Archived: Hollydene EMI Rest Home

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.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, spending time with people who lived at the home, talking with their relatives, staff providing support, talking with health and social care professionals and looking at records.

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

Is the service safe?

Effective arrangements were not in place to ensure the people living at the home were protected against the risks of receiving care and support that was inappropriate or unsafe. Risk assessments had not been undertaken for people who used bedrails. Care plans did not always reflect the findings of risk assessments. Care plans had not been revised to capture the risks identified following assessments carried out by external health professionals. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People living at the home were supported to maintain good health and had access to a range of healthcare services when they needed it.

A Deprivation of Liberty Safeguards (DoLS) application had been appropriately completed for a person living at the home to ensure their safety. However, evidence was not in place to demonstrate that the service fully protected the rights and welfare of people in accordance with the Mental Capacity Act (2005). Mental capacity assessments were inconsistently completed. The care records did not clearly show that people had given valid consent to their care. People living at the home and/or their families had not been routinely involved in the development and review of care plans. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

During the inspection we observed staff supporting people with their individual needs in a kind, dignified and respectful way. People seemed to have a good rapport with the staff. With reference to the staff, one of the people living there said, 'For the most part they are patient and understanding.'

Is the service responsive?

We observed staff providing personalised care to people during the inspection.

Families told us the manager and staff communicated with them regarding any changes to their relative's needs. A family member said, 'They [staff] keep me up-to-date with what's going on with my relative'.

Is the service well-led?

Processes were in place for people living at the home and their families to express their views about the quality of the service. These included meetings for people living at the home and an annual feedback questionnaire.

Systems were in place for regularly monitoring the quality of the service. Some of the systems were not effective as they had not highlighted some of the concerns we identified at the inspection. They included the care record audit and medication audit. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The people we spoke with were positive about their care and support. They told us the staff were kind. They said they could decide how to spend their day and staff respected their decisions. One relative said, 'Staff speak very kindly [to people living there]. I couldn't ask for more.'

From our review of the care plans and confirmed by our discussions with staff, staff recognised that need for people to understand what was happening so they accepted the care and/or support they needed. Furthermore, the care documentation we looked at was individualised and included sufficient detail for staff to understand a person's individualised needs. Care records reflected people's current care needs.

People were satisfied with the meals and said they got plenty to eat and drink and we could see they had a choice of meals each day.

We observed that people were comfortable and relaxed. We noted that staff interacted with people in a kind and gentle way when supporting them with their personal care or nutritional needs.

Feedback from people living at the home, and their relatives, about the quality of the service provided was gained through an annual survey; the last one was completed in May 2012. A complaints process was displayed in the foyer.

Care records informed us that assessments and care plans had been developed for each person. We observed that risk assessments and care plans did not always reflect the current care and support people were receiving.

Arrangements were in place for monitoring the safety of the environment. A refurbishment plan was in progress and we could see that the two lounges, dining room and some of the bedrooms had been refurbished.

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Effective processes were in place for the recruitment of new staff.