Archived: The Hollies

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant people’s outcomes were not consistently good.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People had lived with the registered manager for many years, and overall, people’s health needs were assessed. Some people’s assessed needs had changed and been identified and acted on by the registered manager and volunteer manager. For example, 1 person had changes in their memory, and a referral had been arranged for them to the memory clinic. Another person was having hospital consultations related to a change in their health. However, some improvement was needed to record information in their plans of care.

Improvements were also needed to ensure people’s plans of care contained all the relevant information about people’s health, care and support needs and risk management. The volunteer manager told us, “I have been working on updating and putting together new plans of care for people following the local authority visit earlier this year.” They showed us work in progress of newer plans of care which contained detail, for example, of a person’s routine for the day. However, there was no evidence of people being involved in these updates in their plan of care.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always deliver care in line with legislation and current evidence-based good practice and standards.

Improvement was needed in the registered manager and volunteer staff undertaking training to ensure their skills were up to date and care was delivered in line with evidence based best practice. For example, the registered manager told us 1 person preferred not to sit and eat meals at a table, but to walk about the home with finger food and only ate when they felt like it. The registered manager told us they weighed this person to check they were not losing weight, but no record was kept of this. There was no nutritional care plan to ensure this person’s hydration and nutritional needs were consistently met. Evidence-based practice promotes record keeping so an oversight of any fluctuations can be monitored effectively.

One person told us they enjoyed their food and the registered manager assured us people had daily choices about what they wished to eat and drink. We observed fruit and vegetables were available and fridges and freezers were well-stocked.

The provider did not always work well across teams and services to support people.

The registered manager and volunteer manager shared details of feedback they had received from a local authority visit. The volunteer manager told us, “It was about March, this year they came and they did suggest about training and that we should have DBS checks, but we haven’t done anything about that yet. But we have started daily notes for people and improving care plans.” This meant that whilst advice and guidance had been given to the registered manager from a commissioning team, this had not always been acted on in a timely way to ensure teams and services worked together and further improvement were needed to achieve this. Commissioning teams work within the local authority to purchase packages of care for people.

The provider did not always support people to manage their health and wellbeing to maximise their independence, choice and control. Staff did not always support people to live healthier lives and where possible, reduce their future needs for care and support.

Improvement was needed in people’s plans of care to reflect how their independence, choice and control should be promoted. During our visit, we did not observe examples of how the registered manager or volunteer manager promoted people’s independence, however, the volunteer manager gave us an example related to 1 person. They told us, “[Name] is very independent, but their mobility is declining a little, so when we are out in the community, I offer them my arm and do this is a gentle way, so they think it is their idea.”

The registered manager shared their concerns about 1 person being reluctant to accept support with daily oral care, though assured us dental visits took place and we saw annual checks were recorded. We suggested it might be useful to discuss any alternative approaches, with the dental team, for when this person declined support with oral care.

The registered manager and volunteer manager told us they supported people to attend GP and hospital appointments when needed. Two people attend ‘well person health checks’ annually. However, the registered manager told us 1 person did not want to attend this. Whilst there was no evidence of any best interests’ meeting being considered to agree this, both managers told us they supported this person with personal care and checked for any lumps or bumps during this time and if they had any concerns whatsoever, they would seek professional guidance.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent.

There was no effective system in place to monitor the effectiveness of people’s care. For example, care records and informal checks did not evidence that people’s health and wellbeing was routinely being monitored. Without clear systems for monitoring outcomes, the registered manager could not effectively demonstrate that support provided was achieving positive outcomes for people or identify where changes were needed to improve people's quality of life and wellbeing.

People’s plans of care did not currently include future goals, however the registered manager and volunteer manager told us about things people liked to do. The volunteer manager added this was something they could add into the new plans of care they were working on. Whilst there was no current information about how people had been involved in agreeing their activities and how they spent their time, the volunteer manager assured us people be involved in planning and agreeing future goals and outcomes to aspire to.

The provider did not always tell people about their rights around consent. Consent was respected when delivering person-centred care and treatment.

The registered manager had installed CCTV cameras externally and internally in the home. They told us this was a live feed to their phone and the volunteer manager’s and was purely for security reasons. We found no evidence of people living at the home being made aware of this, the purpose of the CCTV or giving their consent for this. The registered manager could not demonstrate people had been consulted about the use of CCTV or that they understood why monitoring equipment was being used within their home environment. This reduced assurance that people's rights, privacy and consent had been fully considered.

People appeared at ease with the registered manager, volunteer manager and maintenance man who were present during our visit. We observed the volunteer manager and handy man engaged in conversation with 1 person and took time to listen to the person’s responses.

Both managers explained to people who we were and the purpose of our visit and asked their consent before we went into their bedrooms. This showed staff respected people’s home, involved them in some decisions and sought their consent.