Holly Bush Nursing Home

We found the following examples of good practice.

The service followed current government visiting guidance. Visitors were required to have a negative lateral flow test result by conducting the test at home or when they arrived at the care home. Visitors were required to contact the care home and book in their visits to ensure visits were staggered in order to minimise visiting numbers at any one time. This ensured the area allocated for visits was available.

The service also facilitated outdoor garden visits, which meant families were able to see their relatives in the safety of the outdoors and following social distancing guidelines. People were also driven to their family homes, where they completed window visits in the comfort of a minibus that was owned by the provider.

All visitors were verbally asked and screened for symptoms of infection before being allowed to enter the care home. They were supported to wear appropriate personal protective equipment (PPE) and hand washing before and after visiting.

The service carried out monitoring checks of staff IPC practice and further training was provided when needed. This helped to assure the provider that people were protected and safe. Risk assessments had been carried out on people and staff belonging to higher risk groups and action taken to reduce the risks. Managers completed daily visual checks on staff testing registers to make sure all staff on shift had completed lateral flow testing.

Staff had received training on Infection Prevention Control (IPC) provided via external organisations as well as online training provided by the service. We observed staff used PPE effectively to safeguard people and visitors. The signages on donning and doffing of PPE and handwashing were visible in all relevant areas.

There was an up to date infection control policy in place and there were standard operating procedures that were regularly updated in line with changes in government policy. Staff and people receiving care had been vaccine. Regular testing was also carried out for people, visitors and visiting professionals in order to identify any positive cases as early as possible so that people could self-isolate to reduce the spread of infection.

The service had ensured there were sufficient supplies of PPE. During the COVID-19 pandemic, the service was able to reliably get hold of enough of the right PPE to meet people’s needs. During the pandemic the provider promptly communicated with staff, people and relatives. This and regular communication with the host local authority, public health teams and community healthcare professionals helped to ensure the home carried out good IPC practice that kept people safe.

Holly Bush Nursing Home provides care and accommodation for up to 12 people with learning disabilities, sensory impairments and physical disabilities. T

he home is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service has been developed and designed in line with the principles and values that underpin ‘Registering the Right Support’ and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were protected from the risk of harm and abuse. Safeguarding procedures were in place, which staff were aware of.

There were comprehensive risk assessments in place. These were kept under review, which ensured that risks to people's safety and wellbeing were monitored and managed properly.

Staff had been recruited safely. They underwent appropriate recruitment checks prior to working at the service. There were enough staff deployed to keep people safe. We observed that staff were busy but there were no delays in people being attended to.

Relevant health and social care professionals were involved in assessing, planning and delivering care and treatment.

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. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People’s privacy and dignity were respected. We observed kind, caring and spontaneous interactions between people and staff. Staff maintained people's independence by supporting them to manage as many aspects of their care as they could.

People’s needs were met. We observed a range of practices that reflected person centred care. People’s care was regularly reviewed to monitor whether it was up to date and reflected their current needs.

Accidents and incidents were monitored for trends and learning points. Regular checks and audits had also been carried out in other areas such as those related to people’s care. We found improvements were always made where shortfalls were identified.

There were effective quality assurance processes in place to monitor care and safety and plan ongoing improvements. There were systems in place to share information and seek people’s views about the running of the home.

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

Rating at last inspection

The last rating for this service was good (published 18 July 2017).

Why we inspected

This was a planned inspection based on our rating at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to inspect as part of our re-inspection programme.

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

Holly Bush Nursing Home provides care and accommodation for up to 12 people with learning disabilities, sensory impairments and physical disabilities. The home is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service has been developed and designed in line with the principles and values that underpin ‘Registering the Right Support’ and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

There were systems and processes to support staff to understand their role and responsibilities to protect people from avoidable harm. There were safeguarding and whistle blowing policies and procedures in place. Staff were able to describe the different ways that people might experience abuse, including financial abuse and the escalation process if they were concerned that abuse had taken place.

There were comprehensive risk assessments in place. These covered a range of areas, including risks from choking, falls and behaviours that challenged the service. Risk assessments were kept under review, which ensured that risks to people's safety and wellbeing were monitored and managed properly.

There were enough staff deployed to keep people safe. We observed that staff were busy but there were no delays in people being attended to. Staff had been recruited safely. They underwent appropriate recruitment checks prior to working at the service

The service leadership, management and governance assured high-quality, person-centred care and supported learning. The provider has acted to minimise potential risks to people who used the service, and this had been effective. The service had improved their systems to ensure records clearly indicated how people’s finances were being managed. We reviewed people’s financial records and found that appropriate records of expenditure and income for each person were recorded.

Accidents and incidents were monitored for trends and learning points. Regular checks and audits had also been carried out in other areas such as those related to people’s care. We found improvements were always made where shortfalls were identified.

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

Rating at last inspection

The last rating for this service was good (published 18 July 2017).

Why we inspected

We received concerns in relation to the management of people’s finances. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions 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. The provider has acted to mitigate risks, and this had been effective. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report.

Follow up: We will continue to monitor the service through the information we receive.

Holly Bush Nursing Home provides care and accommodation for up to 12 people with learning disabilities, sensory impairments and physical disabilities. It is located in Stanmore. At the time of the inspection the home was fully occupied.

Some people who lived at the home had mobility difficulties, which affected manual dexterity and coordination and some had sensory impairment, which meant they could be highly sensitive to sound and touch. Others did not speak verbally, and could only speak by way of communication aids, as well as hand gestures and facial expressions. These impairments meant they could not cope living independently.

The home’s vision was to ‘promote people’s independence and well-being’ by ensuring they maintained and respected people’s rights, dignity, privacy, independence and personal choice. In order to achieve this goal, the home had a set of objectives which defined steps that they needed to take. These objectives included: empowering people to make informed choices; treating people with respect at all times; upholding the human and citizenship rights of all people; and, working in partnership with support services and relatives to ensure that the best interests of people were met. At this inspection we saw that the home had exceptionally addressed these objectives. This was also confirmed by professionals and relatives we spoke with.

The service had 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 and associated Regulations about how the service is run.

Staff understood the needs of people. We saw that they closely monitored these needs to ensure they were met. In some instances this had led to marked improvements in people’s conditions since moving to the home. This was evident where people had been admitted to the home because their previous placements could no longer fully support their needs. We received some exceptional feedback from professionals who had previously worked with some of the people using the service. They were able to tell us about people’s journeys and how Holly Bush Nursing Home had transformed their quality of life. For example, some people had been prone to frequent hospital admissions due to complex medical needs. However, since moving to the home, the hospital admissions had significantly reduced due to support and treatments which suited them.

Staff were resourceful in finding ways to meet people’s needs. They did not give up on trying new things with people even when evidence suggested otherwise. In one example, staff had managed to support one person to go on holiday. This had been their first holiday in many years. Previous homes had not been able to do so. This is one of many good examples of personalisation that we saw.

People were treated with kindness and compassion. Staff consistently went out of their way to meet their needs. Professionals involved in people’s care and people’s relatives were also complimentary about the kindness and empathy displayed by staff. One person had enthusiastically given an account of how a particular member of staff had gone out of their way to support them with their preferences. Their account was consistent with another act of kindness shown by staff to another person. A relative of this person could not stop praising the kindness shown by staff.

Risks to people were minimised because the home had procedures to protect people from harm. Their risks had been assessed, identified and well managed. Staff understood how to keep people safe. They had received training on how to identify abuse and understood procedures for safeguarding people.

The home followed safe recruitment practices. Therefore people were protected from the risks associated with the recruitment of new staff. We also saw that staffing levels were assessed and monitored to ensure they were sufficient to meet people's identified needs at all times.

There were suitable arrangements in place for the safe management of medicines. Staff were trained to administer medicines and received regular checks on their competency to administer medicines.

The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were knowledgeable about the requirements of the Act. Where people lacked capacity we saw staff best interests meetings were carried out.

Risks to people's nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs and to maintain a balanced diet.

Relatives to us told us the management and staff were approachable. Staff told us that they felt supported by the management.

There were procedures in place to monitor the quality of the service. Remedial action was quickly taken if any issues we identified.

We saw that people appeared well cared for, comfortable and relaxed at the home.

We saw that people's care plans were drawn up to take account of their assessed need and that care was provided in a way intended to ensure the safety and welfare of people although there was some inconsistencies between care plans and support and treatment provided.

The planned menus were based on standard English cuisine. We saw that people were provided with nutritious and well balanced meals. Care had been taken to provide for people who needed a special diet for medical reasons.

Staff had been trained in safeguarding and were familiar with safeguarding policies and procedures. The provider had systems in place to audit procedures for ensuring the safety of the services and to assess and monitor feedback about the quality of the services provided.

The staff said they had been on training to understand the needs of people who have autism and told us they found the training, "Extremely beneficial" and, "We can better understand people's needs"

We found that staff were able to communicate with people and understand their needs. We saw that the provider had arranged appropriate training for staff. The provider told us they carried out regular supervision of staff every 2 months and this was confirmed by the staff.