The Hollies

The Hollies is a residential care home providing the regulated activity of accommodation and personal care to up to 10 people. The service provides support to people who have a learning disability and who are autistic. At the time of our inspection there were 8 people using the service.

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

The provider had made improvements to their processes for monitoring the quality and safety of the service since the last inspection. However, these systems were still not robust and had not identified the concerns we found during the inspection. The provider's processes for checking the administration of people's medicines were not always effective in highlighting errors.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. People were cared for and supported by staff who had received appropriate training. There were systems in to minimise the risk of infections.

Staff understood how to raise concerns and knew what to do to safeguard people. Effective arrangements were in place to ensure recruitment checks on staff were safe.

We received positive feedback on the service. A person told us, ''The new manager is great and is very passionate about the service. Staff are excellent and very caring. We can see improvements being made.''

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

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.

Staff focused on people's strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to pursue their interests.

Staff enabled people to access specialist health and social care support in the community.

Right Care

People's care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. However, improvements were required in relation to administration of people's medicines.

Staff spoke respectfully about people and treated them with compassion. Staff respected people's privacy and dignity. They understood and responded to people's individual's needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture

People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people's views.

Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 inadequate (published 17 November 2022) and there were breaches of regulation.

This service has been in Special Measures since November 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 01 March 2023. A breach of legal requirements was found. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve medicines management and quality assurance.

We undertook this focused inspection to follow up on the action we told the provider to take at the last inspection. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

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.

Enforcement

We have identified a continued breach in relation to medicines management. Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

The Hollies is a residential care home providing the regulated activity of accommodation and personal care to up to 10 people. The service provides support to people who have a learning disability and who are autistic. At the time of our inspection there were 10 people using the service.

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

The service’s quality assurance, monitoring and oversight arrangements were not robust and continued to require significant improvement. People did not receive their medicines as they should. Recruitment practices continued to require improvement. We have made a recommendation about recruitment practices. Although there was no impact for people using the service, staff had not received specific training relating to the needs of the people they supported, an induction or formal supervision.

Right Support:

• The service is a large house located within the local community and its amenities. The provider was updating the décor and furnishings to make it more homely for people living at The Hollies.

• People were able to use communal areas as they wished and to have privacy for themselves if they chose to be alone. People were observed to spend time in their bedroom or in the communal lounge.

• Staff were now being supported to take part in activities within their local area, for example, to go shopping or to visit local cafes.

• People had a choice about their living environment and were able to personalise their bedrooms.

• Staff enabled people to access healthcare provision and services as needed to ensure their healthcare needs were met.

Right Care:

• People received care and support that was kind and caring.

• Staff understood how to protect people from harm and abuse. However, where internal investigations were completed, improvements were required to ensure these were robust.

• People’s care plans reflected their needs and the level of support to be required by staff. However, improvements were required to ensure this information was personalised to the individual and not generic.

Right Culture:

• Staff were responsive to people’s needs.

• Not all staff had felt valued and supported but this was improving following the involvement of the provider at the service.

• Staff were not aware of the ethos and values of the organisation or aware of the ‘Right support, right care and right culture’ principles that should underpin their day to day working practices.

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 inadequate [published June 2022].

Why we inspected

We carried out an unannounced focused inspection of this service in February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve relating to

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 of Safe, Effective and Well-led.

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.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, quality assurance and staff training, induction and supervision at this inspection.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

Not all risks to people’s safety were assessed and mitigated to ensure they were kept safe. Infection prevention and control [IPC] measures required improvement. Up-to-date government guidance on the management of COVID-19 was not routinely being adhered to in practice. Suitable arrangements were not in place to ensure staff employed had had the appropriate recruitment checks undertaken.

People were not supported to have maximum choice and control of their lives and staff supported did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported did not support this practice.

The service was not well-managed. The quality assurance, monitoring and oversight arrangements in place were not robust. The provider and registered manager did not recognise where there were shortfalls or corrective actions required.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

• Staff did not always support people in the least restrictive way possible and were exposed to restrictive practices.

• Staff were not acting in accordance with the Mental Capacity Act 2005 and people’s consent was not always sought and recorded.

• People’s medicines were not always being managed safely. We have made a recommendation about the management of medicines.

• The service was a large residential property that comprised of 10 bedrooms within the local residential area.

• People had their own rooms which had been personalised. People were able to use communal areas as they wished and to have privacy for themselves.

• People were able to access specialist community-based healthcare services to ensure their health and wellbeing needs were met.

Right Care:

• The service did not have enough appropriately skilled staff to meet people's needs.

• People were not protected from the risk of harm. Although staff had completed safeguarding training they had not recognised or reported poor care in a timely manner.

• People were not routinely supported to access the local community and its amenities. Staff did not ensure people using the service had a fulfilling and meaningful everyday life.

• People were treated with kindness and staff respected their privacy.

Right Culture:

• The provider and registered manager did not have robust and arrangements in place to monitor the quality of the service. The lack of effective oversight meant people did not consistently receive good care.

• The service did not have a positive staff culture that was person centred and inclusive. Staff were wary about raising concerns with the registered manager and told us there was a culture of blame. There was not a culture of ‘speaking up’.

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 good [published 17 August 2018].

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The Hollies 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.

The Hollies is registered to support up to ten people who have a learning disability, an autistic spectrum disorder and /or a physical disability. There were ten people living in the service on the day of our inspection, of which one person was in hospital.

The care service embraced the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service required, and did have, 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.

The service was safe. Individual risks to people had been identified, managed and reviewed to ensure their safety. There were adequate numbers of staff to meet people’s individual care and support needs. Effective recruitment procedures were in place to protect people from the risk of avoidable harm. Staff understood their responsibilities in relation to keeping people safe from harm and abuse. Systems were in place for the safe management of medicines. People were protected from the risk of infection.

People received an effective service. Staff were trained and supported to fulfil their role and responsibilities. Although people were supported to have choice and control over their lives and there were systems and policies in place to support this, we have recommended that the registered provider reviews legislation and associated guidance to ensure they are acting in accordance with the Mental Capacity Act 2005. People were supported to maintain their health and well-being and were supported to access health and social care services. People’s dietary needs were met by staff.

The service was caring. People were treated with kindness, compassion, dignity and respect by a consistent staff team. Staff and management knew people well and were sensitive to their individual care and support needs and were committed and passionate about supporting and enabling people to live fulfilled and meaningful lives. People’s independence was promoted and, where possible, they were encouraged to do as much as they can for themselves.

The service was responsive to people’s needs. There was a strong emphasis on person centred care. Care plans contained information and guidance to enable staff to support people in line with their preferences. Care plans were regularly reviewed to ensure they reflected people’s current needs. People were supported to pursue their interests and hobbies, both within the home and in the community.

The service was well led. The registered manager and staff were committed to providing good quality care. There were systems and processes in place to monitor the quality of the service and drive improvements. People, relatives and staff were encouraged to share their views on the service provided.

Further information is in the detailed findings below.