Hollies

Hollies is a ‘care home’ which provides personal care and nursing for up to 58 people, some of who may be living with dementia. At the time of inspection there were 49 people residing at the home.

People’s experience of using this service:

Staff were highly skilled and had a natural aptitude to give reassurance and comfort to people living in the home. They treated people with the utmost dignity and respect when helping them with daily living tasks. There was an excellent understanding of seeing each person as an individual, with their own specific needs.

People were protected from avoidable harm and abuse by staff members, who understood their role and responsibility in relation to safeguarding and keeping them safe. Safe recruitment practices were followed to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

People were assisted to take their prescribed medicines safely by staff who were assessed as competent to do so. Where people required their medicines at a specific time or with food, this need was met. Storage and handling of medicine was managed appropriately.

People benefited from a home that was light, spacious and free of malodours. The registered manager advised they would be reviewing best practice on how to ensure they can make the environment more dementia friendly.

People's needs were assessed and their care delivered in accordance with appropriate guidance and best practice. The provider worked with other services to ensure consistent care. Staff received the training and support they needed to carry out their roles effectively. People received appropriate support to attend healthcare appointments, to remain healthy and to eat and drink well.

People who lived at Hollies received care from a staff team who were passionate about delivering a high-quality, person-centred service. People's care and support met their needs and reflected their preferences. The provider upheld people's human rights. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The service was well-managed by a registered manager, who provided clear and direct leadership. Good communication was maintained between the registered manager and the staff team. There were systems to assess the quality of the service and promote continuous improvement. People, staff and relatives were involved in improving and developing the service.

Rating at last inspection:

The service was last inspected on 20 September 2016 and was rated Good (report published on 20 October 2016).

Why we inspected:

This was a planned comprehensive inspection based on rating of 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.

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

Hollies provides accommodation for up to 58 people who require personal and nursing care due to age or frailty. Some may be living with dementia.

At the time of the inspection there were 52 people living at the service and there was a registered manager in post. 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.

People received high quality care from staff with the appropriate skills and knowledge to support them in a safe and effective manner.

People were treated with kindness and shown compassion. Their privacy and dignity was respected and maintained by the staff.

People, and when appropriate, their relatives were involved in planning the care they required. Staff encouraged people to communicate their wishes and maintain their independence. They respected the choices people made.

People had their right to make decisions protected. Staff had received training and understood their responsibilities in relation to the Mental Capacity Act 2005. When people’s freedom had been restricted for their own safety appropriate authorisations were in place under the Deprivation of Liberty Safeguards.

A full and varied programme of activities was available. People were supported to take part in those of interest to them. Outings were organised regularly and people were encouraged to maintain links with the local community. Visitors were always welcome and people were encouraged to maintain relationships important to them.

Staff were well supported by the registered manager and provider. They received regular training and met frequently on a one to one basis with their line manager to discuss their work. Annual appraisals and regular staff meetings also provided valuable staff support.

Staff were knowledgeable with regard to safeguarding people and understood their responsibilities. They were confident any concerns raised would be dealt with promptly.

People were provided with a choice of food and drink which they enjoyed. When necessary their nutrition was monitored to help ensure their well-being. Staff supported people to eat and drink in an unhurried manner.

People received appropriate support to maintain their health and well-being. Health and social care professionals were contacted promptly and appropriate referrals were made when people required specialist support.

The atmosphere within the service was open, calm and friendly. People, their relatives and staff found the registered manager approachable and supportive.

A programme of checks and audits was carried out by the registered manager and provider to monitor the quality of the service and make improvements. People were asked for feedback on their experience of the service and any concerns were addressed appropriately.

As part of this inspection we spoke with three people who use the service, four visitors, one volunteer, the registered manager, three care staff, the chef and the local authority. We also reviewed records relating to the management of the home which included, five care plans, daily care records, risk assessments, audits, policies and procedures.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People had been cared for in an environment that was safe. They were supported by staff who understood and were aware of the Mental Capacity Act and Deprivation of Liberties.

People's records showed they had access to routine and specialist health services. People regularly saw doctors, district nurses and other specialist health professionals. Directions from professionals were recorded accurately in the care plan and staff we spoke with knew how to access and follow them.

Records we looked at were accurate and fit for purpose. We saw they were stored securely and could not be accessed by unauthorised people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke with the manager with regard to the Supreme Court ruling which widened and clarified the definition of deprivation of liberty. They were aware of the ruling and had been in contact with the local authority deprivation of liberty safeguards (DoLSs) team. As a result a number of applications had been made.

Is the service effective?

People all had an individual care plan which set out their care needs. People had access to a range of health care professionals including speech and language therapists, tissue viability nurses and respiratory nurses. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's needs and they knew them well.

People and their relatives had been involved in planning activities and people's life history, their hobbies and pastimes had been considered. During our visit we saw staff supporting people with activities and we observed people smiling as they joined in. People we spoke with told us they enjoyed the activities they chose to take part in and we saw activities had been planned to achieve positive outcomes for people.

Staff had received appropriate training and supervision to enable them to meet the needs of the people living in the home.

Is the service caring?

People said they were supported by kind and attentive staff. Our observations confirmed this and we saw people being spoken to politely and with respect. Staff were patient and encouraging when supporting people in everyday tasks and activities. One relative said they were very happy with the care their relative received, calling it: 'first class.' A person who uses the service said: 'staff are lovely, every one of them. Nothing is too much trouble.' The same person told us that they liked to have a laugh and a joke and said they felt they could do that at Hollies.

Is the service responsive?

People's needs had been assessed before they moved into the home. People's needs were reviewed with them and their relatives as appropriate. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us they felt supported and could approach the manager for advice. They knew and understood their responsibilities and the importance of their role. People and their relatives said they were consulted about their views and they completed satisfaction questionnaires. People said they felt they had been listened to and as a result changes had been made. For example: trips out of the home had been planned and alterations made to menus.

We found that people were treated with respect and dignity. People were given choices and encouraged to make decisions. We found that people's needs had been assessed and that care and support was delivered in line with their assessed need.

People were supported to eat and drink sufficient amounts. A choice of snacks and drinks was always available. We found that, where appropriate, special diets were made available to people and advice had been sought from other health care professionals to make sure that people were given the most appropriate food and drink.

We found that appropriate checks were made during the recruitment process to ensure that people were cared for, or supported by suitably qualified, skilled and experienced staff.

We found that while records relating to staff were current and accurate, there were errors in the care and support plans for people living in the home. The records did not always reflect the care that the people had received.

During the visit we spoke with eight people in private. People told us that they were well looked after and their needs were met. People said that they were "happy living in the home" and that staff were "helpful and they never felt hurried". Another person said of the staff 'they are lovely, they lighten my day'.

People said that they made decisions about where they wanted to spend their time. They said that they had a varied menu choice and a range of activities was provided. One person told us that 'the staff are very kind and supportive, I have no complaints'.

We looked at a range of records, spoke with senior staff, a qualified nurse and two care staff in private. We also spoke with the visiting family members, the activities co-ordinator and two visiting professionals who were in the home during our visit. We saw the communal areas of the home and spent time observing interactions between staff and people living in the home.