Archived: Holly House

Holly House 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. Holly House is registered to provide accommodation and personal care for up to four people and predominantly supports people living with a learning disability and mental health needs.

At the time of the inspection there were three people living at the service. Best practice guidelines recommend supporting people living with a learning disability in settings that accommodate less than six people. The service model at Holly House was aligned to the principles set out in Registering the Right Support. Outcomes for people using the service, reflected the principles and values of Registering the Right Support including; choice, promotion of independence and inclusion. People's support was focused on them having new experiences and maintaining their skills and independence.

People’s experience of using this service:

People told us they were happy living at Holly House and felt supported to live their lives. One person told us, “Oh yes I’m very happy.”

People were supported to maintain their independence as much as possible and encouraged to participate in activities of daily living.

Staff supported people to access the community for social opportunities as well as employment.

People were supported to make choices in line with legislation and staff recognised people’s individual needs.

People were cared for in a way that respected their privacy, dignity and promoted their independence. Staff knew people extremely well, enabling care to be delivered effectively. People had lived at Holly House for many years and had built positive relationships not only with the staff but with each other. There was a close family atmosphere in the home.

Care plans were detailed, and person centred. People were involved in deciding how they wished to be supported and in reviewing their care plans when needed. Information was available in a format they could understand.

Staff had completed training that equipped them to do their jobs. They received regular supervision to help develop their skills and support them in their role.

Quality assurance processes ensured risks to people and the environment were managed safely. The service was clean and infection control audits ensured that cleaning tasks were completed, and any issues were identified and acted upon quickly.

There was a clear management structure with staff being supported by the registered manager and provider.

Rating at last inspection:

The service was rated as Requires Improvement at the last full comprehensive inspection, the report for which was published on 21 June 2018.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Holly House 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.

Holly House is a care home service which provides accommodation for up to four people with learning disabilities. At the time of our inspection, there were three people living in the service.

The service was arranged over three floors with all of the bedroom accommodation on the second and third floors. There was a bathroom available to people on the ground floor. There were three communal areas in the service, which were a kitchen, a dining room and a lounge. People also had free access to the garden.

The providers are a partnership, and one of the providers is the registered manager of 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 last comprehensive inspection of this service was in January 2016, when the service was rated Good. At this comprehensive inspection, we found the service was not meeting legal requirements and was rated Requires Improvement.

The systems and processes used to monitor the quality and safety of service provision had not been fully effective.

People were not always treated with kindness and compassion. We observed a senior member of staff talking about someone in a negative way, and other people we spoke with also expressed concern about some interactions between the same staff member and people.

People told us that they felt safe at Holly House, however we identified that the provider, registered manager and care staff were not up to date with essential training, such as first aid, fire safety, medicines administration and infection control.

Medications were managed safely and there were arrangements in place for the safe recording, storage and administration of people’s medications.

Risks to people and the environment were assessed and reviewed regularly.

The service supported people to meet their needs and make their own decisions. Legislation relating to the protection of people’s rights had been followed appropriately.

Staff had developed close relationships with the people they supported and people received care and support which reflected their preferences, capabilities and needs. People’s care plans were person-centred and recorded in a format which was accessible to them. Care plans contained risk assessments specific to each person and described actions taken to reduce the level of harm.

People had enough to eat and drink, and were able to get snacks when they wanted to.

The provider and registered manager supported people with regular work placements and other activities in the community. The service environment was suitable to meet people’s needs.

Staff worked in partnership with health and social care professionals to promote people's health and wellbeing, and knew how to seek further advice. People were supported to have access to health services when necessary.

People were happy with the care and support they received and could not suggest any ways for the service to be improved.

During the inspection, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

There was a registered manager in post. 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.

People lived in a homely environment and were treated with kindness and compassion. We observed supportive positive interactions between people, the registered manager and the provider. There was an open, trusting relationship; it was clear they knew each other well and the registered manager understood people’s needs. People were involved in planning the care and support they received.

People felt safe at Holly House. The registered manager and staff had received appropriate training in a range of subjects, including how to protect people from the risk of abuse. People were supported by staff who had received the appropriate training to meet their individual needs. Staff were available when people required them.

The home was meeting the requirements of legislation designed to protect people’s rights. People’s needs were met effectively and they were supported to make their own decisions.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided information to promote independence.

There were suitable systems in place to ensure the safe storage and administration of medicines. Healthcare professionals such as GPs, chiropodists, opticians and dentists were involved in people’s care where necessary.

People enjoyed their meals and received a choice of suitably nutritious meals based on their needs and preferences. People were supported to engage in a range of work and leisure activities of their choosing.

People were satisfied with the way the service was run. None wished to move from the home and none could suggest any ways that the service could be improved. The provider sought informal feedback from people and had a process in place to deal with any complaints or concerns.

We considered five outcomes during this inspection. These being

Outcome 1 Respecting and Involving people who use services

Outcome 4 Care and welfare of people who use services

Outcome 9 Management of medicines

Outcome 13 Staffing

Outcome 16 Assessing and monitoring the quality of the service

We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.

Is the service safe?

We spoke with all three of the people living at Holly House. They all told us they were happy with the service they received. They said they had the same staff who knew what support they required. People told us they felt they were safe. Staff had completed safeguarding and other essential training. They were able to tell us what they would do if they had any concerns about people's safety or welfare.

Risks to people's health and safety had been assessed and management plans were in place to reduce these risks. There were systems in place to ensure staff with appropriate skills and knowledge were employed and available at the times people required them.

We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards. People's human rights were therefore properly recognised, respected and promoted.

Is the service effective?

People were receiving a service which effectively met their needs. The manager and staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills necessary to care for people. The manager and staff were aware of who to contact for specialist advice and when this may be required. We saw, where necessary, external health professionals were appropriately contacted. People were supported to be as independent as possible and encouraged to use and their develop skills.

All of the people we spoke with were positive about the service they received. They were supported to lead valued lives and enjoyed their leisure activities.

Is the service caring?

People were supported by kind and attentive staff. People said they were treated with respect and dignity by the care staff and were happy living at the home. They also told us the staff were very kind and helpful and they were happy with the way they were supported. One said 'yes, it's good here, everything's OK'. We saw people were able to laugh with the manager and staff.

Staff said they had time to meet people's identified needs and could provide care at times people wanted it. Staff were aware of people's rights to refuse care and stated they would respect this. The manager was aware of the actions they should take if people refused medicines or care. They had contacted external professionals when this had occured. Records of care provided showed people had received care as detailed in their care plans.

Is the service responsive?

The service could be flexible and responsive to people's changing and urgent needs. For example, one person returned home during the inspection and stated they had hurt their knee. Appropriate action was taken by staff. This showed people's changing needs could be supported.

Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. Staff and people were aware of what they should do in the event of an emergency.

Is the service well-led?

The provider and manager were in daily contact with the home providing direct care and support for people. They were aware of people's needs and how they should be supported. The provider, manager and staff had all completed relevant training and qualifications. People's views were informally gathered on a daily basis through general discussions such as at meal times when everyone ate together. People were able to make suggestions and voice their opinions. For example, we were told how they had been involved in discussions about replacement floor covering in the kitchen. Where incidents had occurred, the manager had analysed these and plans were put in place to reduce the likelihood of reoccurrence.

We observed people were happy and relaxed at the home. There was open communication with the manager and provider who appeared to know the people living in the home very well. People told us they could have the meals they wanted and one person who had specific dietary preferences said they received a good variety of meals. People told us they felt safe in the home and they received support from the manager and provider. People we spoke with had lived at the home for several years and clearly viewed it as their home.

We toured the building and found the environment was suitable for the people living in the home. People who wished to personalise their room had done so and the communal areas were suitable for the size and type of service.

Staff records showed the relevant checks for staff had been carried out and that staff had appropriate qualifications to care for people's needs. The manager carried out audits on a monthly or weekly basis and an annual survey was used to gather people's views on the service.