Holly Grange House Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first inspection for this newly registered service. This key question has been rated requires improvement. This meant people’s needs were not always met.

This service scored 61 (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 did not always make sure people were at the centre of their care and treatment choices, and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Permanent staff told us they felt they were not always able to provide person centred care. They told us they wanted to spend more time with people and provide more personalised support but felt this was not always possible due to workload pressures. One staff member told us, “We used to have time to sit and talk to residents. We don’t now and that’s where our care has dropped drastically.” A second staff member commented, “It's nice to bring a smile to their face, but now I don’t have time. No time for the extras. It's all about tasks that need to be done.” Another staff member described their experience by saying, "I'm a headless chicken. I am running from 1 task to the other." During our inspection we found some interactions were primarily task focussed with limited engagement beyond the completion of care activities.

Some care plans were reproduced from templates and were not person centred. Some referenced other people’s names and appeared to have been copied and replicated across the system. In addition, some care records focused primarily on care tasks and support needs rather than describing how people wished to be supported. For example, 1 person could demonstrate anxiety, distress and agitation when receiving personal care. Opportunities to explore the underlying causes of this anxiety, why the person was presenting that way and identify strategies to reduce its impact had not been fully considered. Some staff had adjusted and adapted their approach to improve the person’s experience, but this had not been captured in their care plan. This was particularly important given the provider’s reliance on agency staff, who were less familiar with people’s individual needs and preferences. The quality development manager told us this was an identified area for improvement.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The high staff turnover and agency staff made it difficult to effectively manage and plan staffing rotas, so people received continuity of care from staff who knew them well, were suitably trained and experienced to care for them. Speaking with people and relatives showed us people had different experiences; however, many agreed their main concern was a lack of continuity of staff. Comments included: “The agency staff are very poor which sometimes makes me feel unsafe”, “The staff change so much I can’t get used to them” and “My only concern is about the large number of agency staff; it’s a constant staffing problem.”

Permanent staff acknowledged the impact a lack of continuity within the staff team had on people, explaining that it heightened their confusion and anxiety. One staff member told us, "It is not great when we are relying on agency staff purely for the consistency of the residents. Although we have good agency, they don’t know the residents and there might be a communication barrier, especially on Middlemarch which is the dementia floor and facial recognition is important to those residents. When you are working here a lot, you get a good rapport with the residents. The residents notice when it is not the normal staff on.”

Relatives who wished to remain involved in their family member’s care were supported and encouraged to do so. This helped ensure care remained aligned with people’s preferences.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s sensory needs were assessed to ensure they had all the appropriate aids in place to support effective communication. For example, spectacles and hearing aids. One person’s call bell had been adapted to make it more accessible to them.

Where a need was identified, people were given information in an alternative format, for example to enable them to take an active role in decision making. One member of staff was learning British Sign Language to support communication with people with a hearing impairment.

Consideration had been given to providing an environment which supported people to communicate and remain connected with family and others who were important to them. Wi-fi in all areas of the home enabled people to use electronic equipment and mobile phones to communicate with family and friends.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Overall, people told us they were able to speak to staff, raise concerns and provide feedback about the service they received. Comments included: “I go to residents’ meetings, and they do ask my opinion”, “If I had to complain I would and know how to” and “All staff are pretty good; they would listen and anything in their grasp they would make it happen for you.” One person had recently moved bedrooms and told us, “When they moved me from the middle floor, [staff member] came and spoke to me about it before the move.” However, feedback we gathered during our inspection demonstrated the provider needed to consider how they ensured the views of those people with a quieter voice were heard.

Relatives told us they felt informed and consulted with. One relative told us, “They talk direct to the appropriate medical personnel and if there’s any question, like one time [Name] didn’t want to go to hospital, they always check with [Name] and myself.” Another relative said, “They’re (staff) all absolutely lovely, very friendly and very approachable. Anything you want you just go up and ask and it’s sorted straight away.”

Care records demonstrated that relatives had been updated when concerns arose, or when people’s needs had changed. Relatives had been involved in making decisions about people’s care when they lacked capacity to do so for themselves.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

The provider could not consistently demonstrate that people had equitable access to opportunities and experiences that promoted inclusion and quality of life.

Some people said they were not always kept physically and mentally stimulated and their opportunities to engage in meaningful activities were limited. One person told us there were not enough staff available to facilitate their transfer into a wheelchair so they could access planned activities when they wanted to. Another person told us, “I find this place very lonely at night. A lot of them (people) go to bed at 6.00pm so I sit here on my own. I sit in this chair nearly all day, every day." Two people told us they did not always have access to a call bell to request support. They commented, “When I am in the lounge, I can’t reach the buzzer to call anyone. If I need anyone I have to shout” and “I do have a buzzer in my room, I can’t reach it though it’s not to hand.”

However, staff understood the additional support people might need to access healthcare. For example, where people could not verbalise their pain, staff used a pain assessment tool to ensure discomfort was identified and addressed promptly. Staff also used a tool to identify when people’s health was deteriorating, and they needed intervention from other healthcare professionals. One person commented, “I was having an episode yesterday; my blood pressure was low, but they were right on it.”

Concerns about people’s health were escalated via their GP, district nurses, ambulance services and directly with the hospital as clinically indicated with relevant health information shared to inform decision making.

Staff understood when to escalate concerns urgently through emergency healthcare support.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Some people and their relatives described positive experiences and outcomes because of input from therapy services and the equipment they had to enable them to mobilise and transfer safely. One relative told us, “They’re always willing to put him in a chair almost all the time. They always have at least 2 staff to do that, and it can take a long time, but they always manage it.”

However, other people did not have the same equality in experiences and outcomes. For example, assessments by occupational and physiotherapy services had identified 1 person needed a specialist chair to support them when sitting out of bed. At the time of our inspection a chair had not been sourced, and the person was being cared for in bed. When the person asked to be helped to the toilet, a staff member explained they were unable to assist because the equipment they required was not available. Another person with mobility issues told us they could not have a shower when they wanted one because staff were not using their shower chair even though it was available to them. The provider’s regional manager assured us they would investigate these issues.

People’s religious and spiritual needs were explored during the assessment of their needs. The registered manager acknowledged there were limited opportunities to support people’s faith and religious beliefs but assured us this would be addressed by the appointment of a second lifestyle staff member.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People told us there had been some discussions around their plans for future care. One person told us, “I do remember a care plan, and I have a DNR (Do not attempt resuscitation) in place and my daughter has power of attorney.” Another person said, “My children have power of attorney, and I have my funeral plan already set up.”

Where people or their families had chosen to share information about how they wished to be supported when their health deteriorated and they reached the end of their life, this was documented in their care records.For example, whether they had any specific faith or cultural needs and who they would like to be contacted.

People were treated with dignity and respect when they left the home for the final time. We saw a tribute in the reception for a person who had recently died at the home, and a thank you card from their relatives to the staff.