home vary in size and layout, are individually decorated and retain many original features. There is car parking available and well kept lawns and gardens to the side and rear with outdoor seating for the people living there. At the time of the inspection there were 22 people living there.

There was a registered manager at the home. 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.

At this inspection we found the service remained good overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. At this inspection we also found the service was continuing to improve and demonstrated some characteristics of 'outstanding' and that they were continuing to develop the service for the future. The service was particularly skilled at caring for and supporting people and their families at the end of life and responding quickly to people's changing needs.

People told us they were happy and felt safe at the home. People told us that the staff were “so very, very good” and “kind” and they supported them when they needed it. People who lived there told us, “The staff are marvellous and speak to me and my family with genuine feeling and that “Nothing is too much trouble, they always have time to listen.” Relatives told us their loved ones’ care had been “exceptional” and “outstanding" and that staff responded "quickly and compassionately" to people’s needs. We saw staff showed real concern and compassion for people's wellbeing and responded quickly when people required their help. Professionals who visited the service spoke very highly of the service provision and said that it was "very responsive" and "person centred" in the care provided.

People told us they were happy with the variety and choice of the home cooked meals being provided and that there was always a choice at meals. We observed regular snacks and drinks were provided between meals to help make sure people received adequate nutrition and hydration.

The service had an effective safeguarding policy and staff had undertaken safeguarding training and could explain the process. Staffing levels were consistent and flexible to meet changing needs and staff recruitment procedures were robust. The staff team worked well together and had the skills, knowledge and experience required to support people with their care and social needs. Registered nurses were available to support people's day to day nursing needs.

Medicines management systems were safe and staff had undertaken appropriate training in medicines administration. Staff were being appropriately trained for their roles and well supported by the registered manager. Systems were in place to give staff the opportunity to discuss their work and have appraisals.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they worked within the law to support people who might lack capacity to make some of their own decisions. People living in the home were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and the policies and systems in the service support this practice.

Risk assessments had been developed to identify and minimise the potential risk of harm to people during the delivery of their care. These and detailed individual assessments and care plans had been developed and were kept under review and updated when necessary to reflect people's changing needs and to make sure their care preferences had not altered. Hollow Oak supported people with life limiting illnesses and as they approached the end of life. Staff were knowledgeable about this important area of care and had received end of life care training on supporting people and their families.

The registered provider continued to improve the environment for the people who lived there. The building was being well maintained and was a clean and homely place for people to live. We saw that equipment in use was regularly cleaned and had been serviced and maintained as required.

Systems were in place to deal with any complaints or concerns raised about the service. The registered manager treated complaints as an opportunity to learn and improve the service.

People had access to a range of organised and informal activities. Relatives told us that they were welcomed in the home and their views and feedback were encouraged. Quality assurance surveys and regular meetings were used to seek the views of people who used the service and there were a number of audits being carried out to monitor systems and to focus on continually improving the service for the people who lived at Hollow Oak. The registered provider was in the home daily to oversee this.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based upon our observations, discussions with people who used the service, their relatives and the staff who supported them and from looking at the records held in the home. We also observed the interactions between people living there and the staff supporting and caring for them.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The people we spoke with who lived at Hollow Oak told us that they felt safe living there and that staff listened to what they had to say.

We saw that risk assessments had been carried out to help make sure that people who lived there received safe and appropriate care and treatment. This included the important areas of nutrition, personal care, skin care and wound management, mobility and moving and handling and the risk of falls.

We saw that the premises and grounds were being well maintained and were accessible to the people living there. Appropriate measures were in place to ensure the security of the premises to keep people safe. The service had systems in place to manage and monitor the prevention and control of infection and a clean environment.

The home had a range of equipment to support the people who lived there. We saw that all the equipment was serviced and checked regularly to ensure it was safe for people to use.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes and we saw that appropriate policies and procedures were in place. The home had appropriate policies and procedures in regard to The Mental Capacity Act 2005. The manager of the home was knowledgeable about the Mental Capacity Act 2005 and the Mental Capacity Act Codes of Practice. This meant people could be confident that their rights would be protected.

Is the service effective?

We saw that the staff in the home treated people with respect. People were supported to carry out as much of their care as they could themselves, with the care staff assisting them to do the things they couldn't manage on their own. This supported people to maintain their independence and control over their lives.

We found that people's health and care needs had been assessed with them and they were involved in deciding the care and treatment they wanted, including at the end of life. We saw records that showed staff had undertaken accredited end of life training to give them the skills and knowledge to look after people properly at that time. Where people had been identified as at higher risk due to complex needs, appropriate specialist services had been contacted for advice and support.

Is the service caring?

Everyone we spoke with made positive comments about the staff employed at this home. We were told they were, 'Very kind' and 'A lovely bunch'. We observed that people living at Hollow Oak were comfortable and confident with the staff on duty.

Where people needed additional time to be able to express their views and wishes we saw staff gave them the time they needed to do this. The staff in the home took the time to talk with people as they went about their duties. We saw many positive interactions between the staff on duty and people who used this service. These positive interactions supported individuals' wellbeing.

Is the service responsive?

We saw that people living there were involved in the way the home was being run. They were able to take part in activities they wanted to inside and outside the home and to decide for themselves how they spent their time.

The care plans and information we looked at about the people using the service was written in a holistic and positive way. We saw from the sample of care plans we looked at that the plans of care, treatments and support were subject to evaluation, review and alteration in response to changes in people's needs and preferences.

We could see that the manager and staff monitored people's conditions and made timely referrals to others to access the care people needed. The manager took responsibility for making sure care had been well coordinated between different services involved in people's care and support.

Is the service well led?

When we visited the home we found there was an effective and verifiable system being used to assess and monitor the quality of the services and records about the care and support people living at the home received. Formal systems were in place to audit the quality of the service provided. We saw that the findings of these audits and the analysis of trends and incidents in the home was used to learn from, inform practices and continually improve the service. This helped to ensure that people received a consistently good standard of care at all times.

We saw that information about the safety and quality of the service was being gathered from different and relevant sources and that this was being recorded and stored securely. People we spoke with told us they were asked their views on the way the home was run at the home's 'resident and relatives' meetings and that their suggestions were welcomed by the manager and provider. We saw that where people had made suggestions about such things as meals and activities inside and outside the home they had been acted upon.

Staff working there told us they felt well supported by the manager of the home and the provider and said their views and ideas about the service were listened to. Staff we spoke with told us it was a good place to work and they were clear about their roles and responsibilities. Staff we spoke with had a good understanding of safeguarding procedures and whistle blowing to report on poor practice. Staff we spoke with said they were confident the manager and provider would support them if they needed to raise concerns.

People living there said that they had not needed to complain about care and told us they had confidence in the manager to support and help them. One person said "I don't have to worry about anything now, I am safe and I have good company so I am a lady of leisure." More than one person told us that they felt they had made the right decision to live there.

From our observations and conversations with people living there we found they received the support they needed and were given choices about their care and their social activities. We observed that staff encouraged people to maintain their independence and control over their lives. All the people we spoke with gave positive feedback about how their privacy and dignity were promoted and how staff asked them what they wanted. We saw that people were comfortable and confident with the staff on duty.