This unannounced inspection was carried out on the 22 January 2015.
Holly Court Care Home is situated in Salford and provides accommodation and support for people with various types of dementia. Accommodation comprises of 25 single en-suite bedrooms over two floors. At the time of our inspection there were 25 people living at the home. There is parking for several cars to the front of the property. The home is close to local amenities and bus routes.
Holly Court had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
At the last inspection carried out in April 2014, we identified concerns in relation to safe recruitment procedures of staff, we found not all people were adequately protected against risk and some people did not have suitable care plans in place to meet their needs. As part of this visit we checked to see what improvements had been made by the home to address these concerns.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
We looked at how the service managed people’s medicines and found that not all aspects of the service were safe. We found records supporting and evidencing the safe administration of medicines were not always completed. This meant it was not possible to tell if a course of treatment had been taken correctly. In line with good practice, it is essential that staff involved with the administration of medicines maintain an accurate record of which medicines have been administered and by whom.
Whilst observing staff administer medicines to people who used the service, we found that one medicine had not been stored in line with manufacturer’s instructions as it required cold storage.
When we checked the medication fridge temperatures, we found several gaps in records. This meant staff were unable to ascertain if the medication had been stored at the correct temperatures and was safe to use.
This is a breach of Regulation 13 of The Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2010, because the service did not have appropriate arrangements in place to manage the safe administration of medicines.
People who used the service and visiting relatives told us they believed they or their loved ones were safe at Holly Court Care Home. One person who used the service told us; “I feel very happy and perfectly safe here.” A visiting relative said “No concerns, very happy, X is safe here. X seems very happy here.”
As part of our inspection, we checked to see how people who lived at the home were protected against abuse. We found the home had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse.
During our last visit we identified concerns about the safe recruitment of staff. We looked at a sample of five staff files and found each contained records, which demonstrated that staff had been safely and effectively recruited.
During our last visit we found some people were not adequately protected against risk. We looked at a sample of five care files of people who used the service and found there was a comprehensive range of risk assessments in place designed to keep people safe from harm.
On the day of our inspection, there were 25 people living at the home divided between the ground and first floor. We found there were sufficient numbers of staff available including care staff and ancillary staff.
Holly Court Care Home was part of the Pearl Project, which was a specialised dementia care programme developed by the provider. On the ground floor of the home, we found themed corridors had been introduced to help orientate people and provided sensory stimulation. Themes were artistically exhibited in corridors with visual clues.
A comprehensive schedule of e-learning training was undertaken by all staff, which we verified by looking at training records. We looked at supervision and annual appraisal records and spoke to staff about the supervision they received. Staff told us they received support and training to undertake their roles effectively.
During our last inspection we found not all people had an appropriate care plan in place to meet their needs. We found care files reflected the current health needs of each person who used the service. These included a needs assessment and detailed individual care plans which provided direction to staff on the type of support each person required.
The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). We found all staff demonstrated a good understanding of the legislation and all had received training, which we verified from looking at training records.
We found the meal time experience to be relaxed and well organised. We observed staff washing their hands and asking people whether they wanted to wear an apron during the meal time. We saw people being asked what they wanted to eat and were offered a choice of foods. For people who had difficulty communicating, we saw picture cards being used to demonstrate the choices available.
We observed people were clean and nicely dressed. We found staff were kind and attentive and engaged with people in a pleasant manner.
Visiting relatives told us they were regularly consulted about the needs of their loved ones and felt confident in raising any issues with the management, which would be listened to.
The home was part of the North West End of Life Care Programme known as Six Steps to Success. Three members of staff had received training in this end of life care programme, which enabled people to have a comfortable, dignified and pain free death.
We found people’s needs were assessed and care and support was planned and delivered in accordance with people’s wishes following a needs assessment and included religious and spiritual needs.
The service employed an activities coordinator and maintained individual journals for people detailing their involvement in any activity. Events organised included games, visits and pub lunches, themed parties such as Halloween, baking, craft and cinema sessions that included popcorn. During the afternoon we observed a quiz session which was lively and good natured and involved a number of people.
We found the service routinely listened to people’s concerns and experiences about the service. Resident and family meetings were undertaken together with the circulation of a newsletter. An annual questionnaire was also circulated.
People told us they thought the home was well run and managed. They were able speak freely to staff and the manager about any concerns and were confident these matters would be addressed by the home.
Both staff and people told us the manager who was very approachable was responsible for an open and transparent culture at the home. Comments from members of staff included; “The manager is very good, we are all very happy with him.” “The manager is very open. We have an open culture here and the freedom to say what we want.”
The service undertook an extensive range of audits of the service to ensure different aspects of the service were meeting the required standards.