The Hollies

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents and incidents were recorded and reviewed so any trends or patterns could be identified. If needed, referrals were made to other services to make improvements or assist with reviewing incidents. Feedback to staff of any changes to people’s care following an incident were communicated in communication books, handovers, and staff meetings. This helped to reduce the risk to people’s safety.

The registered manager was aware of their responsibility to thoroughly investigate any concerns raised and promote an open culture within the service. They were able to give detailed examples of where this had occurred, and the steps taken. Staff had a debrief after incidents to check staff wellbeing as well as to review the situation. Staff felt able to raise concerns if needed and felt they would be listened to. One staff member talked about how they learned from complaints and said, “Whatever the area of complaint is for we will have a meeting and a conversation in what we could do better, and we will look at implementing change.”

People and their relatives knew who the registered manager was and how to raise concerns if they had any. This meant people benefited from a service that continually improved through reflection and learning.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager worked with others to solve problems and make improvements. Staff communicated with other agencies to help ensure continuity of care. Regular contact was maintained with the local authority, social workers, GPs, and other professionals. Staff said they could reach health professionals when needed. Staff had completed recommended training for learning disabilities and autism, to equip them with the skills to provide safe and compassionate care to people with a learning disability and autistic people including transitions to other services. Staff also demonstrated a clear understanding of the importance of sharing relevant information with hospitals and other professionals to ensure continuity of care and appropriate support.

Where people were moving in or out of the service permanently, they were supported to ensure the transition was well managed. The registered manager told us about a person who had moved from The Hollies to another service. They said, “We kept in touch with their support worker who started looking at different options. We talked the process through with [name] but explained they had a lot of say in it and that they could ask questions and go and see the services.” This meant people experienced smooth, safe transitions between services, reducing risk and promoting continuity of care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The provider shared concerns quickly and appropriately.

The provider had a process in place to report concerns. The management team ensured relevant authorities such as the CQC, and the local authority were informed of incidents or allegations of concern that could affect people’s safety. The Hollies had 2 safeguarding officers and information including pictures of them were displayed on notice boards.

People, and their relatives felt people were safe, knew the registered manager well and felt able to raise concerns if needed. Staff had confidence any issues reported would be acted on by management. Staff had completed training in safeguarding; they understood their responsibilities and reported any concerns to management. They were confident any concerns would be dealt with but were aware how to escalate issues outside of the organisation if needed.

Staff were skilled and proactive in supporting people experiencing distress. Staff followed behaviour support plans or equivalent protocols. Unplanned use of restrictive strategies triggered reviews and debriefs. The provider and staff team had a good understanding of what made people feel safe, and what they needed staff to do to keep them safe.

This meant people experienced care that protected them from the risk of avoidable harm, and abuse and protected their right to live safely.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

Any risks were identified and recorded with guidance for staff on how to manage those risks. When restrictions were necessary to keep people safe, these were proportionate and the least restrictive option. The provider was pro-active, encouraged and supported staff to follow a positive risk management approach. The registered manager had a good understanding of implementing the least restrictive options for people to ensure people lived better lives.

Support plans and risk assessments identified potential risks to people’s safety. This included risks such as the support people needed when going to local shops and other amenities, without unnecessarily restricting their freedom. Measures were put in place to support people in the least restrictive way, whilst monitoring the potential risks to the person’s safety as well as the safety of staff and members of the public.

Plans showed evidence of a positive risk-taking approach. Staff supported unplanned changes and continuously assessed risks. This supportive approach enabled people to maintain their autonomy, do the things that mattered to them, while receiving the care they needed to keep them safe and well.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

During our last assessment of the service, we had identified a breach of premises and equipment. This was due to the premises not being properly maintained including exposed electrical wiring, unfinished plaster, issues with the key fob system, worn furnishings, curtains not rehung which affected privacy and fire safety issues. We found that these areas had all been fixed and The Hollies was no longer in breach of regulations.

Prior to our visit the provider had done an audit of the property and created a plan to make improvements. We noted that there was discarded furniture and a clinical waste bin next to the bin store. The management team said they were waiting for this to be collected but were also looking to get the bin store extended. This was not accessible by the public as it was behind a gate which required a code to open. Any similar issues were pointed out by management to the inspection team which demonstrated openness and transparency in the assessment process.

We were shown one of the buildings which had been completely renovated and were advised they were looking to replicate this across the site. The management team took swift action to address any issues we found meaning people were kept safe from harm.

People and staff were involved in fire safety drills, and people had a detailed Personal Emergency Evacuation Plan (PEEP) in place. Checks of utilities and equipment were regularly carried out by external contractors. Staff completed weekly and monthly checks such as water temperatures and fire safety equipment. During our visit, the home was visibly clean and well maintained. This helped to keep people and staff safe.

The provider made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs.

The provider had safe recruitment practices to help ensure suitable staff were employed. All necessary pre-employment checks were completed before staff began working in the home. New staff completed an induction before starting work. Staff told us they were very well supported. Staff received regular supervision. Staff completed regular training, to make sure they had the knowledge and skills to carry out their duties. A training matrix showed most staff had completed training in relevant areas including supporting people with a learning disability and autistic people. The management team monitored the training matrix to make sure staff remained up to date.

People were supported by their own staff on a one-to-one or two-to-one basis each day, this enabled people to choose what they liked to do each day. Relatives and people told us there were enough staff to meet people’s needs and enable them to take part in any pastimes or hobbies they enjoyed. During our on-site visits we observed people getting timely support. This meant people received care from staff who were skilled, available, and able to meet their needs safely.

Some staff said that team meetings were not frequent, and that they had not had a survey sent out in a while to feedback their views. Some staff said they felt the service was occasionally short staffed but told us this was improving as more people were being recruited, and staff stayed on shift longer to cover. We saw this was being actioned in the service development plan and updates had been mentioned in the last team meeting.

This meant people received timely care and support, as staff worked flexibly to maintain safe staffing levels while the service actively addressed recruitment and communication through its development plan.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff were trained in relation to infection, prevention, and control (IPC). Staff had access to personal protective equipment [PPE], which included gloves and aprons. Systems were in place to promote safe infection, prevention, and control practices, such as cleaning schedules and auditing.

People received the right support from staff to maintain their personal hygiene and the home was kept clean and well maintained when any issues arose. This meant people were protected from infection and disease.

Some issues were identified, including food defrosting unsafely on countertops, an over-frozen freezer, a fridge temperature was too warm and unlabelled fresh and frozen food items. An external clinical waste bin was observed outside the designated bin store open and unsecured. This could pose a potential infection control risk. These issues were not identified in every kitchen and were addressed quickly, and evidence of corrective action was provided.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff involved people in planning, including when changes happened.

People were given their medicines safely and in a timely manner. This was recorded on their medicines administration record (MAR) and medicines were stored safely and securely. There were processes in place that ensured the safe and effective use of medicines. Instructions for medicines which should be given at specific times were available. Staff administered medicines as directed by the prescriber which reduced the risk of the people experiencing adverse effects from the medicine.

When people required medicines to be given on an ‘as needed’ basis, guidance was available for staff to administer these medicines appropriately and safely. We checked the quantities and stock balances for 10 people and found them to be correct. This meant that we could be assured that the correct doses of medicines had been administered as signed for by staff. The use of topical creams and ointments were recorded on the medicines administration records (MARs). Body maps were in place to show staff the site of application.

There were records of people’s preferences to indicate how they wanted their medicines to be administered. Temperature records to ensure the safe storage of medicines were completed in accordance with national guidance. This meant we could be assured that medicines were safe for use.

There was evidence that there was a process in place to record medicines related incidents or errors. There were appropriate arrangements in place for the management of controlled drugs (medicines that require extra checks and special storage arrangements because of the potential for abuse). Records showed that staff completed regular balance checks in accordance with national guidance. Records also showed that staff had received medicines handling training. Staff competencies were assessed regularly to make sure they had the necessary skills. Managers and members of staff qualified to handle medicines regularly completed audits (checks) to make sure that procedures were followed.

This meant people received their medicines safely and effectively, supporting their health and wellbeing.