Holly Park Care Home

Holly Park Care Home is a residential care home providing personal care to up to 43 people in one adapted building. The service provides support to older people who may be living with dementia or other mental health conditions. At the time of our inspection there were 15 people using the service.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in West Yorkshire. To understand the experience of social care Providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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

The provider had taken sufficient action to address breaches found at the last inspection in relation to managing medicines safely, although some improvements were still needed in relation to protocols for ‘as required’ medicines, management of creams and storage of medicines.

We have recommended that the provider includes the issues we identified in their monthly auditing of medicine management.

People told us they felt safe and risks to their health and safety were assessed and reviewed regularly. Staff knew what to do to make sure people were protected from abuse. There were enough staff available to meet people’s needs. The home was clean, and systems were in place to minimise the spread of infection. Regular checks on the safety of the environment were made.

Since the last inspection the provider had changed the registration of the service which meant they no longer provided nursing care. This meant that a breach recorded at the last inspection relating to supporting nursing staff was no longer relevant. Staff had received the training they needed to support people safely. Staff worked with healthcare professionals such as GP’s and district nurses to make sure people’s health and social care needs were met.

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 needs and choices were assessed and reviewed regularly. People were supported to make choices for themselves but they, or where appropriate, their families were not always involved in developing their care plans.

Care plans were person centred, promoted people’s rights to choose, promoted independence. and contained good detail of people’s choices. However, some care plans did not always contain all the information staff might need to make sure people’s needs were fully met.

People had 'This is me’ documents which helped staff get to know and understand the person.

People’s wishes for end of life care had not been explored.

Care plans were in place to support people with their communication needs and staff understood how people’s behaviours might communicate how they may be feeling.

People were supported to engage in activities they enjoyed, and links were being forged to support people to become part of local village life.

The provider had made some improvements in monitoring the quality and safety of the service, but some improvements were still needed. The provider was asking people, staff and relatives for their opinions about the service. Complaints made to the service were managed and responded to well.

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 inadequate (published 20 August 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 June 2021. 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 Safe care and treatment, Person-centred care, Staffing and Good governance.

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, Responsive and Well-led which contain those requirements.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe, Effective, Responsive 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 changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 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.

Holly Park Care Home is registered to provide accommodation, personal and nursing care for up to 43 people who may be living with dementia or other mental health conditions. There were 26 people using the service at the time of inspection.

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

Not enough improvement had been made since the last inspection in May 2019, and the provider continued to be in breach of regulation 9 (person-centred care), regulation 12 (safe care and treatment), regulation 18 (staffing) and regulation 17 (good governance). The service has failed to achieve a good rating and has a history of breaching regulations since being registered with the CQC in January 2011.

Medicines were not always managed safely. Infection control practices were not sufficiently robust to be assured the risk of infection was being mitigated. The provider was not taking appropriate steps to assess risks to people and to keep the premises safe.

People did not have an accurate and complete care record. The care records were not person-centred and did not focus on how the person wanted their care and support needs to be delivered. There was insufficient information to demonstrate the provider was working effectively with other healthcare professionals to ensure care was provided and planned in a timely manner.

The provider’s audit systems were not effective as we found the breaches from the previous inspection had not been addressed.

People and staff told us there were enough staff to meet people’s needs. Safe recruitment processes were in place to ensure staff were suitable to work with vulnerable people. People told us the manager and staff were approachable. Relatives told us they were kept up to date with management changes and about their family member.

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 24 June 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service had deteriorated to inadequate. This service has been rated either inadequate or requires improvement for the last five consecutive inspections.

Why we inspected

At the last inspection on 29 April 2019 and 1 May 2019, 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 person centred care, safe care and treatment, good governance and staffing.

We undertook this focused inspection to check the provider 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 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 inadequate. 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 Holly Park on our website at www.cqc.org.uk.

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 medicines management, risk management, safety of premises, infection prevention and control, good governance, person-centred care, lack of support for clinical staff and insufficient partnership working, at this inspection.

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

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Holly Park Care Home is registered to provide accommodation, personal and/or nursing care for up to 43 people who may be living with dementia or other mental health problems. There were 20 people using the service.

People’s experience of using this service:

The service met the characteristics of requires improvement in all areas; more information is in the full report.

Medicines were not always being managed safely.

People said they had been asked about what care and support they would like when they first moved into the home, but this had not continued. Care plans were not always up to date and there was little on offer in the way of activities to keep people occupied.

Some staff training was not up to date and staff supervisions were discussions around ‘tasks’ rather than the developmental needs of staff and reflective practice.

There had been a lack of continuity in relation to the management of the service. Audits have not always been effective in picking up issues.

People have been asked for their views about the service but these have not always been acted upon.

People were not always raising their concerns directly with the manager or provider.

Staff had been recruited safely and there were enough staff to provide people with care and support.

People said they felt safe at the home. Staff had completed safeguarding training and understood how to keep people safe.

People’s health and dietary needs were being met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People said the staff were kind and treated them with dignity and respect.

Rating at last inspection: Requires improvement (report published 27 June 2018). This service has been rated requires improvement at the last three inspections. Will we be requesting an improvement plan and meeting with the provider so they can tell us how they intend making improvements to the service.

Why we inspected: The scheduled inspection was brought forward due to us receiving information concern.

Enforcement: We found four breaches of regulations in relation to safe care and treatment (management of medicines) and good governance. Please see the ‘Action we told provider to take’ at the end of this report.

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

Following the last inspection in March 2017 the overall rating for the service was ‘requires improvement.’ The provider was in breach of one Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to ‘safe care and treatment’ (Regulation 12) specifically about medicines management. On this inspection we found they had rectified the issues we identified last time. However, we found the providers systems and processes had not identified some further issues with medicines management.

Holly Park Care Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 43 older people who may be living with dementia in one adapted building. Accommodation is provided over two floors.

There was no registered manager in place. A manager had been recruited and was in the process of applying to CQC to be registered. 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.

There were enough staff to keep people safe and to meet their care needs. Staff were receiving appropriate training and they told us the training was relevant to their role. Staff told us they felt supported by the manager and were receiving formal supervision.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. We saw appropriate referrals were being made to the safeguarding team when this had been necessary.

People’s healthcare needs were being met; however, improvements needed to be made to make sure medicines were managed safely.

People's nutritional needs were met and meals at the home were good, offering choice and variety.

People who used the service and their relatives told us staff were helpful, friendly, kind and caring. We saw people were treated with respect and compassion.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home was clean, comfortable and improvements to the environment were on-going.

The complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

Some activities were on offer to keep people occupied and the manager was keen to introduce more things for people to do.

Everyone spoke highly of the manager and said they were approachable and supportive. People using the service and relatives were consulted about the way the service was managed and their views were being acted upon. There were some good audits being completed that were picking up issues. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The inspection took place on the 21 March 2017 and was unannounced. At the time of the inspection, 26 people were living in the home and nursing care was not being provided.

A new registered manager was in place, who registered with the Commission in January 2017. 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 the last inspection in November 2015, we rated the service ‘Requires Improvement’ overall and in the ‘Safe’ and ‘Well Led’ domains, due to issues identified with medicines and a lack of evidence of sustaining previous improvements over time. At this inspection, we again rated the provider “Requires Improvement” in the same areas. This was due to concerns over the way medicines were managed and because systems to monitor and improve the service were not sufficiently robust. However we also identified some good areas of practice with the ‘Effective’, ‘Caring’ and ‘Responsive’ domains rated as ‘Good.’

People and relatives provided positive feedback about the service. They said good, personalised care was provided and said they would recommend the home to others.

People said they felt safe living in the home. Following incidents and accidents, investigations were undertaken to help keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place to help keep people safe.

The premises was warm, homely and suitably spacious. However we identified some defects with the premises, including a lack of hot water in some areas of the building.

Medicines were not consistently managed in a safe way. Some people did not always receive their medicines as prescribed.

During observations of care and support we saw staff were available to provide prompt care and assistance. Some people told us that at times, they thought there were not enough staff on duty. In light of these comments and due to new people coming into the home, we have made a recommendation about the need to review staffing levels in the home.

New staff were recruited safely to help ensure they were of suitable character to work with vulnerable people.

Staff received a range of training and support relevant to their role. People provided good feedback about the quality of the staff that supported them.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Consent was gained and where people lacked capacity the correct processes were followed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

Nutritional risks were well managed by the service. People had access to a range of suitably nutritious food. There were several options available at mealtimes and snacks and drinks were provided throughout the day.

People’s healthcare needs were assessed and appropriate plans of care put in place. The service worked with external healthcare professionals to help meet people’s needs.

Staff were kind and caring and treated people with dignity and respect. We found a warm and inclusive atmosphere within the home with all levels of staff taking the time to interact and chat with people.

People choices were sought and respected by staff. We saw a personalised approach to care and support was practiced by staff.

People’s needs were assessed and appropriate plans of care put in place. We saw care and support delivered in line with people’s plans of care.

People were provided with a range of activities which was based on people’s individual likes and preferences. We saw these were well received during the inspection.

A system was in place to log, investigate and respond to complaints. People and relatives said management were approachable and they were able to raise any concerns.

People and relatives praised the registered manager and said that since their appointment a number of improvements had been made to the service. The registered manager knew people well and took the time to listen and act on any comments they had.

Systems were in place to assess and monitor the service however these were not sufficiently robust, for example in preventing the shortfalls in medicines management from occurring. Care plans were not always kept up-to-date and required reviewing.

We identified one breach of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at back of the full version of this report.

After the visit they spoke with another relative and visitor from the local church the by telephone. The inspectors also looked around the premises, observed staff interactions with people who lived at the home and looked at records. There were 34 people living at the home on the day of the visit.

At the last inspection in December 2013 the service was found to be meeting the regulations we looked at.

Before this visit we had received information of concern about how the home dealt with complaints and how the home kept people safe. We found evidence which supported this information.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

The service was not safe. People were not adequately protected from abuse and avoidable harm. We saw several people with unexplained bruising and skin tears. Following our visit we made a safeguarding referral to the local authority so that someone independent of the service could consider the issues we identified.

Care was not planned and delivered in a way that ensured people's safety and welfare. There were insufficient numbers of suitably qualified staff to meet people's needs. We have asked the provider to make improvements.

The premises and grounds at the home were not adequately maintained and the home environment was not clean and hygienic. This meant people were not living in safe surroundings that promoted their wellbeing. The temperature at the home was not adequately controlled and peoples' medicines were stored in a room which was above the required temperature; this meant vulnerable elderly people were being put at risk. We have asked the provider to make improvements.

Is the service effective?

The service was not effective. The home did not promote a good quality of life for the people that lived there.

Most people told us they were happy with the care provided at the home and that they thought their care, treatment and support needs were being met. From our observations and from speaking with staff and people who lived at the home and their relatives we found staff knew people well and were aware of their support needs.

However, staff had not received appropriate training to meet the needs of the people who lived at the home. Staff we spoke with were not aware of how best to support people living with dementia. We have asked the provider to make improvements.

Audits were not effective; they either failed to identify issues or failed to follow up on issues when they were identified. This meant peoples' care needs were not being met. We have asked the provider to make improvements.

Is the service caring?

Staff who worked at the home were kind and caring. However, the provider had failed to take appropriate action where issues were identified which impacted on peoples' care, safety and welfare. We have asked the provider to make improvements.

People we spoke with who lived at the home told us they were generally happy living there. One person said, 'I've got no complaints about anything. I get looked after here.' Another person said, 'It's alright living here. It's not like home, but they do their best.' A relative said, 'I think the care here is as good as anywhere else.'

All of the people we spoke with who lived at the home and the relatives were complimentary about the care staff. One person said, 'They are lovely people. Always rushing about and trying to help you.' One relative said, 'The staff here are very friendly and they seem to know the residents well.' This was confirmed by our observations during the visit; we observed care staff were courteous and patient when speaking with people.

We observed various issues relating to people's dignity during our visit. This included not offering to take people to the toilet on a regular basis and people wearing clothes without buttons, which meant their underwear was in view.

Is the service responsive?

The service was not responsive. Accidents and incidents at the home had not been followed up appropriately to ensure the risk of recurrence was minimised. People who needed additional support with their healthcare needs from external professionals did not always receive their support in a timely manner.

Care and support was not always provided in accordance with peoples' wishes. People's preferences, interests and diverse needs were not taken into consideration. For example we found people were not receiving baths and showers in accordance with their documented preferences. This meant peoples' needs were not being met.

We heard call bells going off for long periods during our visit. We also saw several call bells which were out of reach and/or the cord was of poor quality in bedrooms and bathrooms we looked in. This meant people may not be able to access the call bell system which had been put in place to help them summon assistance.

All of the people we spoke with, including relatives and visitors, told us that there were not many activities for people to engage with. One person said, 'There's not much to do except watch TV, but I don't like TV.' One regular visitor said, 'I've never seen much going on in the way of stimulating activities. It's a shame because some people really enjoy a chat and going out. I think people only get out if they have relatives to take them.' We have asked the provider to make improvements.

We also found the complaints system at the home was not effective. Comments and complaints people made were not responded to appropriately. We have asked the provider to make improvements.

Is the service well-led?

The service was not well-led. People were not protected against the risks of inappropriate or unsafe care because the provider did not have effective systems to assess and monitor the quality of the service people received. The leadership and management at the home did not assure the delivery of high quality, person centred care. We have asked the provider to make improvements.

The manager at the home had been in post since December 2013 and had registered with the Care Quality Commission as the home's registered manager in May 2014. Nearly all of the people we spoke with said they did not know who the manager was.

People we spoke with who lived at the home were not aware of residents' or relatives' meetings and they could not recall completing any questionnaires.

We observed a lack of organisation and direction of staff. Staff told us they were not always clear about their responsibilities and they did not feel well supported by the manager. They said their views were not always taken into consideration. This suggested the home did not promote an open and fair culture and did not support learning and innovation.

We found that risk assessments and care plans were written in appropriate detail that ensured staff were fully aware of people's needs and how to meet their needs. We also found that staff knew the people living at the home well and care was person-centred. We found staffing levels to be adequate and staff and people who used the service felt staffing levels were sufficient.

We found that the environment of the home, in the main, was visibly clean throughout and people's bedrooms were comfortable. Some areas of the home, especially communal toilets and bathrooms, were dated in appearance and some parts of the environment were worn which made effective cleaning more difficult.

We found there was a clear complaints process in place and saw examples where the complaints process had been followed appropriately. We spoke with three people who used the service; one person said the home was lovely and they liked living there. Another person said, "All the nurses are nice" and "The food had improved". A third person we spoke with described how staff were caring and they were happy and comfortable at the home.

The other told us they felt people were safe and well cared for. They also told us there were some really good carers working at the home, many who would "go the extra mile." They also said they would not hesitate to report any concerns they had to the manager.

We observed care in the home and saw people being spoken to respectfully and care was being delivered in a sensitive way. We spoke with two people who used the service and one relative. They told us they were happy with the care they received. One person told us "I am like the Queen of England, I couldn't be looked after better."

The provider may wish to note the relative we spoke with felt the food was okay but they thought their relative had lost weight. They felt this was partly due to the low level of one to one attention. Also that one of the people we spoke with told us they felt the activities were not available as they had been, they also said "We used to do trips but we don't go out any more."

They told us that the newly furnished conservatory was now their favourite place to sit as it was bright and quiet away from the television. They told us they enjoyed doing something useful and they were going to sell the necklaces they were making at a local fair and the funds raised would help them to do more activities.

There was a visitors book at the entrance to the home and the following comments had been made in the months before the inspection;

"Staff look after my mother very well."

"Staff were always helpful and pleasant and give care above and beyond what their pay would reflect, they have great patience."

"Staff have made Holly Park my mothers home, she always looks clean and comfortable."

"Pleasant surprise, very clean and not smelly home"

"I can rest easy knowing she is in good hands."