The Hollies - Care Home

The Hollies – Care Home is a residential care home. The service offers accommodation and personal care to people aged 65 and over and people living with dementia. At the time of the inspection, 34 people were using the service. The building is split into 3 different units, Humber unit provides support to people living with dementia, Tranby unit provides support for women living with dementia and Hessle suite offers studio apartments for people.

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

Improvements had been made to the quality and the safety of the service, although the provider’s systems needed further work to ensure they remained effective around health and safety, mental capacity records and quality assurance systems. People told us they were safe, systems were in place to protect people from abuse and concerns had been appropriately reported.

People received their medicines safely and the registered manager was working to improve guidance for ‘as and when required’ medicines. Staff understood risks to people’s safety and well-being and worked to mitigate these risks. Staff were recruited safely and there were sufficient staff to meet people’s needs. The building was clean, tidy and a programme of redecoration and building improvements had recently been undertaken.

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. Restrictions on people’s liberty were identified and appropriate authorisations had been sought.

People’s needs were assessed and information was used to create detailed care plans which supported staff to provide person-centred care. People’s health and dietary needs were met as staff worked closely with relevant professionals. People were provided with appropriate support at the end of their lives. A relative said, “I couldn’t ask for better care at the end of [Person’s names] life.”

Staff were kind and caring and we received a lot of positive feedback about the care provided. One relative told us, “Whilst we would love [Person’s name] to be in their own home, we are quite happy that they are here. We have no concerns about their safety, and they always look clean, tidy and well nourished.”

A range of group and individual activities were available for people to participate in, though records of people’s participation needed improving.

The registered manager had worked closely with the senior management team to improve the service. We received positive feedback about the registered manager and the culture of the service. People and their relatives had been included in the development of the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 July 2021) and breaches of regulation were identified.

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.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Recommendations

We have made recommendations regarding health and safety processes, systems for the Mental Capacity Act 2005 and quality assurance systems.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to address recommendations. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Hollies – Care Home is a residential care home. The service offers accommodation and personal care to people aged 65 and over and people living with dementia. At the time of the inspection, 37 people were using the service.

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

Risks to people’s safety and wellbeing were not always assessed, effectively managed or reviewed following incidents. Advice and guidance were not always sought from relevant professionals where concerns were identified around people’s medicines or further instruction was needed to support the safe administration of medicines.

Records relating to recruitment were not always appropriately completed. Induction processes were in place to ensure staff had the skills and knowledge required for their role, but records were not always in place.

Staff ensured people lived in a clean and tidy environment. Infection prevention and control (IPC) practices had been updated to follow government guidance. However, on one occasion isolation processes were not implemented in a timely manner.

Quality assurance systems were in place but had not identified or addressed all the shortfalls found during the inspection which placed people at risk of receiving a poor-quality service. The management team monitored accidents and incidents, but analysis was not always completed which made it difficult to learn from identifying patterns and trends.

Staffing levels were appropriate to meet people’s needs and staff were deployed to ensure they monitored communal areas for people’s safety. Staff were trained in safeguarding and appropriate referrals had been made to the local authority.

Staff were kind and caring and people’s relatives provided positive feedback. Staff were positive about the impact the manager had on the service in a short space of time.

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 Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published11 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 02, 07 and 08 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 safe care and treatment and governance systems.

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 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 not changed and remains requires improvement. 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 The Hollies – Care Home 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 monitor the service.

We have identified breaches in relation to risk management, medicines and quality assurance at this inspection.

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

People’s experience of using this service: People did not always receive their medication as prescribed. Risks to people were not effectively mitigated. The nurse call system was not in working order meaning people's sensors mat could not work effectively. This meant people could be left at risk of harm as staff would not be alerted.

Accident and incidents were not recorded and logged correctly meaning they could not be effectively monitored. At times, people were unsupervised, and we observed them carrying out unsafe activity. This was not observed by staff, as they were busy elsewhere. There was concern from staff about staffing levels, however people who used the service told us there was enough staff available.

We have made a recommendation about staffing.

Further work was required to help people with dementia make choices regarding their meals. Monitoring records were not consistently completed, meaning effective monitoring could not take place. People were supported by staff who were trained and supported in their roles he premises were designed and decorated taking account of the needs of people with dementia.

We observed mixed interactions between staff and people who lived at the service. We saw some staff offering people reassurance in a caring manner. However, we also saw some staff supporting people with tasks and not speaking to the person first. People told us staff were kind and caring.

Care plans were not regularly reviewed and did not always reflect people’s needs. Activities were available to people if they chose to participate.

Meetings were held with people, staff and relatives to engage them in the running of the service. Feedback was gathered from people in surveys, however it was not always correctly analysed. Governance systems had failed to address areas of concern identified at inspection. The provider had developed an action plan, although extensive it had failed to address all areas identified at inspection.

Details of the action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated good (Published 18 April 2018).

Why we inspected: This inspection was brought forward due to information of risk and concern.

Enforcement: We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. Please see ‘the action we have told the provider to take’ section towards the end of the report.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor the service through the information we receive 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

At our last inspection we rated the service good. At this inspection we found the rating remained good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm and abuse. Systems and processes were maintained to record, evaluate and action any outcomes where safeguarding concerns had been raised.

Assessments of risks associated with people’s care and support and for their environment had been completed. Associated support plans ensured people received safe care and support without undue restrictions in place.

People who used the service were safe in respect of staffing levels, recruitment, management of medicines and infection control.

The service continued to provide effective care to people who used the service because staff were supported to have the skills, knowledge and supervision they needed to carry out their roles.

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 continued to be caring, paying attention to people’s well-being, privacy, dignity and independence.

Staff upheld principles of equality and diversity ensuring everybody received care and support that reflected their wishes and preferences.

People’s support plans continued to be person-centred and people continued to be supported with a range of activities and interests of their choice wherever possible.

People we spoke with confirmed they knew how to make a complaint. Records showed that complaints had been managed appropriately.

The service continued to operate an open and inclusive management style where people were supported to participate in the running of their care provision.

A quality assurance system remained effective with oversight at provider and director level. People and their care workers were consulted and action plans were formulated to improve the quality and delivery of the service.

Further information is in the detailed findings below.

At the last inspection on 10 and 11 December 2015 the service met all but one of the regulations assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the registered provider was in breach of Regulation 15: Premises and equipment. This was because the registered provider did not ensure that weighing equipment was working properly and people were weighed regularly. This meant that people were at risk of harm due to inadequate monitoring of their health and nutrition, particularly where people were at risk of being malnourished.

At this inspection there was sufficient improvement identified to show that the breach was met. The registered provider had acquired a new set of weighing scales and people were being regularly weighed. We saw recorded evidence of this in four people’s files, which meant the registered provider monitored people’s weight to ensure their health.

The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been in post for the last four months. They had been interviewed and approved as the registered manager by the Care Quality Commission (CQC) one week before the inspection. A registered manager is a person who has registered with the CQC 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 cared for and supported by qualified and competent staff that were regularly supervised and appraised regarding their personal performance.

People’s mental capacity was appropriately assessed and their rights were protected. Staff had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves.

The registered manager worked with other health and social care professionals and family members to ensure decisions were made in people’s best interests where they lacked capacity to make their own decisions.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing.

The premises were suitable for providing care to older people and to people living with dementia, as the environment was conducive to their needs.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were unable to tell us their experiences.

We spent half an hour observing the lunch time meal in the Humber unit dining room. We spoke with one relative who was visiting the service, and held brief conversations with four people who used the service. We spoke with staff and the manager about the care and wellbeing of people who used the service. We also gathered evidence of people's experiences of the service by reviewing care records and quality assurance documentation.

We carried out this inspection to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. One person told us 'I like it here' and another person said 'I am okay. The staff look after us well.'

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and in how to submit one. This helped to ensure people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly, therefore not putting people at unnecessary risk.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure unsafe practice was identified and people were protected.

Risk management plans were in place that had been written for some people with particular needs. This kept these people safe from unnecessary risk of harm.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. People and relatives told us they were able to discuss their care needs and make decisions using the care review process and on a daily basis with the manager or staff.

Specialist dietary, mobility and equipment needs had been identified in the care plans where required. Input from health care professionals was sought when concerns about a person's care were identified.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with cognitive and physical disabilities.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One relative told us that they visited the service daily and they were delighted with their partner's care. The relative said "My partner has really settled in well and the staff are lovely".

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed. People had commented 'The home is good at support, comfort, safety and stimulus for people who live there' and 'The food is good and also some of the care staff are good. The senior care staff will always get the GP out when people are ill and let you know what is going on.' Other comments we noted included 'Friendly, caring staff', 'Very patient and obliging. The cook tries to accommodate any requests.'

Is the service responsive?

People we spoke with said they were confident of using the complaints system if they needed to. They told us that they would speak to the staff or the manager about any issues and that when this happened action was taken quickly to resolve any problems.

The manager had risk assessed the environment and had plans in place to make changes as needed. One relative who spoke with us said 'I have noticed a number of really positive changes in the service since the manager took over the role in 2013. The cleanliness of the place is much better and the whole atmosphere in the home has improved.'

Is the service well led?

The service had an effective quality assurance system, which indicated the quality of the service was continually monitored. The records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Feedback from these individuals was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was analysed by the provider and where necessary action was taken to make changes or improvements to the service.

The service had an open door policy so staff were able to discuss any concerns with the manager. Regular staff meetings were held so that people could talk about any work issues. This meant that staff were able to provide feedback to their managers and their knowledge and experience was recognised and taken into account.

Systems in the home had improved and medicines were now handled safely.

We spoke to one person who said that they had good access to other health services when they needed them, however they also said that their night time medicines were sometimes given later than they would like them.

We found that one person had been referred to their GP for a change in their presenting behaviour and that this may have been a result of them not receiving their prescribed medicine which was out of stock for two days. We asked the provider to raise an alert to the local safeguarding authority for this to be investigated.

People who used the service who we spoke with told us they were satisfied with their care and treatment. One person told us 'I can't grumble at all'.

A visiting health professional we spoke with told us that they were satisfied with the support their patients were receiving. They told us that staff had been aware of why they were visiting and were 'Really good' at following any instructions given about the care and treatment of people who used the service. They also told us that staff were good at consulting them regarding any health concerns for people who used the service.

Staff told us they felt supported by the manager and were confident that they could go to her if they had any concerns regarding the care and welfare of the people who used the service and that these would be addressed.

Relatives of people who used the service we spoke with told us that that they were generally happy with the support and care their relative received but that there were issues with the laundry and missing spectacles.

One relative of a person who used the service told us 'The manager always has time for you.'

A visiting health professional we spoke with told us that they had only recently started to visit the service but had been satisfied with the support their patient was receiving. They told us that staff had been aware of why they were visiting and that care plans were accurate. They also explained that staff made themselves available to support them during their visit and were welcoming.

Staff told us they felt supported by the manager and were confident that they could go to her if they had any concerns regarding the care and welfare of the people who used the service and that these would be addressed.

During our visit we looked at the administration of medicines and noted some errors that were addressed during our visit.