Hollymount Residential and Dementia Care Centre

Hollymount Residential and Dementia Care Centre is a residential care home providing personal care to up to 38 people. The service provided support to older people, people living with dementia, people requiring support with their mental health and/ or physical health needs. The service consists of a two-storey building with an extended annex to the rear of the property. At the time of our inspection there were 34 people using the service.

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

We found medicines were not managed safely across the home though some actions were taken following the inspection to improve. Care staff expressed mixed views around staffing levels. We have made a recommendation about the use of staffing tools.

People felt safe in the service. Systems were in place to safeguard people. Environmental checks were being completed. The environment was in need of some repair and work was ongoing to renovate. Infection prevention and control measures were in place although not always robust. Immediate action to address this was undertaken by the provider.

Preadmission assessments were completed, and care plans were reviewed. Staff received training and regular supervisions. People’s diet and nutritional needs were met, and they told us they enjoyed the meals. The provider worked in partnership with other agencies to maintain people’s health and wellbeing.

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’s religious and cultural needs were considered. People were treated with dignity and respect and had choices over their care. People were involved in meetings at the service and both people and relatives felt the staff were caring.

People were supported to have person centred care. End of life care was considered and planned for. Activities were offered at the service and processes and systems were in place to respond to complaints.

Systems and processes are not always effective to oversee and manage the service. We have made a recommendation about the provider’s audit systems. Mixed views were given by staff around the approachability of management. Duty of candour was understood by the registered manager and partnership working was seen. Views around the service was being sought from people, relatives and staff.

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 31 March 2022) and looked at the safe, effective and well led domains only. The last comprehensive inspection that looked at all five domains was 15 April 2020.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 changed from good to requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hollymount Residential and Dementia Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe management of medicines at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hollymount Residential and Dementia Care Centre is a residential care home and at the time of the inspection was providing personal and nursing care to 31 people aged 60 and over. The service can support up to 38 people in one adapted building.

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

People told us they felt safe and were happy living at the home. Prior to the inspection we had been made aware of recent concerns at the service around safeguarding people. However, the registered manager provided reassurances and had identified common themes occurring and was already in the process of taking action to minimise these risks. Staff we spoke with had an understanding of safeguarding and told us they received appropriate training. The local authority was working closely with the service and had agreed to provide some additional training for staff. Medicines were managed safely and staff had been safely recruited.

Staff received appropriate inductions, support and supervision to enable then to care for people effectively. People told us they enjoyed their meals and people were being offered choices. Improvements to the premises were taking place, particularly with regard to the bathrooms. However, we advised further consideration be given to people for adaptations, for people living with dementia and for promoting more stimulation.

People were positive about the leadership of the service and staff were complementary about the manager. There was a full schedule of audits in place and it was clear the provider was supportive and involved in the operation of the home. People had been consulted and quality surveys had taken place. The registered manager agreed to collate these results and formulate action plans, in addition to re-implementing more regular resident and staff meetings.

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 good (published 30 July 2021)

Why we inspected

The inspection was prompted in part due to concerns received about how the service was managing safeguarding events. 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. This included checking the provider was meeting COVID-19 vaccination requirements

We received concerns in relation to safeguarding people. As a result, we undertook a focused inspection to review the key questions of safe, effective 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, effective 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. The overall rating for the service has remained the same, 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 Hollymount 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.

Hollymount Residential and Dementia Care Centre is a residential care home and at the time of the inspection was providing personal and nursing care to 27 people aged 60 and over. The service can support up to 38 people.

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

People who lived in the home and their relatives were positive about the way the home was run and the quality of care provided. People told us they felt safe living in the home and that staff were kind and caring.

We were assured regarding the measures in place to protect people from the risk of cross infection Arrangements were in place to enable people to safely receive visitors. Staff had been safely recruited and there were enough staff on duty to meet people’s needs in a timely manner. Medicines were safely managed, and the provider had processes to record and investigate accidents and incidents to ensure lessons were learned.

Staff received the training, supervision and support necessary to provide people with effective care. Care records were detailed and provided good information for staff about how to meet people’s needs in the way they wanted. Systems were in place for staff to monitor people’s nutritional needs. People told us they enjoyed the food provided for them. The chef had introduced themed days to encourage people to eat a wide variety of food. 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. Care records included assessments of people’s capacity to make specific decisions, including whether to participate in the monthly testing regime for COVID-19. Where necessary, best interest decisions had been made to ensure people received the care they required.

The provider had systems to assess and monitor the quality of the service. People spoken with were very positive about the registered manager and the way the service was led. Staff felt people received high quality care and would be happy to recommend the service to members of their own family.

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 15 April 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also carried out an unrated targeted inspection to look at the infection prevention and control measures in place (published 25 November 2020).

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

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 9 and 10 March 2020. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing levels and to ensure they were following the principles set out in the Mental Capacity Act.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. 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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hollymount Residential and Dementia Care Centre on our website at www.cqc.org.uk.

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.

At the time of the inspection there were strict rules in place throughout the County of Lancashire relating to social restrictions and shielding practices. These are commonly known as ‘Tier 3 restrictions’. This meant the Covid-19 alert level was very high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

Staff, management and visitors were using personal protective equipment (PPE) correctly and there were robust procedures in place around the use of PPE.

The provider and manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Where appropriate and consistent with infection control rules, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions in the event of infection outbreak, these visits had been restricted and were only allowed in exceptional circumstances. We noted the processes around this were consistent with the rules and were regularly reviewed and adapted to reflect latest guidance and legislation.

Visiting rules and process were communicated effectively to people using the service and their relatives. At the time of the inspection, the manager was arranging an 'on-line conference' with most relatives and friends to further communicate and advise of processes around visiting.

Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home. The manager insisted people were tested before admission and consistent with local guidance, people were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

People's mental wellbeing had been promoted by innovative use of social media and electronic tablets so people could contact their relatives and friends. Staff had comprehensive knowledge of good practice guidance and had attended Covid-19 specialist training. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

Policies and infection control processes were regularly reviewed when guidance changed. The home was clean and hygienic. A designated cleaner was working throughout the inspection. All staff had received Covid-19 related supervision and had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

Hollymount Residential and Dementia Care Centre is a residential care home providing personal care to 33 people at the time of the inspection. The service can support up to 38 people.

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

People, relatives and staff told us there was not enough staff on duty to meet their needs. We also received concerns prior to our inspection about low staffing levels at night time. People told us they did not always feel safe from people accessing their bedrooms.

We have made a recommendation about people's safety from others accessing their rooms.

People were not supported to have maximum choice and control of their lives and staff did not support 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 example, capacity assessments had not been completed as necessary and consent was not always gained.

We have made a recommendation about person-centred care plans and end of life care and support.

Risks to people’s health and wellbeing had not always been assessed; the manager took immediate action to address this. The design of the service did not always meet the needs of people living with dementia. However, a programme of refurbishment was in place to address this. People were not always supported to engage in activities to stimulate them. The manager had plans to introduce an external company to provide activities in the near future. The service did not have a registered manager in place. The manager had been in post three weeks and had not submitted an application to register with us. This is a limiter for the well-led key question.

Staff had been trained in safeguarding and whistleblowing policies and procedures supported them in their roles. In the main, medicines were managed safely. Accidents and incidents were managed. Appropriate infection control practices were in place and staff wore personal protective equipment. Staff had the skills and knowledge needed to carry out their roles through induction, training and supervision. People received a healthy and balanced diet. People’s needs were assessed prior to using the service to ensure their needs could be met. People were supported by staff who were kind, caring and sensitive to their needs and who maintained their privacy and dignity. Staff supported people to be as independent as possible. Complaints were managed in line with policies and procedures. The service engaged people, relatives and staff through meetings and surveys.

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 1 September 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staffing levels and consent to care and treatment. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hollymount Residential and Dementia Care Centre (referred to throughout the report as Hollymount) provides accommodation and personal care for up to 38 older people. There were 35 people using the service at the time of this inspection. The home is located in a residential area close to Blackburn town centre and local amenities. It offers mainly single room accommodation with some en-suite facilities.

The service had a manager in post who was registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers ('the provider'), 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. As the registered manager was also registered to manage the provider’s sister home a short distance away, they were supported in the running of Hollymount by two deputy managers. This ensured there was management cover in the home seven days a week.

Without exception people spoken with told us staff were exceptionally kind and caring. Comments people made to us included, “I can’t recommend this place enough. The way they are looking after [name of relative] is amazing. Words can’t describe the care. Nothing is too much trouble for anyone. They are worth their weight in gold each and every one of them”, “Staff are very, very kind. I think I get the best care”, “I’ve never regretted coming here” and “Staff are so good with me. They are very caring.” Staff knew people and their backgrounds well and used this knowledge to communicate effectively with people and reassure them when they became anxious or upset. All staff demonstrated a commitment to providing high quality compassionate care.

People were treated with the utmost respect at all times. Staff protected their privacy, involved them in decisions about their care and promoted their independence. The end of life care people received was described as exceptional by relatives.

There were enough staff deployed to meet people’s needs. Recruitment procedures helped ensure only suitable staff were employed. Staff knew the correct action to take to protect people from the risk of harm and supported them to receive their medicines safely.

People were cared for in a safe, clean and dementia friendly environment. The registered manager had used evidence based practice to help support people to mobilise safely around the home and reduce the risk of falls occurring; this included painting Zimmer frames and handrails in bright colours.

Care records included good information about how people wanted to be supported. A professional we spoke with told us they were impressed about the level of personalisation in care records. Detailed risk assessments were in place in relation to the care people required. These had been regularly reviewed and updated to ensure they accurately reflected people’s needs.

People told us staff always provided the care they needed and wanted. Feedback from relatives praised the responsive nature of staff at all levels in the home. The registered manager told us their intention was for people to feel that they were living in a 5 star hotel with immediate access to anything they wanted.

The registered manager had been creative in introducing ways to encourage people to eat and drink as much as possible. People told us they enjoyed the food provided and were aware they could access food or drink of their choice 24 hours a day.

Staff received the induction, training and supervision to help them to deliver effective care. Staff understood the principles of the Mental Capacity Act 2005 and appropriate arrangements were in place to help protect the rights of people who were unable to consent to their care in Hollymount.

A wide range of activities was provided. These were aimed at promoting the health and well-being of people who lived in the home. People were encouraged to remain in contact with their family and friends through the use of social media and events both in the home and the local community.

People were encouraged to comment on the care they received. We saw that the registered manager had acted on all suggestions made in their drive for continuous improvement in the service.

People and their families felt the home was well-led. There was a clear management structure in place. All staff understood their roles, were highly motivated and worked well as a team. Robust systems were in place and effectively used to monitor the quality and safety of the service.

Below is a summary of what we found. The summary is based on our observations during the visit, speaking with nine people who used the service and one visitor. We also spoke with three staff and looked at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with nine people who used the service. They told us they felt safe in Hollymount and were happy with the care provided. Comments people made to us included, 'I definitely feel safe here; staff are great', 'I was in a bad state when I came in and they have really helped me' and 'My daughter couldn't have picked a better place for me'.

Care records provided staff with good information about the individual needs of people. Information included areas of risk and what staff would need to do to keep people safe.

Systems were in place to ensure people received safe and coordinated care when other services were involved.

People had their medicines at the times they needed them and in a safe way.

People were cared for in premises which were safe and secure.

Is the service effective?

People were assessed by a manager from the home before they were admitted to ensure their individual needs could be met.

To ensure that safe and effective care was provided, staff continued to update their skills and knowledge with regular training and updates.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. Risk assessments were regularly reviewed and care plans amended to reflect people's changing needs.

Is the service caring?

People we spoke with were complimentary about the care provided. We were told, 'There's always someone to look after you', 'I'm quite happy with the care my mum receives' and 'I'm really settled here; I'm well cared for'.

It was clear from our observations and discussions with staff that they knew people well and had a good understanding of their care and support needs.

Is the service responsive?

Information in the care records showed that the staff at the home involved other healthcare professionals in the care and support of people who used the service.

People knew how to make a complaint and were confident any concerns they raised would be dealt with by the home manager.

Systems were in place to ensure staff had access to up to date information regarding people's needs. This should help ensure they were supported to respond appropriately to any changes to a person's condition.

Is the service well-led?

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. The person responsible for managing the service was present when this inspection took place. They told us they had submitted an application to CQC to register as manager at the home.

Staff told us they felt well supported by the manager and were able to raise any issues of concern with her.

There were a number of quality assurance systems in place to ensure people were cared for safely. Feedback was sought from people who used the service through annual questionnaires which asked for their views on the care and facilities provided.

Following the inspection visit we were sent an action plan informing us how the provider intended to ensure people were protected against the risks of inappropriate care. We revisited the service to ensure the necessary actions had been taken.

We spoke with two people who used the service and one member of staff. We also reviewed three care files. People we spoke with told us they were happy with the care provided at Hollymount.

We found all the care files we looked at included care plans which had been updated to reflect people's changing needs.

During our visit we observed staff treated people with dignity and respect. We saw interactions between staff and people who used the service were warm and friendly.

We looked at the care files for all of the residents at Hollymount and reviewed three of these in detail. Although we saw many of the care files contained in depth care plans which provided good information for staff, we found eight care files did not contain sufficiently detailed plans of care regarding the support people needed during the day. This meant there was a risk people might receive inappropriate care.

People told us they enjoyed the food served at the home. Comments included, 'You get food just like home here' and 'The cook knows what I like and sees that I get it'.

We found people were cared for in a clean and hygienic environment.

We found suitable arrangements were in place to manage an effective process for identifying, receiving and handling complaints for people living in Hollymount.

We reviewed the care files of four people who used the service and found evidence that there were procedures in place to ensure their consent was gained in relation to the care provided for them.

We saw that care plans clearly identified the needs of the person and included information on how they wished their care to be delivered.

People spoken with told us they received appropriate support with their medication. We saw there were systems in place for the safe administration of medicines. However we found that some issues identified in medication audits had not been fully resolved.

We spoke with three members of staff, two of whom told us they felt well supported in their work. All staff we spoke with told us they were confident in carrying out their responsibilities. We saw evidence that staff were appropriately qualified and provided with training relevant to their role.

We found that there were effective systems in place for the completion and storage of records relating to the care of people who used the service and the maintenance of the premises