Hollyacre Bungalow

We found the following examples of good practice.

¿ Systems were in place to help prevent people, staff and visitors from catching and spreading infection.

¿ There was enough PPE such as aprons, gloves and masks. Staff were wearing this appropriately when we visited. Staff had undertaken training in putting on and taking off PPE.

¿ Staff and people were tested regularly for COVID-19. A COVID-19 vaccination programme was in place.

¿ Staff had worked as a team to help promote people’s wellbeing throughout the pandemic. We observed positive interactions between staff and people.

Further information is in the detailed findings below.

Hollyacre Bungalow is a care home which provides residential care for up to 10 people who are living with a learning disability. At the time of our inspection eight people were using the service.

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

The registered manager and staff consistently demonstrated they valued and respected the people who used the service. The staff were passionate about supporting people to engage in meaningful activities and lead lives with meaning.

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.

Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately and lessons were learnt, which helped to keep people safe. Staff understood where people required support to reduce the risk of avoidable harm. Medicine was administered in a safe manner.

Thorough checks were completed prior to staff being employed to work at the service. People were observed to be happy and settled and supported by a staff team who knew each person’s individual needs and preferences.

The service was well run. Systems were in place, which effectively monitored how the service operated and ensured staff delivered appropriate care and treatment.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. People were given choice and were supported to be as independent as possible. People were encouraged to pursue their individual likes and interests. People were treated with dignity and respect. The service had a person-centred culture and was open to suggestions and feedback.

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

Rating at last inspection

The last rating for this service was good (report published 22 May 2019).

Why we inspected

This was a planned inspection based on the rating at the last 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.

Follow up

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

The service is a large home, bigger than most domestic style properties. It is registered for the support of up to 10 people. Nine people were using the service. This is larger than current best practice guidance. However. the size of the service did not have a negative impact on people. This was because the building design fitted into the local residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going out with people.

People’s experience of using this service: Improvements had been made since the last focussed inspection in 7 November 2018. People and their relatives told us the changes had improved the service for the better.

Some new policies and procedures had been introduced by the registered manager however, these were not fully completed. We have made a recommendation for a plan to be put in place to ensure this is completed in a timely manner.

Staff received support and an improved variety of appropriate training and support to meet people’s individual needs. However, there was still training outstanding. We have made a recommendation that a training plan be introduced for all staff.

Changes to the service had a positive impact on people. Improvements were made to ensure care plans were more person centred, using appropriate language and that care and support was individualised.

Regular outings had been arranged for people to be more active in their local community.

New risk assessments were in place. Staff knew how to keep people safe and were trained in safeguarding.

Audits and monitoring systems were effective at managing the service and making improvements.

Robust recruitment and selection procedures ensured suitable staff were employed.

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.

People were supported to have enough to eat and drink.

Appropriate healthcare professionals were included in people’s care and support as and when this was needed.

People spoke positively about the improvements put in place by the registered manager and the provider. There was an effective quality assurance system in place to ensure the quality of the service and to drive improvement.

There were systems in place for communicating with staff, people and their relatives to ensure they were fully informed via team meetings and communications.

People had links to the local community through regular access to local services.

People were supported to be independent where they could and their rights were respected. Support was provided in a way that put the people and their preferences first. Information was provided for people in the correct format for them.

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: At the last comprehensive inspection (published 26 July 2018) the service was rated inadequate. This was followed up by a focussed inspection and rated requires Improvement (18 December 2018).

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor information we receive about the service. If any concerning information is received, we may re inspect sooner.

We last conducted a comprehensive inspection of this service on 13 June 2018 where breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hollyacre Bungalow on our website at www.cqc.org.uk.

When we completed our previous inspection, we found concerns relating to: fire safety, management of medicines, reporting of safeguarding concerns, person centred care planning, dignity and respect and staffing levels and deployment.

Hollyacre Bungalow 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. Hollyacre Bungalow accommodates up to 10 people. At the time of our inspection 9 people were living at the home.

At our last inspection we found the service was not meeting all of our fundamental standards and was rated as ‘Inadequate’ overall. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the time of our inspection the service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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.

We found that vast improvements had been made to fire safety and people who used the service were no longer exposed to risk of harm from fire hazards at the home.

A new fire safety risk assessment was carried out by a third-party professional to ensure fire risks were adequately managed.

Improvements had been made to the reporting and recording of potential safeguarding concerns and staff training to ensure safeguarding incidents were logged and reported appropriately.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation.

Accidents and incidents records had improved to ensure they were recorded, monitored and managed effectively.

Improvements had been made to the recording and management of medicines to ensure they were administered, stored and managed safely.

Office staff and an activity co-ordinator had been employed to improve staffing levels. This ensured there were adequate staff to meet people’s needs safely.

Personalised risk assessments had improved and were recorded in people’s care plans appropriately to enable people to take risks as part of everyday life safely.

Accidents and incidents were analysed by the registered manager to look for trends to ensure lessons were learned so that similar accidents and incidents could be avoided, or risks of a reoccurrence be reduced.

The home was clean, tidy, well presented and infection control practices were carried out to a good standard.

Staff were employed safely and pre-employment checks were carried out on staff before they began working in the service.

The provider had introduced new and improved policies and procedures to enable the service to be managed more effectively and safely.

The registered manager notified the Care Quality Commission of all significant events which have occurred in line with their legal responsibilities.

Staff felt supported by the registered manager.

At our last inspection in December 2017 we found the service was not meeting all our fundamental standards and was rated as ‘requires improvement’ and following this comprehensive inspection due to further breaches of our regulations the service was rated inadequate overall.

At the last inspection there were issues regarding staffing levels, person centred care, and staff training and equipment. We asked the provider to send us a report on their actions and they completed the outstanding issues raised. At this inspection we found some improvements however, further issues were found and in some areas the service had deteriorated.

The service had a registered manager in place. 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. Feedback from staff and relatives regarding the registered manager was positive.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hollyacre Bungalow 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. Hollyacre Bungalow accommodates 10 people in one building.

The care service provided at Hollyacre Bungalow at the time of our inspection was not 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 to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People were not protected from the potential risk of harm due to a lack of preventative measures in place at the home. We found a lack of fire safety procedures including; poor maintenance of fire safety doors and exits and an inadequate fire safety risk assessment.

Maintenance checks were not always carried out at the home and we found that there was no gas safety check in place at the time of our inspection.

Peoples medicines were not managed safely, we found medicines administration was not always recorded correctly and policies in place for staff were inadequate. When people were administered ‘as and when required’ medicines and topical creams, directions were not clear and the records to support this type of administration were not adequate.

Medicines were not audited regularly and stock counts were not taken and issues were not always found or addressed. Audits were not effective therefore didn’t highlight issues found regarding medicines administration and recording.

People were not supported to have choice and control over their own lives and were not receiving person centred care. Person centred care is when the person is central to their support and their preferences are respected.

Care plans were not person centred and were task orientated. These were written in a style that was not person first but more focussed on the medical model of disability which is an outdated view point and focusses on the person’s disability and not as an individual person.

Care plans were reviewed regularly by the registered manager however were not updated or improved.

Support for people was not person centred this meant their preferences and dislikes were not respected always. People did not have any planned goals to achieve.

Peoples nutrition and hydration needs were not always met, tools such as recording and monitoring systems to support people were not available and people were not regularly weighed.

Peoples dignity was not always protected by staff supporting them or by facilities available to them to support people with their personal care.

Audits carried out by the registered manager were not always effective at highlighting issues or improving the service.

People who used the service were asked for their views about the support through resident’s meetings however actions were not put into place following the meetings. Peoples relatives and other healthcare professionals were not asked for their views via questionnaires or feedback forms.

People were not supported to take risks safely and personalised risk assessments were not in place to ensure people were protected against a range of risks. Where they were in place they were not robust.

Staff had received safeguarding training, and were able to describe signs of abuse however, they were unclear of what they would do to report concerns to protect people.

People who displayed behaviours that can be seen to challenge others were not supported adequately as staff were not trained. Ineffective records were kept and a lack of oversight of incidents showed a lack of understanding and meaningful support for people.

Staff recruitment was carried out with safety checks in place for new staff however, there was no photo identification within some staff files to prove their identity.

There was not always sufficient staff to meet people’s needs safely and in an individualised way.

People were not supported by staff who were trained to meet their individual needs, Staff were trained in for example; safeguarding and first aid. Additional training was not in place or planned for areas specific to people’s individual needs.

Staff received regular supervision and support from the registered manager.

People were not always supported to maintain their independence by staff that understood and valued the importance of this.

Notifications of significant events were not submitted to us in a timely manner by the registered manager.

Health care professionals, including GP, district nurse or specialist consultants were Involved in people's care as and when this was needed and staff supported people with any appointments as necessary.

The home was tidy and free from malodours however kitchen facilities were not maintained to a working standard. The outside of the building was unkempt and not inviting.

Staff, relatives and other professionals told us the registered manager was approachable. We found they had a good knowledge of the needs of people who used the service.

People and their relatives could complain if they wished and were knowledgeable of how to complain or raise minor concerns.

People were not supported to access information in a variety of formats to suit their needs and no evidence was presented that had been made to suit individuals.

People were not always supported to take part in a wide range of activities at home and in the wider community as active citizens and to suit their individual preferences.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. You can see what action we told the registered provider to take at the back of the full version of the report.

Hollyacre Bungalow provides care and support for up to ten people with a learning disability. It is located in a residential setting in Sacriston in County Durham. Nursing care is not provided.

The service had a registered manager. 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 time of inspection the registered manager was on annual leave.

There were not enough staff to meet people’s needs. On the day of inspection there were two staff on duty, one male and one female, supporting ten people who used the service. There were five female people who used the service and they would not accept care from the male staff member. Therefore the female staff member had to support all five female people on their own. This included hoisting which should be carried out by two staff members. Therefore the services practices were unsafe. We contacted the provider at the beginning of the inspection to request more staff were put on duty immediately. The provider arranged for a further staff member to come in and added an extra staff member onto the rota going forward. The service employed 11 members of staff and they were working long hours to cover each shift. Following the inspection the provider increased the number of existing staff hours and they were interviewing for more staff in order to address this shortfall.

Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. However, staff records were not all completed.

Not all people who used the service were supported to access activities. We looked at three people’s daily notes going back to February 2017. One person went to a day centre once a week, the other two people had only left the service once in seven months. People watched the television all day or listened to music. Due to the lack of staff and the need for staff providing two to one care and support, staff told us they could not provide people access to meaningful activities.

A large proportion of risks to people arising from their health and support needs and the premises were assessed and plans were in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use. However, we could not establish that the hoists were safe for use; six people who used the service required hoisting. The service had two hoists which had had a service in May 2017; however, the service on these hoists could not be completed due to some parts being deemed faulty and needing replacement. The person who carried out the service said the parts may be difficult to get as the hoists were old and recommended new hoists were purchased. Nothing had been done about this. We followed this up after inspection and the manager had received quotes for two new hoists and was waiting for the provider to agree to the purchase. We followed this up with the provider due to the hoists being unsafe. Two new hoists were purchased on 27 September 2017.

A gas safety check, which took place in December 2016, was passed but it was recommended the provider purchased a carbon monoxide detector for the boiler room. These had not been purchased until we raised the concern at inspection. The fridge in the kitchen was also broken; it was freezing food and leaking. Therefore the safety of the food stored in the fridge could not be guaranteed. We also raised concerns about this during the inspection. A new fridge and carbon monoxide detectors were purchased after the inspection.

We found people received their medicines as prescribed and they were stored in a safe manner.

We found the care plans were person centred and were reviewed monthly. Good end of life plans were in place.

Audits were taking place, however were not robust enough to highlight the issues we found during our visit.

Staff were not supported by supervision. We were told the manager completed a supervision sheet then left it for the staff member to sign. No conversation took place to support the staff member with their development.

Staff understood safeguarding issues and felt confident in raising any concerns they had, in order to keep people safe.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and demonstrated a basic understanding of the requirements of the Act. The registered manager understood their responsibilities in relation to the DoLS. However, we found no evidence of consent.

We observed lunch and found the dining experience needed improving. The majority of people needed support with eating and some people had to wait until staff finished with one person before they could support the next.

We saw some evidence that staff worked with external professionals to support and maintain people’s health.

The interactions between people and staff were kind and respectful. We saw staff were aware of how to respect people’s privacy and dignity. People and their relatives spoke highly of the care they received. However, due to a lack of staff, people were not provided with choice, for example, they all had to sit in the same lounge together.

Procedures were not in place to support people to access advocacy services should the need arise.

The provider had a clear complaints policy that was applied when any concerns were raised. The service had received no complaints.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

People had their health and welfare needs met by sufficient numbers of appropriate staff.

People's personal records were accurate and fit for purpose.