Archived: The Hollies

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.

The Hollies is a care home providing personal and nursing care to 20 people at the time of the inspection. The service can support up to 27 people.

The Hollies care home consisted of three floors. The ground floor had living facilities, which included the kitchen, dining room, living rooms and people's individual bedrooms. The second and third floor had bedrooms.

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

We found there were not clear delegated responsibilities to managing the medicines. Which meant that people were at risk of not getting their medicines when needed.

The provider did not make sure parts of the home and equipment people used were safe. The environment was in need of repair and decoration, some equipment was damaged and could put people at risk.

The environment was clean, and systems were in place to ensure regular deep cleans continued throughout the pandemic. Staff had enough personal protective equipment (PPE), although we observed that staff did not always use these appropriately. Sufficient checks were not made when visitors entered the building, although improvements had been made on our second visit.

Governance systems were not effective. Where audits had been completed, trends, analysis and actions were not put into place to ensure improvement. The provider did not have oversight of the service, which meant the registered manager did not have that support or impartial observation to offer suggested improvements to the service.

The staff felt they were supported by the registered manager and relatives felt there was regular communication.

The registered manager was passionate about improving the service and was willing to strive to implement all suggested improvement from the local authority and best practice guidance. Following on from our inspection action had been implemented where the provider had more presence within the home and the registered manager had support with additional resources.

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 12 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this as a targeted inspection to follow up on specific concerns that we had received about the service. The inspection was prompted in part due to concerns received about infection prevention controls. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the governance of the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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.

Enforcement

We have identified breaches in relation to safe practice with medication, the environment and equipment in parts of the home were not safe and quality audits, policy’s and governance systems were not all in place at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Hollies is a care home. People in care homes receive accommodation and personal care under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The Hollies provides a service for up to 27 older people, some of whom may be living with dementia. At the time of the inspection there were 23 people living at the service. Accommodation is provided over three floors and people have access to communal areas.

People’s experience of using this service:

• The provider had failed to notify the CQC of important events that they are required by law to do.

There was a lack of monitoring to oversee the running of the service and identify the improvements that can be made to the quality of the service. Areas of the service required redecoration

• People told us they felt safe and staff were kind and caring. Staff understood the risks to people and the measures in place to keep them safe. Systems were in place to manage people's medicines safely and to reduce the risks associated with the spread of infection.

• We have made a recommendation that the manager familiarises themselves with the legislation and responsibilities of a registered manager if they are to consider applying to become the registered manager of The Hollies.

• Staff received training that ensured they had the skills and knowledge to carry out their roles and meet the specific needs of people using the service. There were enough staff on duty to deliver support to each person in the way they wanted.

• People were supported to maintain good health. Staff made referrals to health professionals when required.

• Staff were kind and caring and had developed good relationships with people using the service.

• People were supported to maintain their health and had access to food and drink based on their individual choice and preferences. People had access to a range of activities in the community and within the service, that reflected their culture and interests.

• Care plans guided staff to provide support that met people's needs which were in line with their preferences.

• People's privacy, dignity and rights were respected and upheld. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible.

Rating at last inspection:

Good (report published 13 December 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service has been rated as requires improvement at this inspection.

Enforcement:

Please see the 'action we have told the provider to take' section towards the end of the report.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next inspection is scheduled accordingly.

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

The home had a registered manager in post who had been registered since October 2010. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 inspection took place on 16 November 2016 and was unannounced. At our previous inspection on 28 April and 09 May 2016 we found breaches of regulations 09, 11, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were not always supported to maintain their independence as their needs and individual preferences were not consistently met. People were not supported by sufficient numbers of suitably trained and skilled staff. Staff had not acted in line with the requirements of the MCA 2005 when dealing with matters of consent and best interest decisions. People's medicines were not managed safely and people were unlawfully restrained. Governance systems were not sufficiently robust to allow management to review, monitor and respond to identified concerns.

At this inspection we found significant improvements had been made in areas relating to safe care and treatment, staffing levels, supporting and developing staff and people were no longer unlawfully restrained. However we also found improvements were still required in governance systems to ensure the service was well led and records relating to people's care were accurate.

People were supported by sufficient numbers of staff who responded promptly when they required assistance. Staff we spoke with were knowledgeable in relation to keeping people safe from harm and reporting incidents to management. People were supported by staff that had undergone a robust recruitment process to ensure they were of good character. People's medicines however were not consistently managed safely and we found an incident where one person had not received their medicines as intended by the prescriber.

Staff felt supported by the registered manager and management team who enabled them to carry out their role effectively. Staff had received training relevant to their role and were further training was required this had been organised. People’s consent was sought prior to care being carried out and staff took time to explain the tasks they wished to carry out. People's nutritional needs were met and their food and fluid intake and weight were monitored, although not always documented. People were able to choose what they ate from a varied menu. People`s health needs were met and they had access to a range of health professionals when needed.

Staff spoke with people in a kind, patient and friendly way and respected peoples dignity. People felt listened to and told us they felt they could shape their own care to reflect their own personalised choices. Staff were aware of people’s needs, choices and we saw that a friendly rapport had developed between people and staff who cared for them.

People received care that responded to their needs. People told us they felt able to shape and direct the care they received and that staff listened to their views. People were supported to remain independent and pursue individual hobbies and pursuits. People and relatives felt able to raise complaint or concerns with management, and regular forums were held for people to do so. The Registered Manager operated a robust complaints process that when required reviewed and reposnded to complaints appropriately.

Governance systems and updates in people`s care records continued to be an area that was under development, however the registered manager was able to demonstrate to us how they were addressing these issues. People were positive about the management team and told us that significant improvements had been made across the home by the management team and the provider.

The inspection took place on 28 April and 09 Mat 2016 and was unannounced.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However the details for the Provider’s registration at the time of the inspection were incorrect.

At this inspection we found that there were not always sufficient numbers of staff deployed to meet people`s needs at all times. Risks to people’s health and well-being were identified and responded to positively. People’s medicines were not stored safely and information was not always available for staff on how to manage people`s medicines safely. However the registered manager was reviewing and developing this area.

People told us they felt safe living at The Hollies, and this was confirmed by their relatives and health professionals. People were supported by staff who had undergone robust recruitment processes which ensured they were of sufficiently good character to provide care to people.

Staff told us they felt supported by the manager. However training had not always been provided in a manner that supported staff’s understanding of how to provide care. People’s nutritional needs were met and monitored where required. People were able to choose what they ate and staff responded to people`s changing dietary needs. People we spoke with told us they had access to a range of health professionals, and records demonstrated they were referred quickly when their needs changed. This was also confirmed by visiting professionals.

Staff spoke to people in a kind, patient and friendly way, seeking their consent prior to delivering care. Staff did not always ensure people’s social needs were met and people did not always receive care at a time when they needed it.

People did not always receive high quality care that was well led. The local authority visited the service and required actions were taken in relation to areas such as MCA 2005, training and records. These had not been improved upon, and a service improvement plan had not been developed. The provider’s registration details were incorrect and people’s personal records were not always accurate or kept up to date. People's views about the quality of service they received had been sought and people felt the registered manager was open to discussion about the running of the home.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

The provider had introduced more detailed checks for the administration and disposal of medication. Staff had received training on the safe administration of medication and safeguarding vulnerable adults. The home was clean and free from the risks of infection. People we spoke with told us that they felt safe within the home. People's needs had been assessed and monitored; care documents reflected people's needs and provided care staff with clear information on how to safely care for people. Risk assessments had been put in place for people and staff were aware of the risks and how to manage them.

Is the service effective?

We saw that people living in the home were free to move around and were happy in their surroundings. People told us that staff "couldn't do more" for them, and would "do anything to help" them. They told us that the care they received was "very good". We observed staff were caring towards people and offered them drinks and spoke to people in a kind manner. We saw that the care plans were regularly reviewed and contained detailed information about the person and their needs. This meant that staff were aware of people's needs and were therefore able to provide the correct care and support. The provider had ensured that when staff were recruited, they followed a detailed recruitment process and any required checks were completed prior to the start of employment. Is the service caring?

People told us that staff were 'marvellous'. One person we spoke with said that they had no complaints and that staff "give a lot of help". They said that the staff "keep us going" and encouraged them to remain independent. We observed that staff were attentive towards people. People said that there were no restrictions on what they did during the day and that staff were quick to respond to them when they called for assistance.

Is the service responsive?

Care plans and risk assessments were reviewed regularly and any changes required were made quickly and staff were made aware of the changes.

Is the service well-led?

The provider had a registered manager in post. People we spoke with told us that the home had 'very good managers'. They said that the managers were quick to act on any issues or concerns that they had.

A choice of suitable and nutritious food and drink was provided. People were satisfied with the meals and drinks available. They told us they had plenty to eat and drink and were offered choices. One person said, 'They always bring me something I like.'

People were not protected against the risks associated with medicines because procedures for storing, recording and disposing of medicines safely were not always followed.

Staff recruitment processes were not robust and people were not always supported by staff who were suitably trained and skilled. One person said of the staff, 'The girls are lovely, I must say they look after you fine.'

The provider had a complaints system available. People we spoke with told us they could approach staff if there was anything that concerned them.