Holly Grange House Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first inspection for this newly registered service. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Relatives told us their family member’s needs were assessed prior to moving to the home. One relative told us, “Initially the care home visited [Name] in hospital to talk through what care he would need and look at his medical records to ensure they could support his needs.” Another relative said, “They came out and they said they’d put a personal care plan together. [Name] said when she went in, they spent about an hour and a half with her, going through lots of things.”

Care plans were regularly reviewed and updated. However, when there were changes in 1 area of people’s care, this was not consistently reflected in all parts of their care plan. For example, 1 person had recently been reviewed by SALT, and the consistency of the meals they required had been reviewed. Whilst information had been shared with the catering team and the meals they were receiving were accurate, their care plan still reflected the previous recommendation which meant there was a risk they may not receive their meals consistently as advised.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Managers had made improvements to ensure people received food and drink in line with national standards and best practice guidance. The International Dysphagia Diet Standardisation Initiative (IDDSI) Framework is a global, standardised system of 8 levels (0-7) that describes food textures and drink thicknesses for people with dysphagia (swallowing difficulties). It aims to improve people’s nutritional safety by providing a common language for everyone to use. Care staff consistently used the framework when describing people’s diets and kitchen staff kept their own records to ensure all food served had been correctly modified. Additional safety checks had been put in place to ensure the texture of food and drinks people received were as recommended.

The chef recognised the importance of mealtimes. They told us, “When you get older, the world revolves around eating…cooking for someone else, that’s not just a job. There is love in there.” All meals in the home were homemade and the chef ensured that people were given choices, including if they required a specialised diet.

We received mixed feedback from people about the quality of the meals and the choices available. Some people felt standards were better maintained when permanent staff were preparing their meals.

Other elements of people’s care and support were delivered in line with relevant legislation and good practice guidance. These included a range of risk assessment tools to predict people’s risk of developing pressure ulcers, and malnutrition universal screening tools.

Permanent staff received training for their role and where a need was identified, the registered manager arranged further training to support staff practice. For example, in relation to catheter care, modified diets and pressure care management. Further training in diabetes and dementia care was planned to improve staff practice in these areas.

The provider did not consistently work well across teams and services to support people.

Staff told us information was shared through handovers between shifts, so they knew the care people needed for that day. However, we saw examples of when important information had not been handed over according to expectations. For example, staff had not shared when 1 person had not been repositioned overnight according to their risk management plan or when another person had seen an emergency GP.

Permanent staff described good and effective team working. One staff member commented, “I think we are a strong team. We help each other. It’s hard with so many agency staff but more important, the regular staff work together.” Non-care staff told us they worked flexibly and across roles to ensure people received the support they needed. A staff member explained, “Housekeeping will often step in and help with serving meals and things like that. We don’t do personal care, but we help where we can.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People told us they regularly saw external healthcare professionals to support their health and wellbeing. One person told us, “We can request to see the GP if needed. I see the hairdresser, have manicures and see the chiropodist.” Another person said, “When I was poorly, the district nurses came in. The GP is in weekly, and I see the hairdresser, chiropodist, optician and have hearing tests.”

One person told us how the support they received had improved their health and commented, “When I first came in, I was very dependent upon them but now I am so much more independent. I think they know what they are doing and are well trained.” Another person said, “I was very poorly, and bed bound when I came in first. I am walking now with the care and encouragement from the staff.” A relative commented, “[Name] was very fragile and weak initially and it’s been a gradual process; she’s gone from strength to strength. With the support of staff and building up things like eating patterns and getting more involved with physio, has meant the rehabilitation has grown and now she’s good.”

Staff told us any changes in people’s health were reported to the senior on shift, who they were confident would act on their concerns. When referrals needed to be made to external healthcare professionals such as nurses, dieticians or speech and language therapists, these were done in a timely way.

The local GP carried out a weekly ward round and people who required nursing interventions were supported by the district nurse team. One staff member explained, “The district nurse comes in every day and the doctor visits. We can ask for their help and advice to help the residents.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

There was a lack of detail in the records maintained when people’s nutritional intake needed to be monitored because they were at risk of not eating and drinking enough to keep well. We saw some documentation where staff had written ‘offered breakfast but it was declined’ and ‘had lunch, had tea’ with no description of what food was given. Accurate recording helps determine if the person’s nutritional care plan needs reviewing to meet the person’s needs. It also helps other healthcare professionals make decisions relating to people’s treatment and identifies when people’s planned outcomes are not being met and they need to be encouraged to eat and drink more.

For people at risk of skin breakdown, outcomes were also not consistently monitored, in line with assessed needs. One person’s care plan stated they needed repositioning every 2 hours, however their electronic records did not consistently demonstrate this happened or show what position they were moved to. Paper records had been introduced as an additional monitoring tool, but these contained multiple gaps and there appeared little oversight or monitoring of these. This increased the risk that planned preventative measures were not being delivered as intended.

The provider had identified improvements were required in the standard of people’s daily records. Good standards of record keeping needed to become embedded in staff practice to ensure effective monitoring of risk management strategies to promote positive outcomes.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The provider had systems to ensure the legal requirements of the Mental Capacity Act 2005 (MCA) were met and to support people who lacked capacity to make specific decisions.

Mental capacity assessments and best interest decisions were completed to ensure decisions associated with people’s care were made lawfully. Assessments were decision specific and demonstrated how people had been supported to participate in decision making. Records evidenced how staff had tried to involve people in decisions about their care by making information available and accessible to meet their individual needs. Where people lacked capacity to make decisions for themselves, these were made in their best interest and were the least restrictive option possible. People’s representatives had been involved in any decisions that needed to be made.

Staff sought people’s consent before providing care and respected their right to decline it in that moment. One staff member told us, “Before you do anything, before you start a person’s care you ask them if it’s okay. They have the right to say no and we respect that right.” Another staff member explained, "One of the ladies refused to get out of bed for an agency staff member. I went in an hour later and she got up and sat in a chair. It is about taking your time and listening. You have got to take it slow with them."