We carried out a review of the data available to us about Hollyhurst on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hollyhurst, you can give feedback on this service.
Hollyhurst is a residential care home providing personal and nursing care to 13 people at the time of the inspection. The service can support up to 22 people under its registration but would currently not admit more than 18. Hollyhurst provides accommodation across two buildings with a two-person bungalow and a large two storey house with bedrooms and communal areas.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Based on our review of key questions of safe, responsive and well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The environment of a large (more than 6 people) living in one communal home does not meet the principles of Right support, right care, right culture. Despite the large environment consideration had been given to the principles and meeting these, as follows:
Right Support:
People lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well. This had improved since the last inspection. Where restrictions were imposed these were robustly reviewed, by the staff who knew people best and relevant professionals, to see if these were appropriate or could be reduced. Infection control measures were in place, people were supported by staff to keep their home safe and clean. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. There were effective staff recruitment and selection processes in place. There were enough skilled and experienced staff who knew people well to safely meet people's needs, for example their communication needs. Staff recruitment and retention was a priority in the service, as there were vacant posts. Management had developed induction processes to help them find and keep staff that were right for the needs 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.
Right Care:
People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. Despite the large environment, people did not have their support dictated by the routines of the service. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so.
Right Culture:
Since the last inspection there was a new registered manager. They and staff were working to a development plan with a strong focus on improving the culture and positive outcomes for people. Many of the people and staff we spoke with told us they saw an improvement in the service and the culture. People commented on the positive atmosphere and caring attitudes of staff. People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.
The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. The registered manager recognised the importance of sharing information in an accessible way so people understood it and could respond. Staff had worked closely with the professionals in the service to develop meaningful engagement and increase opportunities for people to have their say.
People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. The service had strong links with other organisations, and the wider community, for the benefit of people who used the service. This included sharing best practice and organising events to increase the wider communities understanding about learning disabilities and autism.
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 08 December 2021).
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.
At an inspection in July 2019 we made a recommendation about person-centred care, the service had sustained improvement in this area.
Why we inspected
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 carried out an unannounced inspection of this service between 26 October 2021 and 05 November 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve processes to assess, monitor and manage risk.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hollyhurst on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Hollyhurst is a residential service providing personal and nursing care to 19 people with a learning disability. At the time of the inspection there were 15 people living at the service. Hollyhurst provides accommodation across two buildings with a two person bungalow and a large two storey house with bedrooms and communal areas.
People’s experience of using this service and what we found
Incidents were not always reviewed in a timely way. This delay meant action to keep people safe may not be taken quickly enough. Medicines were managed safely, however, we did find some 'when required' medicine records were not in place. This was rectified immediately.
Staff raised with us that sickness was impacting on staffing levels. We found staffing levels were safe and the service was working on a recruitment and retention plan to reduce the current high levels of agency staff at the service.
The service had improved care and support plans alongside risk assessments to promote a person-centred approach. Staff we spoke with told us these were clear and easy to follow. There was a new management team at the service and staff we spoke with felt they could raise issues and concerns with them. Feedback from relatives was positive relating to the care and support their loved ones received.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of [key questions of safe and well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The environment of a large (more than 6 people) living in one communal home does not meet the principles of Right support, right care, right culture.
Right support:
• Model and design of care and setting maximises people’s choice, control and independence
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human rights
Right culture:
• Th ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
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 September 2020).
Why we inspected
The inspection was prompted in part due to concerns received about incident management and staffing levels. A decision was made for us to inspect and examine those risks.
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 coronavirus and other infection outbreaks effectively.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hollyhurst on our website at www.cqc.org.uk.
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 have identified a breach in relation to safeguarding at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for 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.
Hollyhurst is a residential care home providing accommodation and nursing care. The home accommodates up to 22 people in one individual adapted building and an adjoining bungalow. At the time of our inspection 13 people with learning disabilities were living at the house and two in the bungalow.
Hollyhurst is one large house with an adjoining bungalow, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people. This was
because the building design fitted into the local residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.
The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence.
People’s experience of using this service and what we found
We received positive feedback from people, who told us they were happy living at Hollyhurst. People received person-centred support and staff knew people well. The care plans in place covered all aspects of peoples care and support preferences to ensure a personalised experience. People were supported to maintain important personal relationships with friends and relatives.
There were systems in place for communicating with staff, people and their relatives to ensure they were informed. People were supported to have their say and to exercise their rights and access to advocacy was available if required.
The environment was clean, recently decorated and maintained to a good standard with personalised bedrooms. As part of CQC’s response to the coronavirus pandemic we are also conducting a thematic review of infection control and prevention measures in care homes. The Safe domain also therefore contains information around assurances we gained from the registered manager regarding infection control and prevention.
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 on (26 July 2019)
Why we inspected
We undertook this targeted inspection following concerns raised from an anonymous whistle-blower regarding the environment and person centred care.
CQC have introduced targeted inspections to follow up on Warning Notices 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. The service was rated good at the last inspection.
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.
Hollyhurst is a residential care home providing accommodation and nursing care. The home accommodates up to 22 people in one individual adapted building and an adjoining bungalow. At the time of our inspection 11 people with learning disabilities were living at the house and two in the bungalow.
The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had not always consistently applied them.
Hollyhurst is one large house with an adjoining bungalow, bigger than most domestic style properties. It is registered for the support of up to 22 people. 13 people were using the service. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people. This was because the building design fitted into the local residential area. 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 out with people.
People’s experience of using this service and what we found
We received positive feedback from people and their relatives. People were happy living at Hollyhurst. They told us they felt safe and were kept busy doing the things they liked, and we observed positive interactions between people and staff.
Care plans were in place, but people had three different plans each and this meant not all information was updated or clear. Some information was person centred but this wasn’t always consistent and not all areas were included for example, end of life care. People did however, receive personalised support and staff knew people very well. We have made a recommendation that plans need to be reduced and improved.
The environment was very spacious and made best use of larger areas however some areas had hospital features, for example hand gels for infection control were on display. Signage that referred to service users and staff information. These were addressed in consultation with the people who lived at Hollyhurst following our first day of inspection.
One area of the home where one person was temporarily residing was no longer fit for purpose due to regular maintenance requirements. Environmental concerns were raised with the registered manager and maintenance staff. These were promptly addressed and following our inspection photographic evidence was also submitted to show progress.
Audits and monitoring systems were used effectively to manage the service and to make improvements as and when required.
Medicines were managed well, safely administered and recorded accurately. Medicines that were ‘as and when required’ had clear instructions in place.
There were enough staff to support people and staff were always visible. Staff received support and a variety of appropriate training to meet people’s needs.
Individualised risk assessments were in place. Staff were confident to raise concerns appropriately to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.
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.
Appropriate healthcare professionals were included in people’s care and support as and when this was needed. People were supported to have enough to eat and drink.
There were systems in place for communicating with staff, people and their relatives to ensure they were fully informed via team meetings and emails. People had good links to the local community through regular access to local services.
People were supported to be independent where they could, their rights were respected and access to advocacy was available. Support was provided in a way that put the people and their preferences first. Information was provided for people in the correct format for them.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; People’s care plans were too large and not completed to ensure they were all person centred. Also, one person’s environment was no longer fit for purpose. Some areas of the home still had hospital features, however these were addressed during the inspection.
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 good (published 13 April 2017).
Why we inspected
The inspection was prompted in part due to concerns received about the registered provider and the handling of safeguarding concerns. A decision was made for us to inspect and examine those risks.
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.
Hollyhurst provides care and support with nursing for 16 people with a learning disability who may also have other complex needs such as mental health issues, epilepsy or behaviour that may challenge. The service has the main house and also a two person bungalow in the grounds for two individuals on the autistic spectrum.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
We last inspected the service in 16 February 2016 and rated the service as ‘Requires Improvement.’ At that visit we found breaches of regulations in relation to staffing levels and also in relation to staff supervision and support. At this visit we saw improvements had been made and the service was compliant with all Regulations at this time.
On this visit we saw staffing was now provided at safe levels and any staff absences were covered largely by the registered provider’s own permanent and bank staff. Where the service had on occasions to use agency staff, we saw this was provided by consistent staff who had been well inducted into the service.
Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff.
We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
People, staff and relatives we spoke with told us they felt safe at Hollyhurst. Staff and people were aware of procedures to follow if they observed or were aware of any concerns.
Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner. People were also supported to manage their medicines themselves with support from staff and subject to appropriate assessments.
The home was clean, spacious and suitable for the people who used the service and people were enabled to access the spacious garden area. Improvements had been made in relation to putting in ensuite bathrooms, décor and furnishings. Appropriate health and safety checks had been carried out on the building.
Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals and told us they felt supported.
The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA). People are 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.
People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists to people’s physical health was supported.
Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service as smoothly as possible.
Staff supported people who used the service with their social and emotional needs. We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with staff members and there was a warm and positive atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and relatives and people told us that staff were kind and professional.
People who used the service and family members told us they were aware of how to make a complaint.
The service regularly used community services and facilities and had links with other local organisations. Staff told us they felt very supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. Family members told us the management were approachable, supportive and understanding.
The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Hollyhurst and actions plans and lessons learnt were part of their on-going quality review of the service.
The service had undergone major changes since our last inspection. The service had developed a two person service called Hollyhurst Lodge in a bungalow in the grounds. This service had transitioned two people with complex needs who had moved there from a hospital environment. The service had worked with the NHS to ensure this transition was managed with the minimum of impact for the two people concerned and some of the staff who had worked with these people in hospital, now supported them at Hollyhurst Lodge and were employed by the provider. The service also de-registered from providing hospital care in 2015 although it still provides nursing care to people with a learning disability. As a result of this change, some people left the service as they continued to require hospital care and other people who remained at the service were re-assessed and consulted about this change. There were currently 15 people using the service.
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 manager of the service took over in January 2016 and they had already applied to be registered with the Care Quality Commission.
Four people who used the service told us they felt safe at Hollyhurst and we observed care and support for people who were not able to communicate with us. This support was provided in a caring and dignified manner. We discussed safeguarding with staff and all were knowledgeable about the procedures to follow if they suspected abuse. Staff were clear that their role was to protect people and knew how to report abuse, including the actions to take to raise concerns with external agencies.
Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene, as well as condition specific training, such as working with people who had behaviour that may challenge. We found that the staff had the skills and knowledge to provide support to the people who lived at the service. People and the staff we spoke with told us that there were sometimes not enough staff on duty to meet people’s needs. We saw that the service had suffered with extreme staff shortages from before Christmas due to unfortunate staff sickness but was now actively recruiting and staff were returning to work from their sick leave. During the course of our visit there were sufficient staff on duty to meet the needs of the people and the staff team were very supportive of the manager and of each other.
Due to several key staff members being off sick at the latter part of 2015, staff supervision had not been carried out consistently. Many staff were new to the service and spoke to us about their induction and support which they said was good but records were not always in place to evidence this. We saw there was now a regular programme of staff meetings where issues where shared and raised with the manager but this had not been consistent in 2015.
Staff were aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) which meant they were working within the law to support people who may lack capacity to make their own decisions. Records in relation to DoLS were well maintained.
The service encouraged people to increase their independence. People were supported to be involved in the local community as much as possible. People were supported to use public transport and in accessing local amenities such as the local G.P, shops and leisure facilities, as well as using the facilities in the service such as their kitchens for cooking meals. We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. People went out routinely with staff and accessed the community. One person told us that they made their own choices and decisions and these were respected.
There was a system in place for dealing with people’s concerns and complaints. Three people we spoke with told us that they knew how to complain and felt confident that the manager and staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service. There were other mechanisms in place to seek the views of people living at the service such as regular 'house meetings'.
People told us they were involved in choosing their meals and were encouraged to help prepare food with staff support if they wished. We saw people had nutritional assessments in place and people with specific dietary needs were supported. Specialist advice was sought quickly where necessary. We observed the lunchtime and evening meal and saw people had a wide variety of choice and were encouraged to take healthy options by staff.
We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans. Two people we spoke with discussed their support plans and how they had worked with staff to develop and review them. Some work was required to ensure plans were reviewed on a regular basis and that that they accurately reflected the current needs of the person.
We reviewed the systems for the management of medicines and found that people received their medicines safely and they were securely stored. Some improvements could be made to the recording of as required' medicines and ensuring peoples medicines were recorded and stored safely when they were on home leave, the manager told us they would action these improvements straight away.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the service and there was plenty of personal protective equipment to reduce the risk of cross infection. We saw that audits of infection control practices were completed.
We saw that in 2015 a full programme of audits had not been completed. The manager showed us the new audit programme for 2016 and we saw other immediate audits for areas for improvement such as care plan reviews had already been undertaken. The service did regularly seek the views of people using the service and provided feedback to them but a more sustained quality assurance programme needed to be implemented throughout 2016 and the manager and regional manager agreed with this.
We found the provider was in breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 You can see what action we took at the back of the full version of this report.