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Hollyrood Requires improvement

Reports


Inspection carried out on 26 November 2019

During a routine inspection

About the service

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.

Inspection carried out on 4 May 2017

During a routine inspection

The inspection took place on the 4 May 2017 and was announced.

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 ga

Inspection carried out on 18 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory feedback. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection.

Hollyrood provides residential care for adults with autism, supporting people with complex behavioural, communication and social needs. On site there were four units or houses which provide support for up to 25 people. At the time of our inspection, there were 24 people accommodated across Pinewood, Ashwood, Cedarwood and Oakwood units. People who used the service had a range of complex needs, including social and communication difficulties, and required a high level of support, either 1:1 or 2:1. The service employed in excess of 140 staff to meet people's needs safely. There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

We observed people as they engaged in activities or moved around the home. We saw that staff supported them in an unobtrusive, friendly, dignified and reassuring manner. Safety risks had been identified in the home and people were encouraged to be as independent as possible. Some people were able to prepare and cook their own meals, supported by staff in the kitchen. Care plans included detailed information about people's complex needs and there were clear plans in place that showed staff how these needs should be met. People had their own allocated keyworker who co-ordinated all aspects of their care. People were involved in their assessments and reviews and, where they were able, to express their preferences and choices. Potential risks were identified and planned for and action that was required to be taken. People's care plans were regularly reviewed and this demonstrated that their most up-to-date needs were met. Relatives confirmed that they had been involved in reviews of their family member's care. For example, one said, "Hollyrood is excellent at looking after [X]".

Meetings were organised for people so that they had the opportunity to communicate what mattered to them. We saw that people's rooms were personalised and furnished in line with their personal preferences. Multi-disciplinary meetings comprising clinical and care staff were organised quarterly so that people's care and support could be reviewed. Staff received essential training as well as planned additional training. They completed an induction programme and work shadowed other staff to learn about their role.

People had activities scheduled on a daily basis and many accessed the Learning Centre. The Centre provided a range of activities and opportunities for people to be creative, achieve qualifications, keep fit and have fun. They were also encouraged to participate in the community and could undertake work or volunteering or attend college. People were supported by staff who knew them well. Hollyrood had a complaints policy and procedures in place and families were asked for their views about the service through questionnaires.

The registered manager was well established and was supported by assistant managers who each had responsibility for different areas. People were encouraged to be as independent as possible and were supported by staff to engage with a range of daily activities that were tailored to meet their needs and preferences. Staff meetings were held regularly and staff were able to feedback their views through questionnaires. We observed that staff were caring of each other as well as of residents and that communication was productive, open and friendly. One health professional said, "Dedicated staff will go the extra mile to help people improve. If I need to speak with a support worker they will spend time talking outside of paid hours".

Inspection carried out on 24 July 2013

During a routine inspection

There were nineteen people living at the service on the day of our visit. We used a number of different methods to help us understand the experiences of people who used the service. This included observing people in their interactions with staff and we spoke with two relatives of people who used the service, the manager and six staff members.

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.

Inspection carried out on 22, 23 March 2013

During a routine inspection

We spoke with two people that used the service. They were both happy with the care that they received and they felt safe.

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.

During a routine inspection

In surveys people said that they were offered choices and made their own choices. People thought the care was good, that they felt safe and had good relationships with staff.

Reports under our old system of regulation (including those from before CQC was created)