Hollycroft Nursing Home

Hollycroft Nursing Home is a residential care home providing personal and nursing care for up to 37 people aged 65 and over, in one adapted building. At the time of the inspection 33 people were living at the home in this accommodation.

Of the 37 places at the home 20 of these were booked for short stay rehabilitation normally after a person's stay in hospital. The home had a physiotherapist and occupational therapist based at the home, during week days, to support these people with their recovery.

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

Systems and processes for safeguarding and whistleblowing to keep people safe were effective. When things went wrong the provider had learned lessons and developed improved systems. People had person-centred risk assessments in place and told us they felt safe in the service. We found people’s needs and preferences were met by a sufficient number of long standing staff. People’s medicines were safely managed. Infection control measures were in line with government guidance and followed by staff.

The registered manager and provider had improved processes to monitor all records and improved oversight of the service. The service was led by a visible registered manager who involved people, their relatives and staff in the care provided. The registered manager established a robust quality assurance and audit program.

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 practice.

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 02 June 2020) and there was one breach 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.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We carried out an unannounced comprehensive inspection of this service on 16 January 2020. A breach of legal requirements was found, and a Warning Notice was issued. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance.

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 and Well-led which contain those requirements.

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 remained the same. 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 Hollycroft Nursing Home 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.

Hollycroft Nursing Home is a residential care home providing personal and nursing care for up to 37 people aged 65 and over, in one adapted building. At the time of the inspection 31 people were living at the home in this accommodation.

Of the 37 places at the home 20 of these were booked for short stay rehabilitation normally after a person’s stay in hospital. The home had a physiotherapist and occupational therapist based at the home, during week days, to support these people with their recovery.

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

People did not always receive safe care. Individual risks to people had not always been assessed and mitigated and an analysis of incidents and accidents had not been consistently completed to reduce the risks of incidents being repeated. Procedures for the recruitment of staff required additional improvement, to ensure staff were always suitable to work with people at the home.

Staff understood how and when to raise any safeguarding concerns. People received their medicines safely and were protected from the risk of infection by good infection control practice.

People did not always receive effective care. 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. However, the policies and systems in the service did not always support this practice. Whilst staff received training in people’s needs, training was not planned in a co-ordinated manner and training around end of life care and the mental capacity act had not taken place. The registered manager advised us that training around the mental capacity act started taking place shortly after the inspection. People received support to eat and drink meals of their choosing and in the most part were supported to access appropriate healthcare.

People did not always feel cared for. We had one concern raised with us that described a lack of caring or empathic response. This has been investigated. People had been involved in developing care plans around their preferences. People had their independence promoted.

People did not always receive responsive care. Whilst some complaints had been investigated appropriately, we found concerns regarding the investigation of one complaint. Care records were reviewed. People had the opportunity to participate in activities of interest to them.

The service was not always well-led. Governance systems were either not in place or not robust. This meant that systems were not effective in monitoring the quality and safety of the service. There were systems in place to seek feedback from people and their relatives.

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

Rating at last inspection

The last rating for this service was requires improvement (published 10 January 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hollycroft Nursing Home 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.

Hollycroft Nursing Home accommodates 37 people in one adapted building. People using the service have a range of needs which include dementia, physical disability or old age. Whilst some people lived there permanently, the service also provides care to people on a short-term rehabilitation basis, often following discharge from hospital. On the day of the inspection, 14 of the 31 people living at the service were living there on a short term basis.

There was 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.

Quality assurance checks in place were not always effective and there continued to be no analysis of accidents, incidents that could improve people’s experience of the service. Staff competencies were not routinely checked. Audits had failed to identify a number of areas that came to light on the inspection, including care records and risks assessments inconsistently kept up to date and information missing in recruitment files.

People felt safe. Staff were aware of their responsibilities to report any concerns and of the risks to people on a daily basis.

Staffing levels were determined by the dependency levels of the people living in the home, but the deployment of staff at mealtimes, remained a concern.

People were supported to take their medicines as prescribed by staff who had received training in this area.

People were happy with the care they received and considered the staff who supported them to be well trained. Staff felt supported and listened to by management and described the registered manager as ‘approachable’.

People said staff were kind and caring. Staff treated people with dignity and respect and supported people to regain their independence, where appropriate.

People said they were involved in the planning of their care, but there was little documented evidence of this. Activities took place but did not always take into consideration people’s choices and preferences.

There was a system in place to record complaints and people were confident if they raised any concerns they would be acted on.

There had been, and continued to be a programme of refurbishment across the home which had a positive impact on the environment.

Hollycroft Nursing Home is registered to provide accommodation, nursing or personal care for up to 37 people. At the time of our inspection 31 people were living at the home. People using the service have a range of needs which include dementia, physical disability or old age. Whilst some people lived there permanently, the service also provides care to people on a short term rehabilitation basis, often following discharge from hospital. On the day of the inspection, 20 of the 31 people living at the service were living there on a short term basis.

There was 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.

People felt safe and were supported by staff who were aware of their responsibilities to act on and report any concerns they may have.

Staff were aware of the risks to people on a daily basis and worked closely with physiotherapists and occupational therapists in order to ensure people’s needs were met.

Staff were safely recruited and new systems were in place to ensure all appropriate employment checks were complete and in place prior to staff commencing in work.

Staffing levels were assessed by a dependency tool, but deployment of staff across the home was not as effective as it could be which impacted directly on people’s experience of the service.

People were supported to take their medicines but protocols for ‘as required’ pain relief were not in place and medication audits had not highlighted this.

People were happy with the care they received and considered staff to be well trained and able to meet their needs. Staff felt well trained and supported by management and able to raise any concerns they may have.

People said staff were kind and caring and treated them with dignity and respect. People were supported to regain their independence where appropriate, by staff who followed guidance provided by visiting healthcare professionals.

People said they were happy with the care they received and had no complaints, but were not involved in the planning of their care. Where complaints had been received, there was little evidence to demonstrate how they had been responded to and acted upon.

People said they had not been asked their opinion of the home or asked for feedback on the service provided.

People were complimentary about the registered manager and the care they received. Staff felt supported but supervision sessions were inconsistent and there were no staff meetings taking place to enable staff to discuss any issues or concerns they may have.

The new provider had commenced a programme of refurbishment across the home which was welcomed by staff. The registered manager and staff group felt supported by the new provider.

Quality assurance audits in place were not always effective and there was no analysis of accidents, incidents or complaints that would improve people’s experience of the service.