Hollin Bank House

Hollin Bank House is a residential care home providing accommodation and personal care to up to 14 older people and those living with dementia. At the time of our inspection there were 7 people using the service.

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

Medicines were not always managed safely. Records relating to safe medicines management were at times inaccurate or missing.

Quality monitoring and audits at the service were not effective or robust. These systems had not identified shortfalls in management of medicines or ensured areas of the home were safe.

People were not always able to express their views on the service they received, as not everyone had received feedback forms and resident meetings were not taking place. We made a recommendation about this.

The environment contained limited dementia friendly aids to help people orientate around the service, and some areas were unsafe for people to use. We made a recommendation about this. Staff received a mixture of mandatory training and service user specific training, but this did not cover all the required areas. We made a recommendation about this.

People were not always offered choices at the service, and we received mixed feedback on this in the areas of nutrition and personal care. People were not always involved in contributing to or reviewing their care and support plans. We made a recommendation about this. People were supported to maintain relationships which were important to them and were involved in a range of activities. People’s communication needs were met and there was a process for managing complaints and concerns.

Risks to people and the environment had been assessed and there were enough staff to support people. Recruitment practices were robust, and people and relatives spoke positively about the staff approach. There were systems and processes in place to safeguard people from the risk of abuse.

People spoke positively about the quality and quantity of food and fluids they received and were supported to eat and drink enough. People’s rights were respected, and the service was working in accordance with the mental capacity act . People were supported by staff who treated them with respect and promoted dignity, privacy and independence. People and their relatives praised the staff approach to providing care and support. Staff understood the need to encourage people to be independent and people we spoke to confirmed this. We observed interactions between people and their care staff which were professional, friendly and considerate.

People and staff spoke positively about the management team and the registered manager was committed to making improvements to the service through partnership working.

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 10 February 2020).

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.

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

Enforcement and Recommendations

We have identified breaches in relation to management of medicines and good governance at this inspection. We have made recommendations in relation to staff training, dementia friendly aids, obtaining service user feedback and care planning. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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 service had been identified for use by the Local Authority as a designated care setting in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. This inspection was to ensure that the service was compliant with infection control and prevention measures.

We found the home was not suitable to provide beds under the designated care setting scheme. This was because the physical layout of the building would not meet the requirement to provide separate facilities for residents and staff.

We found the following examples of good practice

• Visitors to the home were advised of the procedure to follow to ensure they follow infection control procedures. Visitors were offered PPE and hand gel at the entrance.

• Staff have received training and follow national guidance in relation to infection control and use of PPE.

• There is an admissions policy which requires people to have a negative Covid19 test and to isolate for some time after admission in line with national guidance.

• Staff were communicating well with people living in the home, despite the use of PPE and appeared to have provided reassurance, people appeared relaxed.

• People’s rights had been considered and families had been consulted about any decisions people needed support to make which included Covid 9 testing.

• The home was clean, the domestic team followed schedules and the management checked these were completed properly.

Hollin Bank House is a residential care home providing personal to 9 people aged 65 and over at the time of the inspection. The service can support up to 14 people. The service accommodates people across two floors.

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

People told us they felt safe and were supported by staff who knew them and their needs well. Staff treated people with respect and maintained their dignity when supporting them.

Ongoing improvements were being made to the decoration and upgrading of facilities in the building. There had been a change of ownership since our last inspection. Some areas of fire safety had been identified through a recent visit from the fire service and the registered manager and owner were taking appropriate action to address this. There was a lack of outside space for people to access which was being addressed. Checks on the environment and equipment were taking place.

Medicines were managed safely. We identified some minor improvements were needed in relation to the recording of medicines. However, immediate action was taken by the registered manager to rectify this. Accidents and incidents were recorded and risk assessments were in place. Improvements had been made around the prevention and control of infection.

People and relatives were positive about staff and the service they received. There were enough staff employed and on duty to meet the needs of people. The owner had an effective recruitment and selection procedure and carried out relevant checks.

Staff had the skills and knowledge to deliver care and support in a person-centred way. 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 practice. Care plans were detailed and covered all aspects of people's care, including oral care.

The management team were approachable and had an open door policy which enabled people to share their views and raise concerns. During the inspection one relative raised an issue that was resolved effectively. The registered manager was passionate about the service and had worked hard since last inspection to make improvements. There was an activity coordinator in place and although people told us they were happy with the activities provided, we identified areas for further development.

The new owner was responsive and monitored quality and there was a continuous programme of ongoing improvements.

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 8 January 2019)

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

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service:

• The service had deteriorated in some domains since our last inspection.

• The service met the characteristics of requires improvement in three out of the five key questions.

• We found two breaches of the regulations in relation to recruitment and consent.

• People were not always assisted to have maximum choice and control of their lives.

• We have made four recommendations in relation to risks, pureed meals, the environment and audits.

• We also found shortfalls in relation to the recording of controlled drugs, lessons learned, infection control and training.

• There were also good practices within the service.

• People liked living in the service. We observed a homely and friendly atmosphere.

• People were protected against abuse, neglect and discrimination. Staff ensured people's safety and acted when necessary to prevent any harm.

• Staff spoke passionately about their roles and wanting to provide quality care.

• There was good evidence that equality and diversity had been considered, in particular around those with protected characteristics.

• Staff knew people well. They had developed good relationships with people. People clearly enjoyed the presence and attention from the staff.

• More information is in the full report.

Rating at last inspection: At our last inspection the service was rated good overall. Our last report was published on 17 October 2017.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: Information relating to the action the provider needs to take can be found at the end of this report.

Follow up: We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates. We will follow up on the breaches of regulations and recommendations we have made at our next inspection.

Hollin Bank House is registered with the Care Quality Commission to provide personal care and accommodation to 14 people. Hollin bank house is situated on the outskirts of Accrington. There were nine people using the service on the day of our inspection.

At the time of our inspection the service had 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.

During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to restrictions being placed on people without the correct authority in place.

Staff members had received safeguarding training and were aware of their responsibilities to report any concerns. Safeguarding policies and procedures were in place to guide staff. A whistleblowing policy was also in place to protect staff should they report poor practice.

Risk assessments had been completed on an individual basis for people who used the service, such as moving and handling, medication, bathing, dressing and accessing the community. The risk assessments were person centred and provided staff with guidance to minimise the risks. Further risk assessments needed to be put in place in relation to the environment which the registered manager commenced on the second day of our inspection.

Records showed that robust recruitment processes were followed by the service when employing new members of staff. We saw references and identity checks were carried out as well as Disclosure and Barring Service checks.

Medicines were managed safely. We saw that only those staff members trained to do so were permitted to administer medicines to people. Competency checks were regularly carried out to ensure staff members remained competent. Whilst temperature checks of the medicines cabinet were being undertaken, these were not being recorded on a daily basis. The registered manager assured us this would be actioned immediately.

Staff told us and we observed they had access to personal protective equipment (PPE) such as gloves and aprons and confirmed they had received training in infection control. There was a nominated individual responsible for infection control within the service.

Staff members we spoke with and records we looked at showed that when commencing employment at Hollin Bank House, all staff were to complete an induction. The induction covered training the provider deemed necessary for the role and shadowing more experienced members of staff.

Staff had been trained in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and policies and procedures were in place to provide guidance. However, on the first day of our inspection we found some people were being restricted without the correct authorisation in place. We discussed this with the registered manager. On the second day of our inspection the registered manager had commenced making the relevant DoLS applications.

Records we looked at showed that staff members received regular supervisions and appraisals to support them in their roles.

We saw some areas of the service required refurbishment. The service had a programme of refurbishment and we saw some areas had already been improved, such as a new wet room on the ground floor. However, we found the flooring cover in the dining room was creating a trip hazard to people who used the service. The provider was dealing with this on the second day of our inspection.

People who used the service told us staff members were kind and caring. We observed kind and caring interactions between people who used the service and staff. We saw that staff appeared to know people well and understand their needs. People who used the service appeared relaxed.

The end of life wishes of people who used the service had been considered. End of life care plans were in place for staff to follow when a person was at the end of their life.

The service had a complaints policy and procedure in place. Records we looked at showed that complaints the service had received had been dealt with in line with policies and procedures.

Activities were available for people who used the service. These were tailored to meet the diverse needs of people who used the service. We observed some activities on both days of our inspection.

All staff members we spoke with were able to describe how they supported people to remain as independent as possible whilst being supported.

There were detailed person centred care plans in place which directed staff members to ensure the individual needs of people who used the service were met. We saw care plans were regularly reviewed with the person and/or their family member to ensure they remained current.

Policies and procedures were in place to guide staff in their roles. These were accessible to all staff and we saw they had been reviewed on an annual basis to ensure they remained relevant and appropriate.

Regular meetings were held with people who used the service and staff members to ensure the service received feedback and improved the service. Regular newsletters were sent out to family members to update them on the service. Surveys were also sent out as another means of gaining feedback on the service.

All the people we spoke with who used the service, relatives and staff members told us they felt the management team were approachable and supportive.

Further information is in the detailed findings below.