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The Hollies Requires improvement

Our latest inspection of The Hollies, published on 13 August 2014, showed it was meeting all the required standards.


Inspection carried out on 27 June 2019

During a routine inspection

About the service

The Hollies provides accommodation and care for adults with learning disabilities and autistic spectrum disorder.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service accommodated people in six purpose-built bungalows and three individual apartments within the same grounds. It was registered for the support of up to 21 people. At the time of the inspection 15 people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

People were cared for by sufficient numbers of experienced and competent staff who were deployed to meet their care needs. Since the last inspection, people’s dependence needs had been reassessed and the deployment of staff reconfigured. This impacted on people receiving consistency and continuity in care from staff they were familiar with. Robust staff recruitment procedures were used to ensure staff were suitable to care for people.

The prevention and control of infections were minimised due to infection control best practice being followed. Since the last inspection, new cleaning schedules had been introduced and the service had been deep cleaned with an additional deep clean booked. However, increased oversight of cleanliness was required to ensure consistency.

The provider used different systems and processes to monitor safety and quality. Since the last inspection a refurbishment plan had commenced with many improvements made to people’s living environment. However, repairs and maintenance reported by staff to the provider had not been responded to in an effectively and timely manner. This had impacted on people’s safety. Staff responsible for health and safety checks had not identified some maintenance issues identified during this inspection.

People in the main had received their prescribed medicines and staff had detailed information of people’s support needs in relation to medicines. Inconsistencies were identified with one person’s medicine administration, but this had not impacted on their health.

Staff were aware of their role and responsibilities to protect people from abuse and avoidable harm. Where safeguarding concerns had been identified, action had been taken to investigate and mitigate risks in conjunction with the local authority external safeguarding team. Incidents were reviewed for themes and patterns and to consider if incidents could have been avoided or managed differently. Staff had detailed information about how to meet people’s behavioural needs and the use of physical intervention had reduced in the last 12 months.

The restrictions placed on people’s freedom and liberty had reduced for some people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were involved as fully as possible in the care and support they received, this included greater opportunity of accessing the local community and pursuing interests, hobbies and experiencing new opportunities.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice a

Inspection carried out on 26 February 2018

During a routine inspection

We inspected this service on 26 February 2018. The inspection was unannounced.

The Hollies 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.

The Hollies provides accommodation and care for up to 21 people with learning disabilities and autistic spectrum disorder in six purpose built bungalows and three individual apartments within the same grounds. At the time of the inspection 21 people living at The Hollies.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The service had a registered manager who was in the process of de-registering as the registered manager for this service. A new manager had been appointed and had been in post for one week, they were in the process of submitting their registered manager application. We will monitor their progress.

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.

At the last inspection February 2016 the service was rated ‘Good’ in all key questions, at this inspection we found the service had deteriorated to ‘Requires Improvement’ in ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well-led’ and remained ‘Good’ for ‘Caring’.

People were not continuously supported with the required staffing levels to meet their assessed needs. Staff were not always deployed appropriately. Safe staff recruitment checks were followed. Risks to people’s needs and the environment had not always been appropriately assessed and reviewed.

The prevention and control measures for the spread of infections including cleanliness of the service were found to be poor. There was no effective analysis of behavioural incidents or accidents or learning to reduce further reoccurrence. Some inconsistencies were identified in the management of medicines.

Staff had received training in safeguarding and the provider had a policy and procedures to inform practice.

Staff received an induction and ongoing training and support. Staff had not received refresher training in Positive Behaviour Management as required. However, this had been identified and plans were in place for staff to receive this training. Staff were not knowledgeable about all people’s health conditions.

People had their needs assessed and planned for. People received a choice of meals, but some people had undue restrictions placed on them in relation to snacks.

People were not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. Where people lacked mental capacity to consent to their care and support, assessments to ensure decisions were made in their best interest had not been consistently completed. There had been a delay in acting on a condition that had been made on the authorisation of one person’s deprivation of liberty safeguard authorisation. People were supported to access primary and specialist health services.

Staff were aware of people’s needs, routines and what was important to them. Staff overall were kind and caring and supported people ensuring their dignity and with respect. Independence was encouraged and supported. People were supported by independent advocates. It was not clear if or how, people were

Inspection carried out on 1 February 2016

During a routine inspection

This inspection took place on 1 February 2016 and was unannounced.

The Hollies provides accommodation and care for up to 21 people with learning disabilities in six purpose built bungalows and three individual apartments. There were 20 people living there when we visited.

There was a registered manager who was available throughout this inspection visit. 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 were safe and protected from harm at The Hollies. Any risks to the safety of people were assessed and reduced as far as possible. There were enough staff available to meet people’s individual needs and action was taken to ensure people received their medicines safely.

A range of training was available to staff and they had information about the Mental Capacity Act and the manager ensured people’s rights were protected

People received appropriate support with their eating and drinking needs, their independence was promoted. People received their preferred choice of meal and were involved in food preparation where possible. People’s ongoing health was monitored and health needs were met.

All staff showed kindness and compassion in the way they spoke with people. People were supported to maintain relationships with family and friends and there were no restrictions on visitors. Staff showed respect for people’s privacy and dignity. They understood the importance of confidentiality, keeping all personal information about people safe and secure.

The service was responsive to individual interests and preferences, and plans of support and care were specific to people’s individual needs. People were satisfied with responses they had received when they raised any concerns.

There were systems in place for the registered manager to ensure all areas of the service were regularly checked and the overall quality of care was monitored by the care director on behalf of the provider.

Inspection carried out on 23/04/2014

During a routine inspection

The Hollies provides accommodation and care for up to 18 people with learning disabilities in six purpose built bungalows. At the time we visited there were 17 people accommodated. There is a registered manager at this location.

People who lived in the home told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm.

Staff received a wide range of appropriate training and were knowledgeable about the needs of people living in the home. They provided effective care and support that met people’s individual needs.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are a code of practice to supplement the main MCA 2005 code of practice. We looked at whether the service was applying DoLS appropriately and found they were meeting the requirements of the code and following the conditions of the DoLS that had been approved.

During our visit we found a caring atmosphere and people told us that staff were nice to them. One person said, "Staff are kind to me and they listen to me." People were able to pursue a wide range of interests and hobbies with appropriate support from staff.

Management systems were well established to monitor and learn from incidents and concerns. There were also systems to ensure there were sufficient numbers of skilled and experienced staff to meet the needs of people at all times.

Inspection carried out on 7 August 2013

During an inspection looking at part of the service

When we visited on 22 April 2013, we were concerned that some information and documents were either not available or not up to date in respect of some people that used the service and in respect to the management of the service. This meant there was potentially a risk to people's health and welfare and we told the provider to take action to improve how information was recorded.

We reviewed a report about the action taken and we visited the service again to ensure records were fit for purpose.

We examined two people's personal records and some of the records relating to the management of the service. We spoke with two of the support staff and the registered manager about record keeping. Overall, we found improvements had been made.

Inspection carried out on 22 April 2013

During a routine inspection

We spoke with four people who used the service and observed the care of others. We spoke with support staff within each bungalow.

Support staff told us how they continually checked if people consented to their care. Where people did not have the capacity to consent, we found that support staff acted in people's best interests.

People told us they felt safe and comments included, "Happy here." And "They help me".

We performed a partial tour of each of the bungalows and saw a sample of individual bedrooms. We found the premises were mainly well maintained. Action was taken to replace a missing bedroom door during this inspection.

We found that all support staff received planned training and were supported to care for people safely.

The records kept at the service were useful, but we we had minor concerns that some records were not up to date or had not been maintained accurately.

The name of the registered manager was Russell Currie. In this report the names of two registered managers appear who were not in post and not managing regulatory activities at this location at the time of the inspection. Their names appear because they were still on our register at the time.

During an inspection looking at part of the service

When we visited on 14 June 2012, we found from written evidence that improvements were needed in two outcome areas relating to staffing and monitoring the quality of the service. At that time people told us that they felt safe with the staff that were helping them on a daily basis and we observed positive interaction between staff and people living there.

On this occasion, we haven�t been able to speak to people using the service, as we did not visit again. We have followed up the concerns from our previous visit through telephone conversations with the regional manager and written evidence of the improvements made.

Inspection carried out on 13, 14 June 2012

During a routine inspection

We used observation as well as talking with people to help us understand the experiences of people using the service, because many of the people living at The Hollies had complex needs which meant they were not all able to tell us their experiences. We spoke with two people who told us they were happy living at The Hollies. One person said, � I like it here, it�s better than my last place.� When asked if they are given choices about how they live and what they do they said the staff talk with them and ask their views and wishes. Both people named their keyworkers and spoke positively about them. We observed other people with their support workers and there was continual positive interaction.

Two people told us they liked the staff who supported them. One person said, �When I get angry, the staff help me.� This person�s keyworker had a conversation with them about how they were supported to manage their behaviours. The person was eager to share with us a new plan which had been introduced and was helping.

The people we spoke with said that they felt safe with the staff helping them. The staff we spoke with were knowledgeable about individual needs.

We saw some completed questionnaires for people using the service. Some contained ticks in several places and it was not clear what the response was meant to be and others had clearly been completed by staff on behalf of people. We did not see any questionnaires that showed that independent advocates had been involved to assist people.

Inspection carried out on 26 January 2011 and 20 October 2012

During an inspection in response to concerns

During the visit we were shown around the bungalows that form the care home, and this included seeing some bedrooms, where people were willing and able to give us permission to do so. We observed staff interacting very well with the people they were supporting, and the people who we spoke to said that they were happy living at the Hollies.

One person who showed us his room told us that he really likes living at The Hollies. For example one person told us that he enjoys taking part in numerous activities both in the care home and in the community.

In their Provider Compliance Assessment (which is a self assessment form that allows the Hollies to tell us how they are compliant) they said: �Within the separate bungalows staff photographs are displayed. They are there to ensure that people living in the bungalows know who are going to be on an early, late and night shift. Everyone has an activity programme clearly displayed in their bungalow, which is given in their preferred method of communication. Individuals also have an individual health action plan, which is their personal belonging. Information sharing with individuals includes; reviews of care, support plans developed from: �Valuing people with 'our choice' ' our health' ' our say'.�

Reports under our old system of regulation (including those from before CQC was created)