The Hollies

On this page

• 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

During this assessment we assessed the service against 2 quality statements in the key question of Safe. This included safeguarding and safe and effective staffing. We found there were insufficient numbers of staffing deployed to ensure the hours of support people were funded for were delivered. This had an impact on people’s ability to access community events and to receive safe levels of staffing support when in the home. This did not promote person centred practices. There was a risk staff well-being was impacted due to working unsafe shift patterns and limited opportunities to take breaks. We found people were protected from the risk of harm and abuse. The provider had followed the correct procedures to ensure any restrictions on people’s freedoms were lawful. This promoted the principles of maximising people’s choice and control in-line with the right support model of care.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

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.

Staff had received training relevant to their roles. People's care plans contained guidance for staff about how to safely meet their needs in line with their preferences. Incidents and accidents were recorded and monitored, which included a debrief of staff to learn from what had gone wrong. Where people did not have the mental capacity to consent to restrictions in place to keep them safe, the provider had completed mental capacity assessments. The assessments followed the correct processes to ensure restrictions were in the person’s best interest. The provider had applied for deprivation of liberty safeguard approvals.

We observed interactions between people and staff which were comfortable and relaxed. Staff understood what people were communicating. They spoke to people using respectful language and in terms they understood. They supported people to stay safe with things they wanted to do around their home such as accessing food and drink safely.

People told us they felt safe but there were mixed views about the level of support provided due to staffing levels and changes in the culture which 1 person felt had created institutionalised practice. People felt the management were open about incidents and accidents. A relative told us, "I am never left in the dark. There have been a couple of incidents in the past and we had a meeting about it but [management] addressed it." Where people were unable to make decisions for themselves, relatives were involved. A relative said, "[Staff] involve me in decisions, every year we have the [Deprivation of Liberty Safeguards] and mental capacity assessments and go through all the sections."

Staff had a good understanding of abuse awareness and how to keep people safe. They understood how to report concerns but told us they did not always feel listened to by senior management when concerns about the impact of poor staffing levels had been raised. Staff understood how to promote people's freedoms and rights and the reasons for any restrictions placed on people. These were in line with the principals of the Right support, right care, right culture policy. Staff told us they received training about safeguarding people and the Mental Capacity Act 2005. The registered manager told us about the systems used by the provider to assess the safety of people and related risks and training provided to the staff team.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

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

People's views about the quality of support and staffing levels were mixed. Some people felt it was very good with regular opportunity to access community events. Other people felt his had deteriorated recently and the culture of the service was no longer proactive in motivating people to experience new opportunities. A relative said, "[Staff] wax and wane. It goes through phases of a nice period of stability for a couple of years and then new staff. Sometimes staff are together too long, and you get a culture forming." They went on to tell us the impact this could have on their family member such as impact to their sleep and health conditions. However, they said this had started to improve with the new registered manager who had listened to their concerns and acted. Another relative felt there was enough staff and told us, "[My family member] has a full and meaningful life now, they have things to do and are planning for themselves."

We analysed 3 weeks of rota and support data submitted by the provider. We found in a 21-day period, there were 9 days with no cover for the second shift to support 1 person to be able to safely access the community. We noted not all funded hours were used to deliver support. 1 person did not leave the house for 7 out of 21 days reviewed. The person had 14 incidents during this period, 11 of those occurred on days where they either did not go out or the day following this. This suggested a correlation between becoming upset and not being able to go out. We found concerning staff shift patterns on the rota. On 10 occasions out of 21 days, there were unsafe hours of work recorded without sufficient breaks. This included staff working up to 30 waking hours without a scheduled break. This placed both staff well-being at risk as well as risk of harm for people being supported. Staff were responsible for people’s care, medicines and driving during this time.

We observed there were some gaps yet to be filled in the upcoming rota. The registered manager was covering a vacant shift on the day we inspected. We observed, with management cover, there were sufficient staffing on the day of our onsite visit to support people to access the community safely.

Staff told us there was not enough staff planned to meet the needs of people. They told us, 1 person, who requires the support of a second member of staff to access the community, does not always receive this, resulting in not being able to take them out. They told us this negatively impacts the person’s well-being. Staff told us they work long shifts and are not always able to take breaks as there is no-one to provide support. They told us they use the radio to call for assistance, but it was not always answered. The registered manager told us they used staff from other services of the same provider or overtime to cover vacant shifts. They said they monitor gaps and where a regular concern was identified looked at how to fill this void.

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.