The Hollies

The Hollies is a residential care home providing accommodation and personal care for up to 19 people aged 65 and over some of whom are living with dementia. At the time of the inspection the service was supporting 12 people. The Hollies accommodates people in one adapted building.

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

People were observed to be happy and content. We saw people had established friendly and jovial relationships with all staff. There was laughter, banter and conversation seen throughout the inspection.

Improvements had been made since the last inspection in response to the issues that had been identified.

Relatives spoke positively about the home, the management and the quality of care people received.

We observed people to be supported in a safe way, taking into consideration their needs, choices and wishes.

Risks associated with people’s health, medical and care needs had been identified but were not always assessed and documented. Where gaps in information and guidance was identified these were addressed immediately by the registered manager. Other documented risk assessments in place gave clear guidance on how to minimise the identified risk to keep people safe.

People received their medicines safely and as prescribed. Systems and processes in place supported this.

Recruitment policy and procedures supported the recruitment of staff who had been assessed as safe to work with vulnerable adults. We observed enough staff available to support people safely.

The home smelled fresh and was clean. There were increased infection control measures in response to the coronavirus outbreak.

Staff received the required induction, training and support to carry out their role effectively. Care staff told us that they felt appropriately supported and that the registered manager was always available to provide direction and guidance.

The service supported people to eat and drink in ways which took into consideration their support needs, likes and dislikes.

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.

Relatives felt engaged with the service and confirmed that they received regular updates and feedback about their relative.

Management audits and checks enabled managers to oversee the quality of care delivery and make the required improvements where necessary. During the inspection, minor issues were identified with the assessing of people’s identified risks. However, following the inspection, these issues were addressed.

We have made a recommendation about the provider and management ensuring accurate, complete and contemporaneous record of care delivery and risk management are maintained so that people receive safe and effective care and treatment.

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)

The last rating for this service was requires improvement (published 11 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 December 2018. Breaches of legal requirements were found.

Concerns were identified under safe care and treatment, fit and proper persons employed and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Hollies on our website at www.cqc.org.uk.

Follow up

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

This inspection took place on 4 December 2018 and was unannounced. This was the second inspection of this service since the new provider took over ownership in July 2016. The last inspection was in March 2017 and the service was rated good.

The Hollies is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This care home is registered to accommodate 19 older people, some of whom are living with dementia.

This inspection was prompted by a complaint about the home and we looked at aspects of the complaint during the inspection. The complaint was being addressed by the local authority under their safeguarding procedures.

We arrived during the night shift as there had been a complaint that people might be getting up very early possibly against their wishes. We did not find this to be the case during our inspection as nobody was asked to get up early by staff.

We found concerns with record keeping in the home. Some care records had been completed before the care was actually provided in the morning. Records were not kept as evidence of care being provided safely, for example hourly checks on people and charts staff were expected to complete when they helped a person change position or have a drink. This meant there was a lack of evidence of safe care for some people.

There was a registered manager in post. 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 registered manager was suitably qualified and experienced.

Staff understood their responsibilities to keep people safe from potential abuse. The service learned from accidents and incidents and took action to minimise the risk of a similar incident occurring.

Some staff had been employed without all the required checks being in place and some had not received regular supervision. The registered manager agreed to make the necessary improvements.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely but there were some improvements needed as the tablet cutter was dirty and there were no written guidelines for giving a person 'as and when required' sedative medicines.

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. People had choice over their food and when they wanted to get up and go to bed.

Staff told us they liked working at the home and felt supported by the manager and provider. They had formed good relationships with people.

People had support with their health and staff arranged their appointments with healthcare professionals. They had care plans which gave staff information about their needs, their history and their wishes so that they could provide them with person-centred care.

Relatives told us they were happy with the care provided at the home. People in the home told us they were happy with the care.

The auditing system in the home had not picked up the concerns that we found. After the inspection the provider advised us that they were introducing a more formal auditing process to ensure they had a good overview of the service.

There were three breaches of legal requirements due to the failure to have effective oversight of the home, to keep accurate records of care provided, concerns about infection control and safe staff recruitment . You can see what action we asked the provider today at the back of the full version of this report.

The Hollies is a privately owned care home for older people in Enfield. The home is registered to accommodate 19 older people, some of whom are living with dementia.

There was a registered manager in post and who had been managing the service for over 12 years. 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.

People told us they felt safe at the home and risks to people’s safety had been identified, acted on and, where possible, were being reviewed with the person. Staff understood their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about the management and told us they appreciated the clear guidance they received regarding their roles and responsibilities and that their input was acknowledged and praised.

Staff understood the principles of the MCA and knew that they must offer as much choice to people as possible in making day to day decisions about their care. This included making sure people living with dementia were as involved in their care and decision making as much as possible.

People told us they enjoyed the food provided and that they were offered choices of what they wanted to eat.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences.

People told us that the management and staff listened to them and acted on their suggestions and wishes and we saw examples of this during our inspection. They told us they were happy to raise any concerns they had with any of the staff and management of the home.

People we spoke with confirmed that they were asked about the quality of the service and had made comments about this. They told us the service took their views into account in order to improve.