The Hollies Residential Home

The Hollies Residential Home is a residential care home providing personal care to up to 40 people. The service provides support to older people as well as younger adults. At the time of our inspection there were 30 people living at the service, some people lived with dementia, 1 person was cared for in bed.

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

People and relatives provided positive feedback about the service, the staff and the management. Comments from people included, “We are grateful to everyone at the Hollie's”; “I would, and have recommended here to other people”; “I feel very safe here”; “They are very friendly”; “When I want someone they’re here”; “I’m pretty happy” and “The girls (staff) are kind and caring.”

Although people and relatives were happy with the care and support, we found some concerns about people's safety. Improvements to safety had been made in relation to building related risks and risks relating to people’s assessed health needs. Some risks relating to skin integrity and constipation to people had not always been properly managed.

Medicines had not always been given as prescribed, however one medicine had not been given as per the prescriber’s instructions, as it had been given at the same time as other medicines. Medicated patches which can cause irritation to the skin if they are placed in the same position after removal were not always sited in a different place on people’s skin, which increased the risks of a reaction and discomfort. We found no evidence that people had been harmed. This is an area for improvement. Medicines were stored safely in a locked medicines room. Medicines had been stored at the correct temperature to ensure they were safe to use. Staff were trained to administer medicines and we observed good practice when staff were completing the medicines round.

Management oversight of the service had improved. The provider and registered manager had systems in place to check and audit the care and support as well as monitoring health and safety risks and building related risks. Actions were completed swiftly when the management team identified concerns. The provider had changed the electronic care planning system and this was mainly working well. However, some improvements were required to help the management team have better oversight of repositioning, constipation, medicines, and fluid intake.

Enough staff were deployed to keep people safe. Staff had been recruited safely to ensure they were suitable to work with people. People were supported by regular staff who they knew well. Staff were well supported by the management team.

The provider had improved the environment and further redecoration and renovation was taking place, during the inspection a new shower room was being installed. There was signage in place to support people living with dementia (as well as new people to the service) to orientate themselves.

People were assessed to check their capacity to make particular decisions when this was in doubt. Records showed how decisions were made in people's best interest. Mental capacity assessments were in place, these were decision specific, some had some conflicting information, which is an area for improvement. People told us they made choices about their lives. 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.

The provider had effective safeguarding systems in place to protect people from the risk of abuse. Safeguarding concerns had been identified and reported to the local authority appropriately. Staff knew and understood their role in keeping people safe.

The service was clean; the provider was promoting safety through the layout and hygiene practices of the premises. Staff used personal protective equipment when providing care to people in line with infection control guidance.

Prior to people moving into the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person.

Meals and drinks were prepared to meet people's preferences and dietary needs. People told us they liked the food.

People were treated with dignity and respect. People’s views about how they preferred to receive their care were listened to and respected. People and relatives told us staff were kind and caring.

People had access to a range of different activities throughout the week. People told us that they took part in these.

People received good quality care, support and treatment including when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians.

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 inadequate (published 26 August 2022). We served the provider warning notices in relation of breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also served requirement actions for breaches of regulations 9,11 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 9, 11, 17 and 20. The provider remained in breach of regulation 12 in relation to effective risk management and managing medicines safely. The service has been rated requires improvement.

At our last inspection we recommended that the provider considered current guidance on dementia friendly signage and take action to update their practice accordingly. At this inspection we found the provider had acted on any recommendations and had made improvements to dementia friendly signage around the service.

This service has been in Special Measures since 03 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified a breach in relation to effective risk management and medicines management at this inspection. 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, which will help inform when we next inspect.

The Hollies Residential Home is a residential care home providing personal care to up to 40 older people as well as younger adults. At the time of our inspection there were 26 people living at the service (two people were in hospital), some people lived with dementia.

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

People and relatives provided positive feedback about the service, the staff and the management. Comments from people included, “[I feel] very safe here, I trust everyone”; “All of the carers are nice to me” and “The girls are all kind here. They help me when needed. I get myself ready for bed and I use the call bell to let them know to bring my commode in.”

Although people and relatives were happy with the care and support, we found serious concerns about people's safety. Although some improvements to safety had been made, risks to people's safety had not always been well managed. Timely action had not always been taken in response to people falling and injuring themselves. A range of risks to people had not been properly assessed or managed. Fire risks identified were reported to the fire service.

There were not enough staff deployed at night to keep people safe. Following a visit from the fire service, staffing numbers at night were increased.

Medicines management had improved. Medicines administration records (MAR) were mostly complete. Medicines had mostly been given as prescribed. However, there were some areas for improvement in relation to recording prescribed meal supplements and administration of medicines that were prescribed to be taken once a week. Prescribed creams, lotions and eyedrops had not been dated on opening. This meant the provider could not be assured that medicines had been used by the date the manufacturer had recommended. Medicines that required returning to the pharmacy had been appropriately documented and completed in a safe manner.

The environment required improvements. There was no signage to support people living with dementia (as well as new people to the service) to orientate themselves. We made a recommendation about this.

Whilst management oversight of the service had improved, there was still insufficient oversight of the service by the provider and registered manager to pick up and address the risks found by inspectors. Improvements to the service were still being developed and embedded. Records continued to be an area of concern across the service; records were not always complete and accurate.

People were not always assessed to check their capacity to make particular decisions when this was in doubt. Records were not always kept to show how decisions were made in people's best interest. Mental capacity assessments were in place, these were not decision specific and showed a lack of understanding about the Mental Capacity Act 2005. People told us they made choices about their lives. It was not clear that people who lacked capacity 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 provider had effective safeguarding systems in place to protect people from the risk of abuse. Safeguarding concerns had been identified and reported to the local authority appropriately. Staff knew and understood their role in keeping people safe.

Staff had been recruited safely to ensure they were suitable to work with people. People were supported by regular staff who they knew well. Staff were well supported by the management team.

At this inspection the provider was admitting people safely to the service. People had moved into the service and had been isolated in their rooms for the required period in line with COVID-19 guidance. The provider was accessing testing for people using the service and staff. The provider had not been following the COVID-19 government guidance to only test people if they had symptoms. People were being tested monthly. Staff were being tested daily. People were supported to access healthcare services when they needed them.

The service was mostly clean; the provider was promoting safety through the layout and hygiene practices of the premises. However, dining room chairs in the service had become damaged and worn which presented as an infection control risk. After the inspection the registered manager arranged for these to be replaced.

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 inadequate (published 04 March 2022). 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 some improvements had been made and the provider was no longer in breach of regulations 13, 18 and 19. However, we found the provider remained in breach of regulations 9, 11, 12, 17 and 20 (person-centred care, need for consent, safe care and treatment good governance and duty of candour.)

This service has been in Special Measures since 04 March 2022. During this inspection the provider demonstrated that improvements have been made, however the service remained inadequate in safe and well-led. Effective had improved to requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 30 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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 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, effective 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 remained the same. 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 The Hollies Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified continued breaches in relation to person-centred care, need for consent, safe care and treatment, good governance and duty of candour. We have made a recommendation about the considering current guidance on dementia friendly signage.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Hollies Residential Home is a residential care home providing personal care to up to 40 older people as well as younger adults. At the time of our inspection there were 33 people using the service, some people lived with dementia.

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

People and relatives provided positive feedback about the service, the staff and the management. Comments from relatives included, “[Manager] said he would adapt to meet her needs and he didn’t lie, he’s done everything he can”; “They encourage her to walk everyday as it helps with the oedema she has in her legs”; “When the carers come in, they talk to her nicely, they are tactile and kind, they treat her like one of their buddies”; “She has blossomed since being here” and “I have struck gold with The Hollies.”

Although people and relatives were happy with the care and support, we found serious concerns about people's safety. Risks to people's safety had not been well managed. A range of risks to people had not been properly assessed or managed.

Medicines administration records (MAR) were incomplete so we could not be assured medicines had been given as prescribed. Medicines in stock did not tally with records. Medicines that required returning to the pharmacy had not been appropriately documented and completed in a safe manner.

The provider did not have effective safeguarding systems in place to protect people from the risk of abuse. Safeguarding concerns had not always been identified and reported to the local authority.

We were not assured that the provider was admitting people safely to the service. People had moved into the service and had not been isolated in their rooms for the required period. This meant the provider was not meeting government guidance in order to prevent the risk of spread of COVID-19 and to keep other people safe. PPE was not consistently used appropriately. This put people at risk. The provider was accessing testing for people using the service and staff.

Staff were not always recruited safely. Checks on employment history had not always been carried out. Disclosure and Barring Service (DBS) criminal record checks were completed as well as reference checks. Staff training and induction was not adequate to provide staff with the guidance and skills to safely carry out their roles. Some people lived with conditions such as epilepsy and diabetes. No training had been provided to staff in relation to epilepsy. Staff had been administering insulin to a person without being trained to do so.

There was insufficient oversight of the service by the provider and registered managers to pick up and address the risks found by inspectors. Records were an area of concern across the service; records were not complete and accurate. The provider took immediate action following the inspection to address the issues found, the provider submitted an action plan to CQC to detail how they would address the concerns and improve the service.

Assessments were not robust or complete. Assessments for people were basic and had not explored key information such as life history, wishes or people's protected characteristics under the Equality Act (2010). People were not assessed to check their capacity to make particular decisions when this was in doubt. Records were not kept to show how decisions were made in people's best interest. Mental capacity assessments were in place, these were not decision specific and showed a lack of understanding about the Mental Capacity Act 2005.

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

Care plans were not always person centred and were inconsistent. Care plans were basic and lacked details of people’s assessed needs (including medical and health conditions. There were limited opportunities for activities to meet people’s interests taking place in the service, people told us that activities did not take place. Some people told us they were bored and had nothing to do.

People's care plans and most information (such as relevant procedures, information and advice) was not available in accessible formats such as easy read, pictorial and large print. This did not meet the accessible information standard. We made a recommendation about this.

People were supported to access healthcare services when they needed them. Relatives told us their loved one's health needs were met.

The environment required improvements. There was no signage to support people living with dementia (as well as new people to the service) to orientate themselves.

People were mostly treated with dignity and respect. People’s views about how they preferred to receive their care were listened to and respected. People told us staff were kind and caring.

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

Rating at last inspection

This service was registered with us on 02 November 2020 following a change in the provider’s legal entity and this is the first inspection.

The last rating for the service under the previous provider at The Hollies Residential Home was requires improvement, published on 28 August 2019.

Why we inspected

We inspected the service as it had been registered for a year.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

The inspection was also prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risk of burns from hot surfaces. This inspection examined those risks. The provider had taken some action to mitigate risks, however these were not robust and not fully completed.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to medicines management, risk management, safe recruitment practice, infection control, safeguarding people from abuse, consent and capacity, staff training and induction, nutrition and hydration, assessment and planning of care need, duty of candour and good governance.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Hollies Residential Home is a care home that accommodates up to 40 older people in one adapted building. The Hollies Residential Home is a large detached house situated in a residential area in Gravesend. At the time of the inspection 32 older people and people living with dementia were living at the service, two further people were in hospital.

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

The provider and management team were not following advice and guidance from other agencies about infection control and prevention.

Staff were not using personal protective equipment (PPE) appropriately which could increase the risk of infection. Staff had access to specific PPE. There were PPE 'stations' around the service to ensure PPE was readily at hand.

People were encouraged and supported to stay in their bedrooms to isolate when returning from hospital and when moving into the service. This enabled people to keep safe from the risks of contracting COVID-19. People were offered reassurance and reminders of how to keep themselves and others safe.

People were supported to maintain contact with their relatives through video calling, phone calls and through the use of social media.

Why we inspected

The inspection was prompted in part due to concerns received about infection control. 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. We have found evidence that the provider needs to make improvement. 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.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.