Archived: The Hollies

Updated 11 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Hollies is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Hollies is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 05 April 2022 and ended on 19 April 2022. We visited the service on 05, 12 and 19 April 2022. In between 05 and 19 April 2022 we spoke with relatives of people living at the Hollies by telephone and reviewed documentation sent to us by the registered manager.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed how the staff interacted with the people who used the service and looked at how people were supported throughout the day. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with seven people, the registered manager, the clinical lead, the deputy manager, three care staff, and three visiting professionals. We spoke with 10 relatives of people using the service by telephone.

We looked at care and support records for eight people and medicine records for 10 people. We viewed records relating to the management of the service. These included quality audits, incident and accident records, training records and policies.

Updated 11 November 2022

About the service

The Hollies is a residential care home providing personal care to up to 27 people. At the time of our inspection there were 21 older people using the service, some of whom were living with dementia.

The Hollies care home had three floors. The ground floor was made up of the kitchen, dining room, living room, shower room and people's individual bedrooms. The second and third floor had bedrooms.

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

People were not safe because risks were not identified and managed in an effective and timely manner. This included issues in relation to the environment that presented a risk of people tripping and high-risk shortfalls in fire safety planning and equipment. Medicines were not managed safely and guidance to people at risk of choking was not always followed. People were not protected from the risk of infection because the standard of cleanliness and repair to the premises was inadequate.

There were not enough skilled and knowledgeable staff to care for people. Staff practice in relation to following guidance from health professionals, moving and handling people, recognising and acting on concerns about avoidable harm was poor. Some people told us they did not feel safe at the service due to physical aggression from other people using the service. Guidance was insufficient on how staff should support and maintain the safety and wellbeing of all parties concerned.

Care was task led and people’s choices were limited. For example, there was a set rota for showering and each person had a set day for a weekly shower. This was, in part, due to the lack of bathing facilities on the premises. There was only one shower to meet the needs of all the people living at the service. The registered manager confirmed that two additional bathrooms were not, and had never been, in use.

Staff were kind but did not have time to chat to people. People told us they were bored and did not have enough to do. We saw that some people sat all day with no stimulation or interaction from staff beyond tasks such as offering a cup of tea or personal care. Although some activities were provided on three mornings each week, these had not been developed in line with people’s interests. People told us they never went out other than into the garden during the summer.

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

The provider and the registered manager did not have sufficient oversight of the service and had not identified the concerns we found during the inspection. Despite some issues being identified at previous inspections, and by other professionals including the fire service, they had failed to take timely action to make improvements to ensure people received care that was safe, person-centred and of a high quality.

People and relatives told us that staff and the registered manager were nice and approachable. Relatives told us the registered manager kept them informed of issues related to their family member’s care.

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 06 February 2021) and there were breaches of regulation. 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 the provider remained in breach of regulations.

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.

The inspection was prompted in part due to concerns received about medicines management, infection control, and staffing. The inspection was also prompted by notification of a specific incident following which a person using the service sustained a serious injury. The information CQC received about the incident indicated concerns about the management of trip hazards and repairs to the premises. This inspection examined those risks.

We undertook a focused inspection to follow up on the specific concerns which we had received about the service. We also found there were concerns with staff training, consent, choice and control, a lack of dignity, person centred care and engagement. We widened the scope of the inspection to become a five key question inspection which included the key questions of safe, effective, caring, responsive and well-led.

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 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 breaches in relation to keeping people safe from avoidable harm and unsafe care, staff training and knowledge, infection control, maintenance and cleanliness, consent to care, people’s experience of their care and how the service was managed.

Following this inspection we took enforcement action to cancel the registration of both the provider and the registered manager.

Follow up

The provider and the manager are no longer registered to provide this service.