Holly Court

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
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 Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.
 

This service scored 78 (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.
Staff had a clear understanding of the action to take in the event of an accident or incident.
Families told us their relatives are “absolutely safe and happy.” One family member told us, “I do get calls and I’m told about incidents and it’s all very transparent.”
Records showed events were reported and the leadership team reviewed these and where lessons had been identified, these were shared with the team through supervision, team discussions and workshops. As a result, learning was meaningful, well embedded and led to safer care, greater consistency and better outcomes for people.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care in which, safety was monitored and managed. They made sure there was continuity of care, including when people moved between different services.
The service worked well with people and partners, risk assessments were in place and regularly reviewed, care plans were reviewed and updated following any incidents to incorporate lessons learnt. People were well supported to transition from children to adult support.
Staff were proactive in liaising with health professionals and families to improve the quality of life for people, a staff member told us, “The service worked with a family to facilitate access to a more local GP, which sped up access to medicines “[they are] much better since the change, able to engage, the parents see positive change and enjoy more quality time.”
A relative told us, “They support [person] (staying well) and would contact the doctor.”
Records showed people were reviewed by health professionals, when required.
 

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.
Families told us their relative was "absolutely safe and happy" and “I go at different times and turn up at short notice, and don’t see anything that worries me.”
Staff at all levels showed confidence in recognising safeguarding concerns, understanding thresholds and taking timely and appropriate action.
There was a safeguarding and whistleblowing policy that gave staff clear guidance to follow in the event they needed to refer any concerns to the local authority.
People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. The registered manager kept a record of DoLS applications and authorisations, and this was regularly reviewed to make sure authorisations were current.
 

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.
A relative told us, “I trust the management to assess risk as they did a safeguarding assessment and made adjustments.”

Risk assessments were in place and supported positive risk taking and were updated following any incidents and reflected in care plans.
People and their families were involved in developing care plans and reviews, one family member told us, “We have an annual review and go through the care plans.”
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
The environment was clean and in good state of repair. Routine maintenance programme was in place which included redecoration of people’s rooms. Staff were able to report any maintenance requirements. Equipment we looked at was fit for purpose. For example, wheelchairs and moving and handling equipment were in good condition and clean. Regular audits of equipment were completed and any issues addressed in a timely way. The service had contracts in place to support some of the complex equipment needed.
We reviewed records of checks carried out to ensure the premises were safe. Personal evacuation plans were in place. These had been regularly reviewed to reflect people’s support needs in the event of needing to evacuate the building in an emergency.
Staff completed IPC training and understood their responsibilities for infection prevention.
Managers maintained oversight of IPC through checks and reviews, and action was taken promptly where improvements were identified.
A fire risk assessment was in place, and the provider had taken actions to address the recommendations.
 

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.
Staff told us, "The ratio is very good" and "Hollybank Trust makes sure there are plenty of staff for each resident, always, day and night."
During our assessment, where people showed any signs of distress staff intervened without delay and were able to offer support to ensure the person's distress was reduced. Staff did not appear rushed and took their time with people.
Staff completed relevant training including mandatory training on interacting with people with a learning disability and autistic people.
 

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 completed IPC training and understood their responsibilities for infection prevention and demonstrated good practice, including hand hygiene and maintaining clean environments. We saw PPE available throughout the home.
Managers completed regular infection prevention control audits. These included audits of the environment, equipment, and staff spot checks.
 

The provider made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff involved people in planning for their unmet health needs, including when changes were made to people’s medicines.
All aspects of medicines management were managed safely including storage and administration. The records about medicines were clear and could demonstrate medicines were all accounted for and had been administered as prescribed, including time sensitive medicines. When people were prescribed medicines to be given ‘when required’ the supporting protocols were person centred and detailed, which meant staff had easy to follow guidance to assist them in deciding when the person needed their medicine. People who needed to be given their medicines via a feeding tube were given them safely by staff who had received specialist training. Staff with responsibilities for administering medicines had completed relevant training and had their competency in medicines management and administration checked regularly.
People were administered their medicines in a person-centred way. In each person’s file, information was recorded about how to explain to them that they were about to be given their medicines. For example, for one person there was information about the body language signs staff should use. For some people who were given medicines via a feeding tube, in their stomach, the information explained how staff should gain consent and how they would help staff by moving their own clothes to allow access to their tube. For another person who was prescribed a cream, the information explained they had sensitive skin and how to reassure them while applying the cream. There was information in place to make sure one person, who had difficulties swallowing tablets, was prescribed tablets that were small enough to swallow, or the tablets could be broken in half which meant they were protected from choking.

When staff noticed changes in a person's health or identified opportunities to enhance their wellbeing, they took proactive steps to explore ways of supporting them. Staff worked closely with healthcare professionals and families, advocating for people and helping to secure changes to treatment and medication where needed.
Staff recognised when changes in people's health were affecting their quality of life and took action to address this. For example, staff identified one person who was suffering with increased pain. Staff advocated for changes and coordinated the multidisciplinary support they needed to manage their pain. These actions played a key role in improving their health and quality of life. Staff said they were back to their “joyful self” and were once again “enjoying life.”
In another example staff recognised a decline in one person’s health and wellbeing. They had stopped engaging in activities, were not eating or drinking properly and their major health condition was less well controlled. Staff also identified that their long-standing specialist support team was no longer meeting their needs. Staff provided evidence that they were instrumental in managing a change of their specialist team and their medicines. The outcome of what the staff called “a hard battle of supporting X with the correct medication” was a marked and meaningful improvement in their life. Their enjoyment of eating and drinking improved and their communication skills increased as did their participation in activities including a change to the things they could do in the community with their family. Their family shared a photograph which demonstrated a very happy outcome which was demonstrated by a very rare but huge smile.
Effective medicine management systems were in place, this meant that a thorough oversight of the management and administration of medicines was maintained. These systems enabled checks and audits to be made to ensure medicines had been administered as prescribed. Checks were in place to mitigate against the risk of any errors in medicines administration.
These measures, together with trained and competent staff helped to ensure good practice for medicines management was embedded. This ensuring people who lived at Holly Court were given their medicines safely and their health was protected.