Archived: Hollies Nursing and Residential Home Limited

Updated 28 April 2023

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

One inspector, 1 medicines inspector, 1 specialist nurse advisor and 1 Expert by Experience undertook day 1 of the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector visited the service on day 2.

Hollies Nursing and Residential Home Limited 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. Hollies Nursing and Residential Home Limited is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

Day 1 of this inspection was unannounced, day 2 was announced.

What we did before the inspection

Prior to the inspection we reviewed the information we held about the service. This included feedback and information the service is required to send to us. We also asked for feedback from professionals. We checked whether Healthwatch had undertaken an inspection. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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 spoke with 8 people and 7 relatives during the inspection and on the telephone, as well as 3 professionals. We spoke with 14 staff members. These included 3 carers, 1 senior carer, 1 agency staff member, 3 kitchen staff, 1 nurse, 1 clinical lead, the registered manager, the nominated individual, and the directors of the company. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We completed a tour of the building. This included, communal areas, the laundry, the kitchen, some bathrooms, and some people’s bedrooms. We undertook observations in the communal areas on both days of the inspection.

We looked at a range of records, these included, 5 care files and recording documentation. We checked 10 medicine administration records and looked at medicines related documentation as well as the storage of medicines. We checked the training records and 3 staff files. We also looked at records relating to the operation and management of the service.

Updated 28 April 2023

Hollies Nursing and Residential Home Limited is a residential nursing home, providing accommodation for persons who require nursing or personal care, and treatment of disease, disorder, or injury, for up to 37 people, in one adapted building over two floors. Twenty four people were in the service at the time of the inspection.

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

Risks were not being managed safely and action was not appropriately taken as a result of accidents and incidents. Not all individual risk assessments had been updated and reflected people’s needs.

Environmental risks and checks on the environment were taking place. We made a recommendation that audits on the environment and identified risks were acted upon in a timely manner.

Gaps in the recruitment of staff were noted. We received mixed feedback about the staffing numbers in the service. Safeguarding concerns were not always being acted on to support investigations in a timely manner. We were somewhat assured about the management of infection prevention and control. We found medicines were not always managed safely in the service.

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 systems in the service did not support this practice. Conditions for DoLS authorisations had not always been reflected in people’s records in a timely manner. People’s individual medical needs had not always been monitored and reviews by medical professionals sought. None of the records we reviewed had preadmission assessments in them, we made a recommendation about this. People were positive about the food provided; new menus had been developed. Plenty of supplies of food was seen in the service.

We observed people were in bed for long periods. Records could not confirm positional changes had occurred. People were mostly treated with kindness and dignity and we saw positive caring interactions taking place. People told us they were supported to be independent, we observed people being offered choices and decisions in their care.

Care records were incomplete and daily records did not confirm the appropriate care was provided. There was no evidence of end of life care planning. The nominated individual told us they had developed a full range of new documentation to support the delivery of care to people. There was some evidence of activity planning and activities undertaken but these were from last year. There were very limited activities taking place, we made a recommendation about this.

The registered manager was new to the service and had recently commenced audits. Some of the actions had not been checked to ensure they had been completed. There was some evidence of senior audits being done, which identified some of the failings we have seen at this inspection, but not all. The provider was very open and transparent about the failings and the actions they planned to take to ensure systems protected people from the risk of harm. People were mostly positive about the new registered manager and the senior team, but not all. Meetings were taking place and a range of policies and procedures were noted, these had been updated.

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 10 June 2022). 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. The service has now been in breach of regulation for the last three consecutive rated inspections.

At our last inspection we recommended that robust systems were in place to manage safe recruitment of staff. And that the premises and the service was suitable to meet the needs of people living there, as well as a recommendation that people were able to access meaningful and regular activities, of their choosing. At this inspection some improvements were seen however, further improvement was required.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and to check if improvements had been made.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to, providing appropriate, dignified and timely care, ensuring systems were in place, completed in, and action taken in relation to risks. The service failed to ensure people were protected from the risk associated with inadequate monitoring of people’s individual needs. They also failed to ensure medicines were managed safely and that systems were robust enough, effective to ensure safeguarding concerns were reported and monitored. We also made a breach in relation to protecting people from the risks of unlawful restrictions, and gaps in MCA and DoLS training. As well as ensuring care records were completed in line with guidance and individual needs, and good governance.

We have issued the provider with a warning notice in relation to regulation 12 (1) (2) (a) (b) (g) Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People who used the service were at risk of harm because the provider failed to ensure systems were in place, completed and action taken in relation to risks. Medicines were not managed safely which put people at risk of harm.

We made recommendations in relation to infection prevention and control, staff knowledge and skills, and safe recruitment of staff. As well as ensuring people’s needs were assessed, that action was taken to address risks in the environment and individualised and meaningful activities were provided.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.