Holly Cottage

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We identified concerns relating to consent for care and treatment. The provider had not always ensured people’s capacity to consent had been assessed according to the specified process set out by the Mental Capacity Act (2005). This meant there was a risk people’s rights were not fully protected. We judged this to be a breach of regulation.

People’s care was documented within their care plans, although some contained inconsistencies, and staff knew people’s needs. A family member told us that they felt involved in the care of their relative and had good communication with the manager and staff. They said, “The home will contact me if they need to discuss something with me or make me aware of anything”.

The care plans contained information on the level of support required to carry out specific tasks or to promote independence but could benefit from more detail in some cases. Deprivation of Liberty Safeguards (DoLS) were in place for those that required them in order to keep safe, and these were kept in date. We found that the provider had good communication with external agencies especially around people’s health assessments.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider aimed to ensure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We observed how staff understood people well and were able to communicate effectively. Staff worked with people to assess the risks associated with their day-to-day activities. Staff knew people’s abilities and aimed to ensure a right balance of support and independence for each person. People’s needs were assessed before they began to receive a service. Some care plans were not accurate which meant there was a risk of a person not having all their needs assessed and met. For example, 1 person’s continence needs were assessed as low dependency, but their care plan stated that they were non-mobile and mostly in bed, doubly incontinent.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Care plans were developed around people’s needs, however, some plans were not consistent and there was a risk of people’s needs not always being fully met. Staff followed guidance and care plans put in place by other healthcare professionals such as speech and language therapists.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Prior to commencing their work, all new employees were required to become acquainted with the care plans of every person.

We had positive feedback from external partners. One professional told us that, “I have been attending this care home for the past 10 years and have always found staff to be courteous, caring and involved with residents‘ needs”. Staff told us that any updates in the care needs of people were shared in a timely manner. We saw evidence of regular team meetings and periodic individual coaching sessions with staff focused on quality and improving outcomes for people. There was effective communication and a good handover process to ensure information was distributed in a timely fashion and issues dealt with promptly.

Rotas and staff allocation boards were in place showing how people got their shared and individual hours. The service worked well with the GP surgeries and other health professionals led by the senior support worker who is a nurse by training. We saw evidence of involvement of multidisciplinary teams in shaping the support people received.

The management team understood people’s needs well and told us how they worked collaboratively with other service providers to achieve positive outcomes for people.

Relatives were happy with the way the service supported people’s health needs. One person told us, ‘I picked [my relative] up last weekend and the staff informed me that [my relative had a health concern] and staff were aware of the condition [my relative] has that can lead to this.’

Some health care plans required more detail to help and guide staff. For example, one person, who had a diagnosis of diabetes, had a care plan documenting their increased risk of high or low blood sugar. However, the care plan did not set out clearly what the signs and symptoms were or give staff clear guidance on what to do if they suspected there was a problem. There was a risk of this person’s particular health needs not being met.

Staff told us that they supported people to see the relevant professionals, and these were booked in advance. People who were unable to access health appointments externally were seen at home. We found that there were clear lines of communication with other professionals. The service had a weekly call with the GP surgery during which any health issues that had arisen were dealt with. The manager told us that referrals were submitted urgently where there were any changes to people’s health and wellbeing. We found that staff knew of any changes and were able to adjust the support they offered people. We saw evidence of future planning for appointments and evidence of this being known to the staff team

People’s meals were prepared in line with their dietary needs. People had nutritional plans in place, and we observed during mealtimes that food was prepared to the right consistency to try and reduce the risk of choking or aspiration. People had choice of meals, and the menu contained healthy meal options.

The provider routinely monitored people’s care and treatment to continuously improve it and we noted a mixed picture. People’s care plans showed that their needs were documented, although records were not always comprehensive. This meant ongoing review risked being incomplete in some cases. The team leader took the lead in care plan reviews, and we saw records of bimonthly reviews of people’s needs. A family member told us that there had been a positive transformation in their relative since moving to Holly Cottage.

Changes to people’s health were discussed with staff at team meetings and recorded within their care plans. Relatives felt they were kept informed of any significant changes in people’s needs, and were able to be involved in their care as much as they wanted to.

We reviewed Mental Capacity Act (2005) (MCA) assessments and found some discussions about people’s communication needs had not taken place or their views appropriately sought. This should be part of the MCA process. We identified the provider had sometimes assessed multiple questions rather than 1 specific decision within 1 assessment, which was not in line with the Mental Capacity Act Codes of Practice. This had also been raised during a quality visit by the local authority on the 17 May 2024, and had not been addressed. The provider recorded details of people’s appointees and details of any power of attorney. Staff had received training in the Deprivation of Liberty Safeguards (DoLS) and there was information around the service. DoLS applications, to deprive people of their liberty for their own safety, had been submitted where necessary. The service worked in collaboration with independent mental capacity assessors, and we saw evidence where they had been involved during the application process. The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.