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The Hollies - Care Home Requires improvement

Reports


Inspection carried out on 2 May 2019

During a routine inspection

About the service: The Hollies 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 43 people were using the service.

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

Inspection carried out on 30 January 2018

During a routine inspection

The Hollies is a care home in Hessle in East Yorkshire which provides accommodation and care for up to 48 older people. At the time of the inspection there were 38 people living at the home. The home is divided into two units, 'Humber' which provides support for people who require residential care and who may have a mild cognitive impairment and 'Tranby' which specialises in support for people with more complex dementia related conditions.

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.

Inspection carried out on 2 February 2017

During an inspection to make sure that the improvements required had been made

This focussed inspection of The Hollies took place on 02 February 2017 and was unannounced. The overall rating for the service was unchanged as this was a focused inspection that took place over six months after a comprehensive inspection. However, the rating for the section ‘Is the service effective’ changed from Requires Improvement to Good.

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.

Inspection carried out on 10 and 11 December 2015

During a routine inspection

We carried out this inspection on 10 and 11 December 2015. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The inspection was unannounced; which meant that the staff and registered provider did not know that we would be visiting.

The last inspection was carried out 24 April 2014; at that inspection The Hollies Care home was found to be compliant with the regulations we looked at.

The Hollies is a care home in Hessle in East Yorkshire which provides accommodation and care for up to 48 older people. On the first day of the inspection there were 40 people living at the home. The home is divided into two units, 'Humber' which provides support for people who require residential care and who may have a mild cognitive impairment and 'Tranby' which specialises in support for people with more complex dementia related conditions.

The home is required to have a registered manager in post and on the day of the inspection there was a registered manager in post who had been registered with the Care Quality Commission (CQC) since August 2015. A registered manager is a person who has registered with 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.

We found that although the homes premises were mostly clean and properly maintained the home had ineffective systems in place to ensure that all equipment was repaired and replaced within reasonable timescales. This was a breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.

We found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Assessments of risk had been completed for each person and plans had been put in place. Incidents and accidents in the home were accurately recorded and monitored monthly.

We saw that there were sufficient numbers of staff on duty and people’s needs were being met. We found that effective recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The home had a system in place for ordering, administering and disposing of medicines and this helped to ensure that people received their medicines as prescribed.

The registered manager was aware of guidance in respect of providing a dementia friendly environment and progress had been made towards achieving this.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the home deemed essential, such as safeguarding, moving and handling and infection control and also home specific training such as dementia awareness.

Staff told us they felt well supported by the registered manager and could approach them if needed. They told us they received formal supervision, but could also approach the registered manager with any concerns at any time.

The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that Mental Capacity Act (MCA) (2005) guidelines had been fully followed. We saw that when decisions were made on people’s behalf these were discussed at a best interest decision meeting to ensure the least restrictive option was always chosen.

People’s nutritional needs were met. However, we saw the lunchtime experience for people was inconsistent with people in the dining room enjoying a relaxed and pleasant environment, whilst the atmosphere for people in the lounges was less pleasing.

People were supported to maintain good health and had access to healthcare professionals and services. People were encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments when necessary.

We observed good interactions between people who used the service and the care staff throughout the inspection. We saw that people were treated with respect and that they were supported to make choices about how their care was provided.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. The care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported.

The home employed activity coordinator’s and offered a variety of different activities for people to be involved in. People were also supported to go out of the home on day trips or to access facilities in the local community.

People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that any comments, suggestions or complaints were appropriately actioned.

We found the provider had audits in place to check that the systems at the home were being followed and people were receiving appropriate care and support.

Inspection carried out on 24 April 2014

During a routine inspection

The Hollies is a care home in Hessle in East Yorkshire and provides accommodation and care for 48 older people. The home is divided into two units, 'Humber' which provides support for people who require residential care and who may have a mild cognitive impairment and 'Tranby' which specialises in support for people with more complex dementia related conditions.

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.

Inspection carried out on 6 September 2013

During an inspection to make sure that the improvements required had been made

The provider was meeting this standard.

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.

Inspection carried out on 12 June 2013

During a routine inspection

We visited The Hollies on 12 June 2013. One purpose of this visit was to follow up on concerns that had been identified regarding the administration of medicines at our previous visit in January 2013 and to ensure actions had been taken to ensure improvements had been made. This visit also incorporated a scheduled annual inspection.

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.

Inspection carried out on 10 January 2013

During a routine inspection

During our inspection visit on 10 January 2013 we spoke with three people about their experience of using the service. The people we spoke with were complimentary about the staff. One person told us that “Staff are good, caring and cooperative.” Another person said “Staff are good at making you feel better by making you laugh” and that “I can raise any concerns with the manager”.

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.

Inspection carried out on 22 November 2011

During a routine inspection

We spoke with four people about living in the home. They told us they felt very included and they said that they made choices and decisions for themselves whenever possible.

People told us they were well cared for, that the staff were pleasant and helpful and that where possible they were encouraged to remain independent.

They told us that their needs were met quite satisfactorily by the staff, visiting professionals and visiting community services.

Some people told us they were usually quite active, but would have liked to go out more often and would have liked to have some more people to talk with in order to vary the company they kept.