The Hollies

The Hollies is a residential care home providing personal care to people aged 65 and over, some of whom are living with dementia. At the time of the inspection there was 28 people using the service. The service can support up to 28 people.

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

We found the staffing levels were not adequate. There were limited activities organised for people however, the service is in the process of recruiting an activity co-ordinator.

The service reported a high number of unwitnessed falls over the previous 12 months. We were not assured that systems were always in place to take action to reduce these. Equipment such as stair safety gates and handrails had been fitted to improve safety in the environment.

There was a lack of effective governance systems. We found some policies were out of date or had no review date, the registered manager stated this would be actioned.

We found risks were not always managed in the least restrictive way. We recommend the provider works within the principles of the Mental Capacity Act 2005 (MCA) to determine whether alternatives could have been considered rather than using restrictive practices.

During our inspection we found issues with medicines storage and administration. We were not assured the service reviewed medicines and records were not always complete. People at the service felt supported to take their medicines, one person told us, “I feel supported to take my tablets on time.”

People told us they felt safe living at The Hollies. The provider had effective safeguarding systems in place. Staff demonstrated a good understanding of how to raise safeguarding concerns.

People and staff provided us with positive comments about the management team “if I need help, I know I can ask”. Staff said they felt supported. We found the management team had taken steps to improve the service.

The service had established good working relationships with health professionals, one health professional told us “the staff are always friendly and approachable”.

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 inspection was not rated and there were no breaches (published 27 November 2020). At the last comprehensive inspection the service was rated requires improvement overall published 28 January 2020.

Why we inspected

This was a planned inspection and was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. The information CQC received about the incident indicated concerns about the management of falls from stairs. This inspection examined those risks.

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.

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

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 have found evidence the provider needs to make improvements. Please see the Safe and Well led sections 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.

We have identified breaches in relation to management of risks, medicine management, governance and

staffing at this inspection.

You can see what action we have asked the provider to take at the end of this full 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Hollies is a residential care home which provides accommodation and personal care for a maximum of 28 people. At the time of the inspection 23 people were using the service. Care is provided in one adapted building. Many of the people in the home are living with dementia.

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

We received positive feedback about the service from relatives who said care met individual needs and that they had been communicated with well during the COVID-19 pandemic. They said they felt involved in decision making regarding their relative’s care.

Since the last inspection, improvements had been made to governance systems. A range of audits and checks were undertaken, and these were used to drive improvement to the service. Feedback from people and staff was regularly sought and used to monitor the performance of the service.

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.

Overall, we were assured that appropriate infection prevention and control systems were in place to help keep people safe within the limitations of the current building layout. However, we have advised the provider on how to further develop their approach to infection control, please see the safe section of this report.

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 28 January 2020) and there were two breaches 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.

Why we inspected

We undertook this targeted inspection for two main reasons. Firstly, as part of CQC’s response to the coronavirus pandemic we are conducting a thematic review of infection control and prevention measures in care homes. Secondly, we inspected to check whether the requirement actions we previously served in relation to Regulation 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

CQC have introduced targeted inspections to follow up on breaches of regulation or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. Therefore, the overall rating for the service has not changed following this targeted inspection and remains requires improvement

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.

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.

The Hollies is a residential care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

Quality assurance systems and processes were not always effective in identifying and sustaining improvements. There was limited engagement with people and staff using the service.

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

People and relatives we spoke with said they felt the service was safe. There were systems and processes in place to ensure people were safeguarded from abuse.

People and relatives said staff were kind and caring. People’s diverse needs were taken into consideration. Staff ensured people retained their independence as much as possible.

People received their medicines safely and as prescribed. The home was clean and there were policies in place for the prevention of infections.

People had access to health and social care when necessary. Staff ensured people’s health and wellbeing were monitored and actions taken when they were unwell.

Care plans contained good person-centred information and they were reviewed regularly to ensure people’s needs were met.

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 March 2016). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of Regulations 11 (Need for Consent) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have told the provider to take at the end of this report.

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.