The Hollies and Hollies Lodge

About the service

The Hollies and Hollies Lodge provides accommodation for persons who require nursing or personal care and is registered for 24 people. People have mental health needs and are accommodated in two separate parts of the building, There were 24 people using the service at the time of our inspection. Each person has their own room, and some are en suite.

We found the following examples of good practice.

The provider took timely actions to keep people safe and follow the government guidance. The management team have taken a proactive approach to help ensure people understand the risks and personal responsibility. People have complex mental health needs which has meant at times there have been significant challenges in implementing the guidance and expecting people to follow it.

Staff have provided consistent support and guidance to people. In house activities have been developed to give people an alternative to community based activities.

Regular testing, cleaning and other precautions such as monitoring temperatures has meant the impact of COVID-19 has been minimal and has been contained.

Vaccination records were monitored and stored by the management team for people, staff and regular visitors. Where visiting professionals attended the service appropriate checks were in place including checking their vaccination status.

The Hollies and Holly Lodge is a residential care home providing accommodation and personal care for people with a mental health need. At the time of the inspection 24 people were being supported. The service can support up to 27 people. The service is divided into two separate units joined by corridors. The main house accommodates most people and has shared communal areas and communal showers. The second part of the building ‘Holly Lodge’ has four residents in ensuite accommodation with a communal kitchen and living room. There are large grounds surrounding the houses which include a vegetable garden and sensory garden.

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

Since the last inspection the management had worked hard to change the ethos and culture in the service to focus on recovery and promoting people’s independence.

People and staff were positive about the managers in the service and told us they listened and responded to concerns.

Staff were engaged in the change within the service and spoke positively about the impact on people living in the home.

There was a positive and calm atmosphere and people told us they felt safe.

Risks had been assessed in relation to people’s care and support needs and guidance on managing risks focussed on promoting people’s independence.

People received their medicines as prescribed. The service was supporting people to be as independent as possible with their medicines.

The service was clean and tidy throughout. People were supported to keep their own areas tidy as part of developing independent living skills.

There were enough fully trained staff with the skills and knowledge to meet people’s needs. Staff focussed on supporting people by focussing on their strengths to aid their recovery and promote independence.

Staff knew people well and had a good rapport with people.

Peoples physical and mental health needs were holistically assessed focussing on supporting people’s recovery and independence. Staff worked with people to achieve their personal goals.

The service worked well with other professionals to access healthcare. People were supported to attend regular check-ups such as the dentist and opticians.

One unit in the home was specifically adapted to support people to develop independent living skills with ensuite accommodation and communal kitchen and living room. The provider had plans to reconfigure other areas on the building to create similar self-contained accommodation which would help people to develop skills they would need to move into the community.

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.

People directed their own care. Each person met weekly with their ‘recovery worker’ to discuss progress towards their personal goals and any difficulties they were facing.

The service responded to people’s needs. Care plans were updated as needs changed or as people achieved their goals.

People were supported to access the community and take part in social activities to reduce isolation.

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 13 September 2018) and there were multiple breaches of regulations. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Hollies and Holly Lodge 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 service is registered for up to 27 people who primarily have a mental health need. However, people might also have a learning disability, a diagnosis or autism or issues relating to alcohol and substance misuse.

The Hollies and Holly Lodge 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 service is divided into two separate units joined by corridors. The main house accommodates most people and has shared communal areas and communal showers. It offers single occupancy bedrooms and generous gardens and grounds. The second part of the building has fewer number of people and separate communal facilities and separate staffing.

During our inspection on 4 July 2018 there was a manager in post but they were not yet registered with the Care Quality Commission although they advised us they had put their application in and had been waiting at least twelve weeks.

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.

At this inspection we found people were receiving care that was not always safe or met their identified needs. The manager had taken actions to try and ensure people got their medicines as intended after a series of medication errors. This had resulted in either people not getting their prescribed medicines or medicines administered incorrectly. There had also been issues with accounting for medicines to make sure they were available as people needed them. The manager had put more robust procedures in place and had supported staff to ensure they were competent and had accessed the right level of training.

The manager confirmed they had significantly increased the staffing levels since coming into post including the introduction of waking night staff. However, we were unable to see what people’s assessed needs were as some people had not been reviewed for some years. Some people had high risk behaviours which could put themselves or others at risk. Staffing levels meant that people were not always supervised for their safety and were not sufficient for people to have personalised care around their needs. The service did not have a dependency tool in place to show how they calculated the numbers of staff they needed.

The environment was not safe for its intended use. We found during our inspection broken window restrictors, ligature risks, uncovered radiators, water that exceeded recommended temperatures, and exposed pipework. We also found the environment was excessively hot with little means to keep people cooler. The service had long, thin corridors which were inappropriate for people with a physical disability. Some people using the service were becoming more frail with reduced mobility. Should they need walking aids or be permanently in a wheelchair, the service would not be able to accommodate them safely. The service was not appropriate for people with sight impairment or cognitive impairment as there was nothing to orientate people. The communal areas were too small for everyone to use at once. It was a hot day so some people were outside but others were stretched out on sofas. There were not enough places for people to sit apart from their own rooms and at lunch time there was not enough space for people to safely move between the table and chairs.

Risks to people’s individual safety had not been adequately considered. We observed people unsupervised during the day.This included people frequently accessing the kitchen to make themselves drinks. Staff were not in the vicinity to support people. The risks from cross infection had not been adequately considered and areas of the service were dirty. There were no separate domestic staff and although staff did clean the service they did not have time to do this continuously throughout the day.

Some people’s needs outweighed what the service could provide and the service did not facilitate people’s independence or autonomy. There was nothing in place around assessing people’s capacity to make decisions about their everyday needs or more complex decisions where required. The manager was in no doubt that some people had fluctuating capacity and there were no systems in place to support effective decision making to ensure it was in people’s best interest. The manager was in the process of getting everyone needs re reviewed and where necessary carrying out capacity assessments. They had reviewed lots of care plans to ensure they accurately reflected people’s needs and provided evidence of how staff were meeting these.

However not all the care plans were up to date and it was difficult to establish what everyone’s needs and risks associated with their care and support were. It was difficult to establish from their records how their health care needs were monitored and met by other professional staff.

There was nothing in place regarding end of life care, and people’s preferences regarding this were not clearly established. Staff had not been given training and this was of a concern given a few recent deaths.

Activities for people were provided but it was difficult to assess if they were sufficient or around people’s assessed needs and in keeping with their life experiences.

The meal time experience was poor and staff did not enhance people’s wellbeing although we saw people did enjoy the food provided. Meal sizes did not consider people’s preferences, neither were they proportionate in terms of those who had been steadily gaining weight. Weights were monitored but we could see little recorded actions regarding weight gain and promoting healthier lifestyles where appropriate.

The manager was experienced and had set about bringing positive change to the service. They had a full staff team and had recently recruited a senior team to help improve the service. They had put in systems to help them measure the effectiveness of the service and identify anything where improvements were required. A new maintenance person was on site and focussing refurbishment and ensuring equipment and premises were well maintained.

Staff recruitment processes were adequate and the manager had improved training opportunities for staff and ensuring staff received adequate support and supervision for their job role.

Staff had sufficient understanding of protecting people from abuse and had received training. We had concerns about the management of incidents as records did not always tell us what actions had been taken and if risk assessments were in place and had been updated.

Overall although we have rated this service as requires improvement we found people were happy with the service and the staff that supported them. We were confident with the new management arrangements and felt given time this service could be turned around to become a good service. We have received assurances that the building is being completely renovated and the service is going to provide a second regulated activity of personal care in people’s own homes. This would increase the scope of the service to provide care and support around people’s assessed needs and become more personalised. We do however have reservations about provider oversight given the level of concern we identified. We also want assurances that the action plan continues to be met and plans for refurbishment and the rebuild go ahead as scheduled.

We previously carried out a comprehensive inspection at The Holies and Hollies Lodge on 21 and 23 January 2015. At this inspection, we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. This was because we identified concerns in respect to the safe management of medicines. The service received an overall rating of 'requires improvement' from that comprehensive inspection.

After our inspection in January 2015, the provider wrote to us to tell us what action they were taking to meet the legal requirements in relation to the breach.

We undertook this unannounced comprehensive inspection in December 2016 to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. At this inspection, we found improvements had been made in the required areas and the provider was no longer in breach of the regulations.

The Hollies and Hollies Lodge provides accommodation and personal care for up to 23 adults living with a long-term mental health condition. On the day of our visit, there were 22 people using the service.

The home had a registered manager in place. 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 registered manager had been in post since March 2016.

Staff were aware of their role in safeguarding people from the risk of abuse and had received appropriate training. Risk assessments had been devised to help minimise and monitor risk, while encouraging people to be as independent as possible. Staff were very aware of the particular risks associated with each person's individual needs and behaviour.

Staffing levels were sufficient to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff worked at the home.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Where people required the use of ‘as and when’ medicines (PRN), these were given safely.

There was positive interaction between people and the staff supporting them. Staff spoke to people with understanding, warmth and respect and gave people opportunities to make choices. Staff knew each person's needs and preferences in detail, and used this knowledge to provide tailored support to people.

The service was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff received specific training in this area and were able to explain to us how they used this in their work.

People were supported to eat and drink sufficiently to maintain a balanced diet and encouraged to be involved in supporting themselves at mealtimes. People were supported to maintain good health and received support from healthcare professionals when required.

People's individual care plans included information about what was important to them. People participated in a range of different social activities and were supported to access the local community.

The registered manager and staff knew what they should do if anyone made a complaint.

Staff liked working at the service and felt there was a good team spirit, which had improved greatly since the appointment of the registered manager. Staff meetings took place regularly, staff felt confident to discuss ideas and raise issues with managers at any time.

People were asked about the quality of the service and feedback was included in plans for future improvements. There were effective systems in place for monitoring the quality and safety of the service. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

A new company, Eastern Healthcare Limited, now own and operate the home. People and their relatives and staff told us that improvements were being made to the environment, staffing levels and the care planning system. This was seen during our visit.

People living at the home and their relatives said that The Hollies and Hollies Lodge was a good place for people to live. They told us that the staff were kind, friendly and polite and provided the people living at the home with the care and support they needed.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant that the staff members employed were suitable and had the qualifications, skills and experience needed to support people living at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). Policies and procedures were held. Staff had been trained and knew when a DoLS application was needed. The manager knew how to submit a DoLS application. However, DoLS applications had not been submitted when required and improvements were needed.

Is the service effective?

People's health and care needs were assessed with them or their family member. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person told us. 'This is a nice home and the staff will do anything to help you.' Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. Relatives told us that staffing levels had increased to ensure people could be involved in activities and outings. Our observations confirmed this. A visitor told us. 'I am happy with the care given to my family member. The members of staff are polite and respectful.'

Is the service responsive?

Care and risk assessments had been completed but not all were up to date and had been recently reviewed. The care and support provided was adjusted to meet the needs of each person. Improvements were being made to ensure that any change in care and support was recorded in the person's plans of care. A record was held of people's preferences, interests and diverse needs. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People had access to a range of planned activities that they said they enjoyed.

Is the service well led?

Staff spoken with had an understanding of the ethos of the home and quality assurance processes were in place but were not complete. Relatives told us that they had been asked for their feedback on the service their family member received. Visitors and staff said that they had felt listened to when they had made a suggestion or raised their concerns. People told us that the manager and new provider were approachable. We have asked for improvements to be made to ensure that we are told when events such as people experiencing an injury or being admitted to hospital occurred at the home.