Archived: The Hollies

The Hollies is registered to provide care and support for up to 14 people living with a learning disability and/or autism, within the 40s to 60s age range. The service comprises two distinct areas with separate entrances known as ‘The Hollies’ and ‘Number 84’. At the time of our inspection, eight people were living at the service, three people at The Hollies and five people at Number 84. Communal areas include a living room, dining room and kitchen in each part of the home. Number 84 has accommodation over two floors and The Hollies is all on ground floor level.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was in post. 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, we found areas for improvement in relation to the guidance for ‘as required’ medicines, the drawing up of capacity assessments and staff understanding in relation to mental capacity legislation and that people and/or their relatives were not involved in reviewing their care. At this inspection we found that improvements had been made and the rating in each domain has improved from ‘Requires Improvement‘ to ‘Good’.

Staff had completed training in the administration of medicines. Medicines that were administered on an ‘as required’ basis were done so safely. People understood what their medicines were for and why they had been prescribed. Medicines were managed safely. People were protected from potential abuse and neglect and staff had completed training in safeguarding adults at risk. People felt safe living at the home. People’s risks were identified, assessed and managed safely and risk assessments provided detailed information about people and how staff should support them to mitigate risks. Accidents and incidents were logged and when things went wrong, lessons were learned. Duty of Candour was applied and the provider ensured that staff were open and honest in their communication with people and their relatives. Staffing levels were sufficient to meet people’s needs. Safe recruitment practices were followed. People were protected from the risk of infection and the home was clean and odour free.

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. Staff had a good understanding of the Mental Capacity Act 2005 and associated legislation. People were only deprived of their liberty where they were deemed to lack capacity in relation to specific decisions. People’s needs and choices were assessed so their care and treatment was delivered effectively. People were encouraged to be as independent as possible. Areas of good practice were shared between the provider and registered manager and cascaded to staff. Staff had the skills, knowledge and experience they needed to look after people effectively and had completed a range of training. Staff had regular supervisions. People were supported to have sufficient to eat and drink and were encouraged in a healthy diet. The service worked with a variety of organisations to deliver people’s care and support. People had access to a range of healthcare professionals and services. People’s rooms were personalised and decorated in line with their preferences.

People were looked after by kind, caring and friendly staff and positive relationships had been developed. People felt relaxed and at ease with staff who knew them well. Relatives spoke positively about the care staff. People’s communication needs were taken account of so that they were enabled to make decisions relating to their care. People were treated with dignity and respect and their independence was promoted.

People and their relatives were involved in reviewing the care and support provided and review meetings took place. Care was person-centred and responsive to people’s needs. Care plans were provided in an accessible format and people, where possible, had signed their care plans to show their agreement with them. Care plans included people’s personal histories, care and support needs and were detailed in providing guidance for staff, for example, in relation to providing support to people perceived as having challenging behaviour. People pursued activities of their choosing and that were of interest to them. Some people went out independently and could use public transport. Complaints were listened to and acted upon and the provider’s complaints policy was accessible and in an ‘easy read’ format. When people reached the end of their lives, people left behind at the home were supported by staff through the grieving process. People’s end of life wishes were recorded within their care plans when they felt able to discuss these with staff.

People’s rights to a meaningful life were promoted and the registered manager was passionate about this. She supported people and valued staff to do their best. The culture of the home was person-centred, open and inclusive. Staff were positive about working at the home and felt the registered manager was supportive. Staff were asked for their feedback about their employment through annual surveys sent out by the provider. Staff attended staff meetings and were encouraged to make suggestions. People were involved in developing the service and weekly house meetings were held. Relatives were happy with communication at the home from the registered manager and staff. Auditing systems were effective in measuring and monitoring the quality of care and the service overall. Notifications that the provider was required to send to the Commission by law had been sent and the rating awarded at the last inspection was on display. The service worked in partnership with other agencies to provide holistic care.

A registered manager was in post when we visited. 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 October 2015, breaches of legal requirements were found in six areas and we issued Warning Notices in relation to repeated breaches of regulations associated with staffing and good governance. The provider was required to ensure these regulations were met by January 2016.

We also asked the provider to take action to make improvements in respect of person centred care, need for consent, safety and suitability of the premises and safe care and treatment. We received a provider action plan which advised us of the steps taken by the provider to address the breaches.

At this inspection we found evidence which demonstrated the warning notices and requirement notices had been met and the service was now complying with requirements. A manager had been in post since December 2015; they registered with the Commission in February 2016. They clearly demonstrated they were responsible for improvements that had been made with regard to the quality of care and the service provided. However, in some areas additional time and work was needed to ensure improvements were implemented and sustained to demonstrate good outcomes for people.

There were sufficient numbers of staff on duty in each house with the necessary skills and experience to meet people's needs.

Documentary evidence we looked at demonstrated how the provider monitored the service to maintain and improve, the quality of care.

Improvements had been made to the standard of cleanliness throughout the premises. There were plans in place to improve facilities, including the bathrooms, toilets and kitchens, in each house.

The registered manager had begun to carry out capacity assessments on identified people, to ensure their rights were protected in accordance with the principles of the Mental Capacity Act 2005 (MCA) and requirements of the Deprivation of Liberty Safeguards (DoLS). We have made a recommendation about recording of capacity assessments and ensuring staff were equipped with appropriate training in line with the principles of the MCA.

People told us they were satisfied with the care provided. Our observations indicated staff knew how to provide the care and support each person needed. Work had begun to make improvements to care records to ensure people received the care and support required. This would include making sure care had been planned and reviewed with them, or their relatives, to ensure that it met their wishes and expectations.

People told us they felt safe. They knew what to do if they had concerns about their treatment or if they wished to complain. Staff confirmed they had been trained in how to identify and report any incidents of abuse they may witness. Any potential risks to individual people had been identified and appropriately managed.

People's medicines had been administered and managed safely. Guidance needed to be drawn up for staff to follow for people who have been prescribed as required medicines such as for pain relief.

People were provided with support to access health care services in order to meet their needs.

Positive, caring relationships had been developed with staff to ensure people received the support they needed.

The culture of the service was open, transparent and supportive. People and their relatives were encouraged to express their views and make suggestions which could be used by the registered manager to make improvements.

People told us, they were happy living at the service.

One person told us, "It's nice here. I like living here with all my friends".

We looked at people's individual care records and saw that, staff demonstrated that they knew how care was to be delivered in line with people's wishes and preferences.

We looked at safeguarding and found that the provider had not responded appropriately to allegations of abuse.

We looked at how the provider stored, handled and administered medication. We saw that there were appropriate arrangements for the management of medicines.

We found that people were well cared for by staff. However, when we looked at staffing levels we found that at times there were not enough, qualified skilled and experienced staff to meet people's needs. This meant people were at risk of being left unsupported.

Individual needs of people had been assessed and were reviewed and care plans were updated in the light of changing needs. People experienced care, treatment and support that met their needs and protected their rights. Three people told us 'I like it here'.

We looked at safeguarding arrangements including staff training, talked to staff and people who used the service, and reviewed care plans. We found that people were protected because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Staff rotas, the training matrix and observation of staff supporting people demonstrated that there were enough qualified, skilled and experienced staff to meet people's needs. One member of staff said 'I like working here ' we always work as a team'.

The provider had in place effective systems system to assess and monitor the quality of service, which sought people's views, took account of complaints and comments and learnt from analysis of incidents.