Hollybank Nursing Home

Hollybank Nursing Home is a 'care home’. It provides nursing and personal care in one adapted building for up to 30 older people, including some who live with dementia. It accommodates people over 2 floors and it has got a specious garden. At the time of our inspection there were 25 people using the service.

People’s experience of the service and what we found

People were not always fully protected from the risk of harm because the provider's approach to risk management was not consistent. There was an increased risk that people could be harmed because potential hazards and risks were not always identified and there were no clear strategies to reduce them, this included the risk of infection control. Information about risks and safety was not always clearly documented.

People’s human and legal rights were not fully understood, because consent to care and treatment had not been obtained in line with legislation and guidance, including the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. People’s assessments of needs were not always comprehensive and some people’s care plans lacked important details about how to deliver care and support.

Governance and quality assurance at the service were not always effective. The provider’s systems and processes such as regular audits of the home were not sufficiently robust in monitoring and improving the quality and safety of the service. Saff did not have access to up to date policies and procedures. This impacted their knowledge of current best practice guidance and put people at increased risk of harm.

People felt protected from abuse, neglect and discrimination.

People were supported by adequately trained, sufficient number of staff. People, their relatives and staff all confirmed this. People were supported with their medicines safely by the nursing staff. When people required additional support from external services, they were promptly referred by staff who were skilled in recognising when people’s needs change.

People enjoyed their meal time experience and they had access to food and drinks of their choice at all times. People’s diet was tailored to their individual needs and preferences.

People and their relatives found the home to be a homely and happy environment. Whilst the home was in need of cosmetic uplift, the communal areas and people’s bedrooms were suitable for people’s needs. There was also a large garden available for people.

People, their relative and staff spoke highly of the management team. They felt the home had an open culture, where the manager was available to support them and encouraged feedback, both positive and negative.

The provider worked effectively with other agencies. This included taking prompt actions in response to feedback.

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 30 June 2018].

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we found there was a concern with ensuring consent to care and treatment in line with law and guidance, so we widened the scope of the inspection to include the key question of effective. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement

We have identified breaches in relation to safe care and treatment, deprivation of liberty and good governance. Add paragraph space below

Please see the action we have told the provider to take at the end of this report. Add paragraph space below

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

Follow Up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in September 2016 we rated the service as Requires Improvement. People who used the service were not always protected from risks associated with unsafe staff recruitment procedures and inaccurate record keeping for people’s risk assessed care needs. At this inspection we found the improvements needed had been made.

We carried out this inspection on 18 April 2018. The inspection was unannounced. There were 25 people living at the service, including three people receiving nursing care. We rated the service as Good.

There was a registered manager 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The environment and care equipment was mostly clean, well maintained and free from observable hazards to people’s safety. Staff were provided with relevant equipment, guidance and training but had now always followed this to consistently ensure environmental cleanliness and hygiene. Action subsequently confirmed as taken by the provider, was sufficient to rectify this, which demonstrated lessons learned and improvements made when things go wrong. Emergency contingency plans were in place for staff to follow for likely foreseen emergencies to ensure people’s safety, which they understood.

People and relatives were confident people safety at the service. People were protected from the risk of harm or abuse by sufficient staff who were safely recruited and sufficiently deployed to provide people’s care.

Risks to people’s safety were assessed before they received care, accurately recorded and regularly reviewed. Staff understood and followed people’s related care requirements. This helped to reduce any known risks to people’s safety.

People’s medicines were safely managed. People were supported to take their medicines safely when they needed them. Staff were trained and assessed to ensure this.

People received effective care from staff who were trained and supported to ensure this. Staff obtained people’s consent for their care; and they ensured people’s safety, choice and best interests in a way that was lawful and in the least restrictive manner.

Staff understood people’s health conditions, related care needs and supported people to maintain and improve their health and nutrition. This was done in consultation with relevant external health professionals and staff followed their instructions for people’s care when required.

People were supported in the way they preferred and needed; to eat and drink sufficient amounts they enjoyed, which met with their dietary needs and choices.

Environmental facilities provided sufficient space and a number of aids and adaptations, which often enabled people to move around safely and independently. The provider has since confirmed their action to fully ensure this by additional environmental directional signage. People were comfortable and satisfied with their own rooms, which they could personalise to their own taste.

Staff were kind, caring and compassionate and had established good rapport and relationships with people and their relatives. People or their relevant representatives were informed and involved in agreeing people’s care and daily living arrangements at the service. Staff were trained and followed the provider’s stated care principles, which helped to ensure people’s dignity and rights.

People received timely, individualised care, which met with their daily living and lifestyle preferences. People were supported to participate and engage in home and spiritual life and with family and friends as they chose.

Staff knew people well and were mindful of their care needs and preferences. Staff knew how to support and communicate with people in a way that was meaningful and helpful to them.

Staff were trained and followed recognised principles to support people’s end of life care when needed. Partnership and cross sector working with external health professionals and similar type care providers, helped to ensure consistent practice and relevant information sharing concerned with people’s end of life care.

People and relatives were informed of how to make a complaint if they needed to and the provider regularly sought their views about the service. Recent findings from this showed overall satisfaction with the service.

The service was well managed and run. A range of management checks were mostly regularly operated to help inform and ensure the quality and safety of people’s care. Action was taken by the provider subsequent to our inspection to consistently ensure safe systems of cleanliness and hygiene and further support people’s environmental safety, orientation and independence.

Staff understood their role and responsibilities for people’s care; and they were confident and knew how to raise any related concerns if they needed to. Communication and record keeping procedures at the service met with nationally recognised guidance concerned with information handling and confidentiality.

The provider had sent us notifications about important events when they happened at the service and they conspicuously displayed their most recent inspection report; thereby following legal requirements.

At our last inspection on 20 January 2014, we found the provider was meeting all regulations.

Hollybank Nursing Home provides residential and nursing care for up to 30 older people, some of whom are living with dementia. The service is registered for 30 people and at the time of our inspection 29 people were living at the service.

The service had a registered manager who was also the provider of the service. 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.

Staff recruitment procedures were not always followed by the provider.

Following accidents, people’s risk assessments were not always updated.

People did not have a choice as whether to have a shower or a bath as there were only baths available. Some activities were provided, the frequency of these did not always meet everyone’s needs and expectations.

Staff were aware of how to protect people from the risk of abuse or avoidable harm. Staff had been provided with training such as the Mental Capacity Act (2005), Deprivation of Liberty Safeguards (DoLS) and safeguarding. Staff felt they received training to enable them to meet the needs of people. We have recommended the provider finds out more about the Deprivation of Liberty Safeguards process to ensure best practice and current guidance is followed.

Medicines were safely stored and administered by nursing staff; accurate records were kept. There were systems in place to ensure medicines were safely stored, administered and disposed of.

People received varied, sufficient and nutritious meals. People’s nutritional needs were assessed and records were maintained. People were monitored, referred to relevant professionals and recommendations were followed.

Care plans were reviewed and staff were provided with the information needed to meet people’s needs. Staff consulted with external health professionals to ensure people’s health and care needs were met. People and their relatives were happy with the care and support provided and everyone felt their individual needs were being met.

Staff demonstrated they knew the people well and were aware of the importance of treating them with dignity and respect. We observed staff supporting people with compassion and respect.

Care plans were personalised and developed based on assessments of people’s needs. People were encouraged to make decisions about daily living. Staff understood people’s likes, dislikes and preferred way of being supported.

A complaints procedure was available and people were confident any concerns would be taken seriously. People’s religious beliefs and faiths were respected.

The provider had a number of audits in place to ensure the service ran safely and effectively. The provider carried out surveys and questionnaires and ensured people had the opportunity to voice their thoughts about the service.

Where people were not able to make decisions, capacity assessments were completed and information about why others had made decisions on their behalf had been recorded. This meant people could be confident decisions had been made in their best interest.

People using the service had care records which recorded how they wanted to be supported. The information we read in the care records matched the care, support and treatment we saw being delivered to people.

We saw people were dressed in their own style. People told us if they needed support, the staff would help them to continue to take a pride in their appearance. One person told us, 'I've had my hair done today. The staff will help me keep it nice. You have to look your best.'

People could participate in activities in the home including attending religious services. One person told us, 'We have some fun here and it's good to be around great friends too.'

Family and friends we spoke with told us they could visit the home whenever they wanted to. People using the service told us family members were able to continue to provide care for them and were involved in providing support.

We saw that care plans were detailed and personalised. Risks were also assessed and managed, and consent was being appropriately obtained for people's care.

We found that people felt safe from abuse at the home. Asked if they felt safe at Hollybank, one person told us, "Yes, very. Completely." We found that staff were aware of how to protect people from abuse and report any concerns.

We saw that staff responded to people's needs promptly and found that the number of experienced staff on each shift was appropriate to provide people's care.

We found that a complaints procedure was in place and that people knew how to raise concerns at Hollybank.

Although the home was comfortable, clean and generally suitable for providing people's care, some of the door closure mechanisms were not working properly which meant that people were not fully protected in case of a fire occurring.