The Hollies

The Hollies is a residential care home, providing personal care and accommodation for up to 4 people. There were 3 people living at the home at the time of the inspection. The home was divided into two separate floors with shared kitchen, lounge, gardens and dining room areas.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

What life is like for people using this service:

People and their relatives were placed at the heart of the service and were involved in choosing their care and support, from pre-admission to living in the home.

People received kind, responsive person-centred care from staff who supported them in a homely environment.

The staff team worked hard to promote people’s dignity and prevent people from becoming socially isolated.

People were involved in making decisions about the service, and their day to day lives.

Staff understood how to keep people safe and embraced team working to reduce potential risks to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People using the service benefited from a well led service. The service was led by a registered manager who was also the provider, they were committed to improving people’s lives.

Partnership working enabled people to maintain their wellbeing.

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

Rating at last inspection: The last comprehensive inspection report for The Hollies was published in December 2016 and we gave an overall rating of Good with a rating of Requires Improvement in Well Led. At this inspection we found the service continued to be Good and have rated the service as Good in all areas.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

A requirement of the provider’s registration is that they have a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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. At the time of our inspection there was a registered manager at the service. We refer to the registered manager as the manager in the body of this report.

At our previous inspection in October 2015 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches were identified in Safeguarding, the Need for Consent and Good Governance. We asked the provider to send us a list of actions they would take to make improvements at the service. The action plan was received on 26 January 2016; all actions were due to be completed before the end of April 2016. At this inspection we reviewed whether all the actions had been taken, and the required improvements had been made.

We found the provider had made significant improvements at the Hollies when we visited in December 2016, so that the breaches in the regulations had been met. Improvements included the training of the manager in a number of key areas including safeguarding, infection control and understanding MCA and DoLS. The manager had introduced safeguarding procedures at the home to identify and act on safeguarding risks. However, the manager had not informed CQC of a safeguarding investigation at the home, as they were required to do.

The risks associated with people's care were assessed, monitored and managed, so that risks to people were minimised. The manager had improved infection control procedures at the Hollies to minimise the risk of infection and cross contamination for people there.

People and their relatives told us they felt safe with staff, and staff treated them well. There were enough staff at the Hollies to support people with care tasks, and provide people with support to go out.

The rights of people who were unable to make important decisions about their health or wellbeing were protected, as staff supported people in line with the principles laid down in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People's care plans were kept up to date, except for people's daily records of the care they received each day. However, staff knew people well and could describe people's care and their current needs. People were given food they enjoyed and that met their nutritional and dietary needs.

People had privacy when they wanted it. Staff at the Hollies supported people to make everyday decisions themselves and to maintain their independence. People who lived at the Hollies were encouraged to maintain links with friends and family who visited them at the home.

People and their relatives thought staff were kind and responsive to people’s needs. People and their relatives were involved in decisions about their care and people were given support to access interests and hobbies that met their preference.

Staff, people and their relatives felt the manager was approachable. People told us they knew how to make a complaint if they needed to. However, no-one had made a written complaint regarding the quality of care they received.

Medicines were stored safely. Medicine records were kept up to date and people received their prescribed medicines as intended. People were supported to attend health care appointments with health care professionals when they needed to, and received healthcare that supported them to maintain their wellbeing.

The manager worked alongside people at the home, and gathered verbal feedback from people during their day to day activities. Written feedback was unavailable for the manager to review and analyse, to identify areas for continued improvement. Verbal feedback was used to ensure people were happy with the care they received.

The manager had established some procedures to check the quality of care people received, and identify where areas needed to be improved. Although these procedures were not recorded, the manager could explain their daily check of medicines and premises checks, including the cleanliness of the home. The manager had also introduced a written check box system in the kitchen to monitor food storage systems. Documented quality assurance checks would provide information for the manager to review, to identify where the service could continue to improve.

The Hollies is registered to provide accommodation to a maximum of four people with learning disabilities. The Hollies is run like a family home where the registered manager, who was the provider, lived at the home. There were four people staying at the service at the time of our inspection.

A requirement of the provider’s registration is that they have a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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. At the time of our inspection there was a registered manager at the service. We refer to the registered manager as the manager in the body of this report.

People and their relatives told us they felt safe with staff, and staff treated them well. However, the manager had not ensured staff were trained to recognise signs of abuse, and how to safeguard people from potential abuse. There was not a recognised procedure within the home on how safeguarding concerns should be reported to the local authority, if there were concerns about peoples’ safely.

Management and staff did not understand the principles of the Mental Capacity Act 2005 (MCA), and did not support people in line with these principles.

There were enough staff at The Hollies to support people with care tasks, and provide people with support to go out. However, staff had not received sufficient training to assess and manage the risks associated with people’s care and in the safe management of medicines.

The risks associated with people's care were not always assessed, monitored and managed, so that risks to people were minimised. The manager did not maintain good infection control procedures to minimise the risk of infection to people at the home.

Medicines were not always stored safely. Medicine records were not always kept up to date, and procedures had not been developed for people to receive 'homely medicines' safely. Medicines audits were not performed to make sure the right amount of medicines were in stock. However, people received their prescribed medicines as intended.

Care records were not always up to date, and therefore did not provide staff with up to date information about how people should be cared for and supported consistently. However, staff at the home knew people well and could describe the support people needed.

People were supported to attend health care appointments with health care professionals when they needed to, and received healthcare that supported them to maintain their wellbeing. However, people's health records were not always updated following visits to health care professionals, to ensure staff were aware of changes and people received the care they needed.

People and their relatives thought staff were kind and responsive to people’s needs. People were supported to go on holiday and to go out in their local community when they wished. Activities, interests and hobbies were arranged according to people’s individual preferences, needs and abilities. People who lived at The Hollies were encouraged to maintain links with friends and family who visited them at the home when invited.

People had privacy when they wanted it. Staff at The Hollies supported people to make everyday decisions for themselves, and to maintain their independence.

Staff, people and their relatives felt the manager was approachable. People told us they knew how to make a complaint if they needed to. However, no-one had made a complaint regarding the service.

People were not supported to develop the service they received by providing feedback about how the home was run. The manager did not gather feedback from people or their relatives through meetings or quality assurance questionnaires. However, the manager worked alongside people at the home, and gathered verbal feedback from people during their day to day activities.

The manager had not established procedures to check the quality of care people received, and identify where areas needed to be improved.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Both people were at a day centre on the day of our visit. We therefore spoke with a family member of one person about the care their relative received. They told us the family were 'more than happy' with the support their relative received at The Hollies. They said, 'We know X is very happy and very much loved.'

Both people had care plans in place. These provided information that would enable people other than the provider to maintain the care and support needed in the event of an emergency.

People were supported to take part in recreational activities that were interesting and stimulating so that they had a meaningful lifestyle. People were able to choose what activities to be involved in including shopping, eating out, sailing, swimming and going to the pub.

We looked at safeguarding procedures; this is how the home ensured people using the service were protected from harm. We saw suitable systems were in place to support and protect vulnerable adults.

People received care and support that met their individual needs. We saw that people had care records which had been written in a style that people understood.

Staff supported people to go out and do the things they enjoyed, including social activities and day care provision. People said they enjoyed going shopping and going to the day centre. They said they were looking forward to going on holiday to Blackpool. People told us, 'If we need help someone is always there.'

People were encouraged to be independent and they told us they were responsible for keeping their rooms tidy. We saw one person setting the table for lunch and making themselves a cup of coffee.

People told us they felt safe living at the home and would talk to staff, family or their advocate if they had any concerns. People told us that they knew how to complain if they were unhappy and were confident the registered providers would listen to what they had to say.