Holly Bank Care Home

Holly Bank Care Home is a care home providing accommodation for up to 31 older people, including people living with dementia. At the time of the inspection there were 19 people living at the home.

People’s experience of using this service and what we found

We received information raising concerns about the support for people during hot weather and the suitability of the environment. We wrote to the provider and asked for information around their systems and processes. This included 'hot-weather' protocols, assessment of people's needs, staff awareness and policy and procedure for managing people’s safety (safeguards). We inspected the home to see how care and support was being provided against the information the provider had shared with us.

During the inspection we noted people were offered drinks and there was a choice of drinks available and within easy reach. Hydration charts had been completed by staff. When there was a concern people were not drinking enough, they were monitored with action taken in appropriate cases.

Heating equipment was working properly and had been inspected by an expert and certified as being safe and effective.

Whilst we did not identify any additional concerns in relation to Holly Bank Care Home, we found that the provider’s progression of environmental improvements required updating. Some areas of the home required refurbishment. We have made a recommendation about this.

The manager and provider representative was working closely with the local safeguarding team to reflect on the current practice within the service to ensure that lessons were learned and to make improvements where needed. Rating at last inspection The last rating for this service was Good (published 15 June 2022).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about the support for people during hot weather and the suitability of the environment.. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the safe section of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holly Bank Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Holly Bank is a residential care home registered to accommodate up to 31 people in need of personal care. Accommodation is provided over three floors with rooms including some with en-suite facilities. On the days of the inspection there were 13 people living in the home.

People’s experience of using this service and what we found

The provider needed to review their recruitment processes. They did not always meet current legislation and guidelines. There were issues around management oversight. Other senior staff were providing this cover in the absence of a manager. In these circumstances, we noted some shortfalls with staffing levels. We have made recommendations about staffing levels and safe recruitment in the 'Safe' section of the report.

People's care records and risk assessments required some improvements. They did not always reflect people's current position and mental capacity status. These issues were resolved during the inspection.

People did receive their medicines as prescribed by their health care professionals.

Infection, Prevention and Control (IPC) processes were generally appropriate. We had some concerns about the robustness of processes when professional visitors attended the home. This was corrected during the inspection and we were assured about the service's ability to mitigate the transmission of infections.

Staff were competent with safeguarding processes and knew how to protect people from abuse. A relative said their loved one felt safe in the home and were trusting of staff and management. We observed good practices and interactions between staff, the provider representative and people during the inspection. The service's safeguarding processes were robust.

Staff supported people to have access to healthcare professionals and specialist support and the service worked well with external professionals. Healthcare professionals were particularly complementary about the care and support people received at the home.

People told us they felt cared for and were happy with the service they received. Relatives said staff were kind and caring and treated their loved ones well. At inspection, we noted good interactions between people, management and staff.

People and staff were happy with the way the service was managed. People's views and opinions of the service were sought and acted on.

In part, the inspection was as a result of concerns around an environmental issue and the subsequent temporary re-location of people. It was established the service could not have foreseen these issues. Maintenance processes were in place and could not have expected to warn of the likelihood of a concern in this area.

The provider acted during and immediately after the inspection to address the issues we found. This included increasing the staffing team and implementing improved checks and reviews.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was 'Good' (published 15 July 2019).

Why we inspected

We received concerns following a water leak in the home and the subsequent relocation of people. Residents were temporarily relocated to another home. It was accepted relocation was only used as a last resort and in the best interests of people in these particular circumstances. These issues raised questions of the provider's preparedness to deal with emergencies and the general maintenance of the home. As a result, we undertook a focused inspection to review the key questions of 'Safe' and 'Well-led' only. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the 'Safe' key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 'Holly Bank' on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

We found the following examples of good practice.

Staff were trained in infection prevention and control and using Personal Protective Equipment (PPE) safely.The provider had ensured sufficient quantities of PPE were available.

The manager ensured clear information about maintaining social distancing was in place to guide staff and visitors. They had rearranged communal and dining areas in the home to support social distancing.

The manager had followed government guidance about visiting. They had supported relatives to be able to visit people and stay in touch. Consent for Covid-19 testing and vaccination had been obtained from people, with appropriate support from their representatives, families and professionals.

The manager followed best practice around safe admissions when people moved into the home.

The manager had arranged for regular COVID-19 testing for staff and people who lived in the home.

The staff team kept the home uncluttered, clean and hygienic. Audits were done. Frequently touched surfaces were cleaned regularly throughout the day to reduce the risk of infection and rooms were deep cleaned.

The manager had reviewed staffing arrangements. Staff were allocated to consistently work in specific areas of the home to reduce the risk of transmission of infection.

The provider had contingency plans in place to ensure the safety of the service during the pandemic.

Holly Bank Care Home is a residential care home that provides accommodation and personal care for up to 31 older people, some of whom are living with dementia. At the time of this inspection there were 21 people living there. The building comprises of a pair of semi-detached Victorian villas that have been combined, adapted and extended for its current use as a care home. The home has three floors with a lift for access between floors.

People’s experience of using this service:

People we spoke with told us the service had improved since our last inspection. One relative said there had been a number of changes that included some different staff being employed and improvements to the environment. A staff member told us that since the last inspection, “There’s been some changes to the staff and we are still recruiting new staff.”

The provider had implemented a new system to determine peoples’ levels of need in relation to the level of support required from staff. This supported the registered manager in identifying the times of day where the greatest number of staff should be on shift.

The provider had an ongoing recruitment drive to attract new staff to the service, in the interim, to ensure people were fully supported they were using regular agency staff.

Since the last inspection the provider had implemented an electronic care planning and records system. This had improved the quality of records held about people. The registered manager told us this had reduced the amount of time staff had to spend completing records and allowed them more quality time to spend with people.

There were improved systems established for completing a variety of audits that demonstrated the service was monitored regularly and was a safe environment for people to live in.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Medicines were stored and managed safely and people received their medicines as they had been prescribed.

Since the last inspection the provider had employed an activity coordinator who supported people with a varied activity programme.

People we spoke with were very happy with the service they received and told us they felt well cared for. One person said, “You cannot fault anything here, I think it’s perfect.” A relative told us, “We couldn’t have picked a better home, the staff are so lovely, and I see people are happy here. The atmosphere is so welcoming and it’s homely.”

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 4 June 2018). The overall rating for this service has improved to good.

Why we inspected:

This was a planned inspection based on the previous rating.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Holly Bank Care Home is a care home in Arnside. It is registered to care for up to 31 people assessed as needing residential care. The building comprises a pair of semi-detached Victorian villas that have been combined, adapted and extended for its current use as a care home. The home has three floors with a lift for access between floors. At the time of the inspection visit 23 people were receiving care and support at the home.

Holly Bank Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in place. 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. The registered manager was supported at the home by a manager. The manager had responsibilities for the day to day running of the home.

Holly Bank Care Home was last inspected December 2016 and was rated as requires improvement. During that inspection process we made recommendations in regards to staff training and requirements relating to the Mental Capacity Act.

We used this inspection visit carried out in February 2018 to check to see if the recommendations had been acted upon to ensure improvements had been made. We found some but not all improvements had been made. Work was on-going to ensure documentation maintained in relation to MCA reflected good practice. The registered provider had reviewed staff training and had invested in an on-line training package so that staff training could be provided and monitored. In addition staff had been provided with face to face training.

Although we noted some improvements we found staffing levels and deployment of staffing was not always effective to ensure the safe care of people who lived at the home. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We found recruitment procedures were not robust. Pre-employment checks had not been consistently carried out to ensure fit and proper people were employed. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We found that paperwork maintained by staff at the home was not always accurate, complete and up to date. Auditing systems implemented at the home were sometimes ineffective and had failed to pick up concerns we identified during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Arrangements were in place for managing and administering medicines. However these were not always consistently carried out to ensure good practice guidelines were followed. We have made a recommendation about this.

People’s healthcare needs were monitored and managed appropriately by the service. People told us guidance was sought from health professionals when appropriate. We saw evidence of partnership working with multi-disciplinary professionals to improve health outcomes for people who lived at the home.

People who lived at the home and relatives told us relationships with staff were sometimes limited due to staff not having time to respond to people’s needs and due to communication barriers.

There was an emphasis on promoting independence for people who lived at the home.

Arrangements were in place to protect people from risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

We saw evidence risk was appropriately managed and addressed at the home. This included managing the risk of people falling and managing behaviours which can challenge a service.

Infection prevention and control processes were embedded into service delivery. People praised the standards of hygiene at the home.

End of life care had been discussed with people and their relatives. Provisions were in place to promote a dignified and pain free death.

Feedback was routinely sought. We saw feedback had been received through residents meetings and formal questionnaires.

Care plans were person centred and took the needs and considerations of the person into account. People who lived at the home said they were involved in the care planning process. People were asked to consent to having care and support provided. Care plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff we spoke with were aware of the principles should someone require being deprived of their liberty. Good practice guidelines were consistently implemented to ensure all principles of the Mental Capacity Act (MCA) 2005, were lawfully respected.

People were happy with the variety, quality and choice of meals available to them. People’s nutritional needs were addressed and monitored.

People were offered opportunities to carry out activities of their own choosing. Staff understood the importance of encouraging and motivating people to be active. Activities were person centred, innovative and creative.

People who lived at the home praised the living standards offered at the home. The home was described as a ‘home from home.’ Bedrooms had been personalised and individualised with people. Premises and equipment were appropriately maintained.

The registered manager was aware of their role and statutory responsibilities and demonstrated a commitment to continuous improvement at the home.

This is the third time the service has been rated as requires improvement.

During this inspection we found that notifications required to be provided to the commission had been made when necessary.

Holly Bank Care Home provides accommodation for up to 31 people who need personal care. The home is situated in the village of Arnside on the coast line of Morecambe Bay. The building has been adapted and extended for its current use as a care home. Accommodation is provided on two floors and there is a passenger lift to help people to access the first floor.

There was a registered manager. A registered manager is a person who has registered with the (CQC) 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. The provider had made arrangements for the home to be supported by a manager that was registered with CQC from another of their homes pending registration of a new manager.

The numbers of staff on shift during the day had not always been consistent this was because some of the care staff had been covering the role of a full time cook. The provider was in the process of recruiting more staff to work at the home.

We found a bedrail that was in use that was not being safely managed. The type of bedrail in use was not specific to the bed it had been attached to and we could not see any safety checks had been regularly completed. The provider immediately rectified this during the inspection by removing the bedrail from use.

Staff told us they had received regular supervision to support them in their roles. However records provided relating to staff training indicated that some staff required elements of training to be updated to refresh their skills and knowledge. Some topics of refresher training in cores skills such as health and safety, food handling and hygiene, first aid and the safeguarding of adults for some staff had expired.

We have made a recommendation that the provider ensures that staff receive refresher training in the identified timescales.

Decisions made in people’s best interests and the consent required about the use of restrictive measures that may deprive people of their liberties had not always been obtained appropriately.

We have made a recommendation that the provider review their best interest decision making and obtaining consent process to ensure it follows guidance outlined in the Mental Capacity Act 2005 when using any restrictive measures.

We observed staff displayed caring and meaningful interactions with people and they were treated with respect. We observed people’s dignity and privacy were actively promoted by the staff supporting them.

People living in and visiting the home spoke highly of the staff and told us they were very happy with their care and support.

The recruitment procedures demonstrated that the provider operated a safe recruitment procedure to ensure that fit and proper persons had been employed.

Medicines were being administered and recorded appropriately and were being kept safely.

A varied range of activities were made available to people living in the home.

Some people had limited verbal communication and understanding and were unable to hold a conversation with us. To help us understand their experiences of living in the home we observed the care they received and the interaction by staff. Those people we did speak with told us they liked living at Holly Bank. Comments included, 'I have been here for a few years. I love living here it's very relaxed'. Also, 'I love it here at this time of year. All the Christmas decorations and parties it's great'.

In order to gain a general overview of how care was being delivered around the home, we spent time in all the communal and dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We were shown around the building and checked maintenance records for fire, water, gas, equipment and electrical safety. They met with statutory requirements. We spoke with told us they liked the facilities available to them at the home. This included comments about individual rooms. One person said, 'I have everything I need in here its home from home'. Another person told us they loved spending time in the lounge as the views over the bay were beautiful.