Archived: Hollyrood

Hollyrood is a residential care home that provides care and accommodation for people with autism and learning disabilities. It was registered for the support of up to 25 people. 14 people were living at the service on the day of our inspection.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was registered before Registering the Right Support was developed. The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The guidance ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning

disabilities and/or autism to live meaningful lives that include control, choice, and independence.

This service was able to demonstrate how they were meeting most of the underpinning principles of right support, right care, right culture.

Right support:

• The service was much bigger than most domestic style properties. The provider had tried to mitigate the effects of the environment by dividing the service into smaller living areas and supporting people to increase their access to community facilities. Further work was planned to provide more suitable accommodation. People received personalised care and support specific to their needs and preferences. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Staff understood the risks associated with the people they supported. Risk assessments provided guidance for staff about individual and environmental risks. People received their medicines safely, when they needed them.

Right care:

• Care was person-centred and promoted people’s dignity, privacy and human rights. People’s individual needs and choices were recognised, and respected. This had been effective in supporting people to achieve goals and encouraged them to learn and grow as individuals. People were supported to have 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.

Right culture:

• Despite the need to keep people safe during the COVID-19 pandemic taking priority, the provider and staff had worked hard to develop good leadership. Quality monitoring systems had been embedded and morale was good amongst the staff team. We received positive feedback in relation to the care people received and how the service was run. One relative told us, “[My relative] has been at the home a long time, he has improved no end. When I think about the things he’s doing now to what he used to be able to do, I’m really pleased”.

Due to the COVID-19 pandemic, the provider had ensured that appropriate infection control procedures for the pandemic were in place to keep people safe. This included increased cleaning and ensuring adequate supplies of personal protective equipment (PPE) were available. Staff completed training in relation to COVID-19. We were assured the provider managed infection prevention and control through the COVID-19 pandemic.

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

Rating at last inspection

The last rating for this service was requires improvement (published 3 February 2020) and there was a breach 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, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection in light of concerns we had received in respect to the care people were receiving. Concerns included, infection control, staffing levels and a negative and closed culture at the service. A decision was made for us to inspect and examine those risks. Therefore, this report covers our findings in relation to the Key Questions: Is it Safe? and Is it Well-led? We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the key question of effective, caring and responsive. We therefore did not inspect these. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has improved to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hollyrood on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hollyrood is a residential care home providing accommodation and personal care for up to 25 people with autism. The registered manager reported at the time of the inspection they were only using 15 bedrooms and would not accommodate more people.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service was institutional and much bigger than most domestic style properties. The provider had tried to mitigate the effects of the environment by dividing the service into smaller living areas and supporting people to increase their access to community facilities. Further work was planned to provide more suitable accommodation for people.

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

The systems to support people to take the medicines they were prescribed were not safe and increased the risk that people may be harmed. Staff did not keep accurate records of the medicines they supported people to take.

Records of support for people were not always completed in ways that maintained their dignity and privacy.

The systems for checking how the service was operating did not always identify shortfalls. Checks had been completed but did not identify poor medicines practice or issues with people’s records.

Relatives were happy with the support people received at Hollyrood and said they felt they were safe. Staff knew what to do to keep people safe and were confident any concerns would be taken seriously.

Risks to people’s well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively.

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 had support plans that were specific to them. These plans were reviewed with people and their relatives regularly, to ensure they were up to date. The plans contained clear information about people’s communication needs. Staff had worked with people to ensure information was accessible for them and they used the communication methods people preferred.

People were supported to maintain good diet and access the health services they needed.

The registered manager provided good support for staff to be able to do their job effectively.

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

Rating at last inspection

The last rating for this service was good (published 22 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Caring and Well-led sections of this full report.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Hollyrood is a service for a maximum of 25 adults with learning disabilities and complex needs including autism and challenging behaviour. On the day of the inspection there were 22 people using the service. The accommodation comprised of one flat and four distinct areas referred to as ‘houses’, each of which has its own kitchen, communal lounge and staff room. Each ‘house’ also has a dedicated staff team. There are extensive secure grounds and a range of other buildings including, an activities room, gym, sensory room, woodwork room and weaving room.

At the last inspection on 14 July 2014 the service was rated Good. At this inspection we found the service remained Good

Relatives and staff spoke highly of the service and felt that it was well-led. Since the last inspection a new manager had been employed and registered with the Care Quality Commission. Without exception everyone told us the registered manager had implemented changes that had a positive impact on people. A staff member told us “There’s very much more emphasis on people as individuals, so more person centred; there’s also a greater emphasis of working with staff”. A relative commented “The management is excellent as far as I’m concerned; always open to talk, open to positive and negative feedback.”

People remained to be supported by kind and caring staff who knew people well. People were observed to be relaxed with staff. They were seen to be happy and comfortable with the support provided and staff were kind and caring in their approach. One relative told us “Staff are kind, they know my relative and vice-versa; there is an ethos of respect”. Another relative told us “What’s so important is that staff know how to manage (person’s name), what their flash points are and how to extinguish them. Consistency is the key”.

People’s individual needs were assessed and planned for. They continued to be supported to participate in wide range of activities in line with their personal preferences and to maintain their independence. A relative told us “They enjoy the activities; they go out a lot into the community, go for a walk daily, sometimes go out for meals, goes to Brighton and to do their weekly shopping with staff support. They do woodwork as well, go to the gym and go to the cinema sometimes. They have an enjoyable life”.

People continued to be supported to maintain good health, access health care services and supported to maintain a varied and nutritious diet. One relative commented “The food seems sufficient in quantity and healthy. They try and make sure my relative gets what they want when they want. They are relaxed about what to eat and when”.

People received safe support in a secure environment. One relative told us “My relative is very safe. It’s secure, they can’t wander out onto the street”. People remained protected from the risk of abuse because staff understood how to identify and report it. People were supported to get their medicine safely and when they needed it.

Staff received the training and support they needed to undertake their roles and meet people’s specialist needs. A member of staff commented “I had an induction and training before I worked in the houses. I was introduced to everyone and shadowed staff before I worked on my own. Agency staff have to do an induction too”. A relative told us “They are proactive and work hard to get a new person up to speed”.

There were sufficient number of skilled staff on duty to meet people’s needs and provide effective care. A relative told us “Generally we never have to worry about the number of staff on duty. People have one to one staffing. It is two to one staffing when out in the community”.

The registered manager was aware of their legal responsibilities and kept up to date with good practice. Accident and incidents continued to be recorded and monitored to identify trends and themes. Records had been audited and were gaps had been identified action had been taken to rectify this.

Further information is in the detailed findings below.

We saw that people's needs were assessed and that care plans provided guidance for staff in meeting their needs. We found that the care provided had met their needs safely and had taken into account their preferences. We saw that people who used the service were able to express their choices. Staff told us that opening kitchen and laundry services on each unit had increased people's independence. We observed that people responded well to the support provided and there was good interaction with staff. One person told us that their relative who used the service 'Gets on with the staff team and they get on with them.'

Staff told us they received the support they needed to carry out their work, including relevant training and supervision. Records showed that most staff were up to date with their annual training.

We found that arrangements were in place for the safe administration of medicines and that the service carried out checks and took action to ensure procedures were correctly followed.

We found that the provider had carried out regular checks on the service and acted on their findings.

We spoke with five staff members that all enjoyed working at the service. One staff member told us 'We promote people to be individuals and everything that we do is for the people living here'. Another staff member told us 'We give people the best quality of life that we can for themselves and for their families'.

We spoke with the relative of a person that used the service. They told us that they were more than happy to raise any concerns that they had about the service and that they felt that the staff had a large impact on the standard of the service and well being of people that used the service.

We found that people's needs and behaviours were assessed and support plans had been put in place to ensure that people's needs were met and that staff knew how to consistently support people with their behaviours. We observed staff following people's support guidelines and we found that people had an activities plan that was specific to their interests.

We found that the provider had a detailed complaints policy and medication policy in place. However we had concerns about the recording of stock medication. We also had concerns as not all staff members had received adequate training and not all staff had not received an annual appraisal.