Archived: Hollydene EMI Rest Home

Updated 7 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the 4 October 2016 and was unannounced. The inspection was carried out by two adult social care inspectors.

Prior to the inspection visit we gathered information from a number of sources. We also looked at the information received about the service from notifications sent to the Care Quality Commission by the manager. We also looked at the information sent to us by the manager on the provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also spoke with the local authority and other professionals supporting people at the service, to gain further information about the service.

We spoke with four people who used the service and two relatives, and spent time observing staff supporting with people.

We spoke with three care workers, one team leader, the cook and the registered manager. We looked at documentation relating to people who used the service, staff and the management of the service. We looked at three people’s care and support records, including the plans of their care. We saw the systems used to manage people’s medication, including the storage and records kept. We also looked at the quality assurance systems to check if they were robust and identified areas for improvement.

Updated 7 December 2016

The inspection took place on 14 October 2016 and was unannounced. The home was previously inspected in February 2015 and the service was meeting the regulations we looked at.

Hollydene Rest Home is a residential care home providing care and support for people living with dementia. The home can accommodate up to 25 people. When we inspected the home there were 22 people using the service.

The service had a registered manager in post at the time of our inspection. 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.

People who used the service, and their relatives we spoke with, told us they were happy with how care and support was provided at the home. They spoke positively about the staff and the way the home was managed. However, this was not always reflected in what we saw.

We saw there were systems in place to protect people from the risk of harm. However, some staff we spoke with were not knowledgeable about safeguarding people and were not able to explain the procedures to follow should an allegation of abuse be made.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, these were not always followed.

During our inspection we observed people had to wait at times for assistance and staff were not always present in communal areas to ensure people’s safety. Staff told us at times there was only two care staff and a team leader on duty and this was not enough staff to be able to meet people’s needs.

Systems were in place to ensure people received their medications in a safe and timely way from staff who were appropriately trained. However, we identified these were not always followed and staff did not follow best practice when dispensing medicines.

We found the provider had a safe and effective system in place for employing new staff. We looked at a selection of staff files and found pre-employment checks such as, two references, and a satisfactory Disclosure and Barring Service (DBS) check, were mainly in place.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager had a good understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However, some staff we spoke with did not understand what DoLS was and how it affected people they supported.

People were offered a balanced diet sufficient to maintain a balanced diet and adequate hydration. However, we observed staff did not always give appropriate support with meals to people who used the service. We found people had lost weight and their nutritional needs had not been met.

We looked at care files, although peoples choices were documented the care we saw delivered and documented did not always reflect people’s care and support needs choices or preferences.

We spoke with the registered manager about staff training and found training provided was mainly completed by eLearning; however certain subjects such as manual handling were completed face to face. We looked at the training matrix, which was a record of staff training. We found that training had not always taken place. For example, only four out of eight care workers had completed moving and handling training.

The environment could be improved to make it more dementia friendly. Communal areas and corridors were not dementia friendly. Signage was small, basic and misleading and did not always enable people to orientate around the home. For example we saw a sign on a fire door saying ‘garden’ but the door was locked.

People we spoke with all told us staff were kind, caring and thoughtful. A relative we spoke with said, “couldn’t get better care, we are happy.” However, this did not always reflect what we saw. During our visit we spent time in communal areas observing people who used the service. We saw some positive interactions between people and staff, but also saw some poor and task orientated interactions between staff and the people they were supporting. Staff were not unkind in their approach but lacked understanding of looking after people who were living with dementia.

We looked at three people’s care records in detail, who used the service at the time of the inspection. We found that care plans identified people’s needs, setting out how to support each person so that their individual needs were met. However, these were not always reviewed when people’s needs changed. We also found some old records which made it confusing to understand what was the most up to date information to be followed.

The provider had a complaints procedure and the registered manager kept a log of complaints and the outcome. We saw the registered manager had dealt with complaints in line with the company policy.

We saw audits were completed to ensure the quality of the service, however these were not always effective. There was little evidence that people who used the service and their relatives had a voice and given the opportunity to contribute ideas to the service. Accidents and incidents were logged but were not always analysed in enough detail.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.