Holly Lodge Residential Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were safe living at the service. There were systems in place to ensure risks to people were reduced. Staff knew people well and knew how to provide them with the support they needed. People were protected from the risk of abuse. There were enough staff to support people. Staff had the training and knowledge they needed to support people. When things went wrong action was taken to reduce the risk of events re-occurring. People and their relatives were happy with the support provided. One person told us, “Nothing is too much trouble for the staff.”

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they would speak with staff if they had any concerns. They knew who the managers were and told us they were approachable if they needed to speak with them. Relatives told us they were kept updated about their relative and informed of incidents or matters of concern. One relative said, "The best thing about Holly Lodge is [the management] who are easy to get hold of and [they] also contact me often to let me know how [my relative] is and if [they] need anything."

At the last inspection we identified a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to assess, monitor and improve the quality and safety of the service provided and maintain an accurate, complete and contemporaneous record of care and treatment. Some concerns raised by staff had not always been acted upon and the provider and registered manager had not taken the opportunity to learn lessons from the events. At this assessment enough improvement had been made and the provider was no longer in breach of regulation 17. Staff understood how to raise and report incidents and accidents. Where these had occurred, appropriate action had been taken. Incidents were analysed to identify where there were lessons to be learnt. The registered manager told us how they had learned lessons since the last inspection, when it was found staff had raised concerns and action had not always been taken. They told us they made sure incidents and concerns were discussed openly and key lessons were learnt and shared with staff. They encouraged staff to raise issues immediately. Staff confirmed they were encouraged to report all concerns about people’s care. They told us they were always listened to and saw action being taken to address their concerns.

There were systems in place to record incidents and accidents which were reported by staff. Where people needed medical attention, for example following a fall, this had been arranged as appropriate. The registered manager reviewed incidents to identify where actions were needed such as updating people’s care plans. Incidents were reviewed monthly to identify if there were any trends which needed to be addressed to reduce the risk of incidents re-occurring. No trends were identified.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe, and this was clear from our observations. Staff spoke kindly and respectfully to people. The atmosphere was calm, and people were relaxed. Staff were supporting people to stay safe within their home by encouraging regular conversation, giving people their time to sit and listen, so people would feel confident to raise issues with staff if they had any worries.

At the last inspection we identified a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to assess, monitor and improve the quality and safety of the service provided and maintain an accurate, complete and contemporaneous record of care and treatment. This was because staff concerns had not always been fully followed up. At this assessment enough improvement had been made and the provider was no longer in breach of regulation 17. Staff knew how to raise concerns if they needed to. They told us they had confidence in the registered manager and the provider. Staff were positive the provider and registered manager would listen and take action if they raised concerns. Staff told us, “Everyone gets on and we work really well as a team. If things go wrong, we talk about it”.

People told us they felt safe living at the service. One person said, “I do feel safe and would say if I didn’t”. Relatives also told us that the service was safe. One relative said, “[My relative] is being well looked after in every aspect.”

People were protected from the risk of abuse. There were systems in place to enable staff to report concerns should they arise. The provider had appropriate safeguarding policies and process in place. Staff were provided with guidance on different types of abuse and how to raise concerns if these arose. Staff had undertaken training in safeguarding to provide them with guidance on types of abuse and reporting concerns. People can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Some people living at the service were deprived of their liberty in order to support them to remain safe. Where this was the case we found the appropriate legal authorisations were in place.

At the last inspection we identified a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to assess, monitor and improve the quality and safety of the service provided and maintain an accurate, complete and contemporaneous record of care and treatment. This is because care plans did not always accurately reflect people’s needs. At this assessment enough improvement had been made and the provider was no longer in breach of regulation 17. People were supported by staff who had access to up-to-date guidance and knew how to provide them with support. Staff knew people well and understood the risks to people. The registered manager told us they regularly discussed risks with staff. For example, ensuring staff kept the environment free from clutter to help reduce the risk of falls. The registered manager worked alongside staff and was able to observe staff practice. Staff knew to monitor the risks to people and raise issues if people’s needs changed. One staff said, “If for example, someone has a red mark on their skin, we know to report it straight away and not keep the information to ourselves”.

The atmosphere was calm and friendly. We observed there were positive interactions between staff and people and staff knew people well. People’s walking aids were left within reach. Staff reminded people who needed walking aids to use them if they forgot, to support their safety. During the assessment we observed people were being supported to undertake chair-based exercise to support people to maintain their health and mobility. Where people chose to spend more time in their rooms, we observed staff went in to check on them regularly. Staff were present in the communal areas to be on hand if people needed support.

Staff knew people well and understood the risks to people. People were positive about the support they received to manage risks to their health. One person said, “I don’t think I would want anything to change”. Relatives told us they felt listened to when they told staff about people’s health needs. One relative said, “The staff do listen when I talk to them.” People who could walk without the support of staff were walking around where they chose and were not restricted.

Appropriate processes were in place to ensure people were provided with safe support. People had up to date care plans in place which included guidance for staff on how to support people who had risks from health conditions, such as diabetes. Risk assessment provided the essential information staff needed to support people with their health and monitor the effectiveness of these actions. For example, where people were cared for in bed there were risk assessments in place to guide staff to support people to maintain their skin integrity through regular actions such as supporting people to move position. Actions staff took were recorded to enable them to be monitored.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff were on hand throughout the day to attend to people when they needed it. People were not left waiting for help and call bells were responded to quickly. Enough staff were evident and were not rushing around.

Staff were happy at the service and told us how things had improved since the last inspection. Staff were provided with the support they needed to be effective in their roles and provide safe support to people. One staff said, “I am very well supported by [the provider and registered manager]”.

There was enough staff to provide support to people. The provider used a dependency tool to help them assess how many staff hours they needed to provide support to people. This was then reflected in the rota. Staff had the skills and knowledge they needed to provide safe support to people. Staff had completed the training they needed to undertake the role. Staff received regular supervision and their competency to undertake tasks such as administering medicines was checked. Staff were recruited safely. For example, Disclosure and Barring service (DBS) checks were undertaken. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

People and their relatives were positive about the staff who supported them. People told us, “I can’t fault anybody”, “Yes, they don’t keep me waiting, they come as soon as they can”.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.