11 May 2016
During a routine inspection
Holland House Nursing Home is registered to provider residential and nursing care for 10 older people, some of whom may be living with a dementia. It is on the same site as Rose Lodge another of the provider’s homes. Both the homes share their staff and facilities.
At the time of our inspection the manager on our register was no longer working at the home and did not have any managerial oversight. There was a new manager at the home but they were not yet registered with the CQC. We discussed with them the need to register. 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 Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS were in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. The manager had made appropriate requests for people to be assessed under the DoLS and all the care provided minimised the restriction on people.
The manager assessed people’s needs and ensured that there were enough staff available to meet those needs in a calm and unhurried manner. Staff received training when they first started to ensure that they had the skills needed to provide safe effective care for people and were supported by ongoing training to maintain a high skill level. Staff had received training in how to keep people safe from harm and knew how to raise concerns and were confident to do so.
Risks to people had been identified and care was planned and equipment was in place to keep people safe. Where people had capacity and chose to not follow the advice and guidance from health care professionals this was respected and staff worked with them to achieve compromises which supported their choices and managed the ongoing risks. People’s dietary needs were assessed and again care was planned to keep people safe and support their independence. People’s medicines were ordered, stored and administered in a methodical way to reduce the risk of infection.
There was a warm and loving relationship between staff and people living at the home. Staff worked beyond their contracted hours to enable people to access the community and to support colleagues. Staff were really knowledgeable about people’s needs and how care could be provided in a person centred way to encourage independence. Staff continually sought the consent of people when providing care to ensure people were happy with what was happening and were involved in their care.
People’s care needs were assessed and reassessed at regular intervals or whenever their needs changed. People were involved in developing their care plans and they contained information on how care was personalised to meet individual needs. People were supported with a varied activity programme which supported them to access the community and to be entertained.
People and staff told us that the manager was often not visible in the home but that they felt supported as they could always raise concerns with the nurse. The provider had effective systems in place to monitor the quality of care people received and to seek the views of people using the home and their relatives.
The provider ensured the manager and staff were supported to provide good care by employing staff at head office who kept up to date with any changes in how care should be provided. This enabled the provider to disseminate the latest guidance around best practice and any changes in legislation effectively and consistently. In addition the provider’s culture was that of an open organisation with a no blame culture which supported learning across their care homes as well as within each home.