Holly Lodge Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 3 quality statements in the safe key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good. During our assessment of this key question, we found concerns around choking risk management which resulted in a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and around safeguarding which resulted in a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below., although appropriate reporting to the external agencies was not always completed. Staff did not always follow provider’s choking management policy which could put people and risk and was a breach of the regulation in relation to safe care and treatment. Staff did not always ensure least restrictive support measures were considered and decisions were made in the best interests of people who could not consent to have their diet modified. The provider did not always recognise when complaints and incidents included safeguarding concerns. Hence, these were not always appropriately reported to the local authority and investigated timely. This put people at risk of harm and of their rights and liberties not being respected. This was a breach of regulation in relation to safeguarding and protecting people from unnecessary restrictions. The provider took action to address those shortfalls following the site visit. People overall received safe care and treatment from staff who understood their individual needs and followed people’s care plans. Staff knew how to safely support people around a range of their individual risks and how to recognise and report any concerns to the registered manager.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us they felt the home was safe. One person said, “I am safe because they are good people. I have no problems at all to worry about.” A relative told us, “[Person] is totally safe here. I can tell you; he wouldn’t be here if I felt he wasn’t.”

Staff knew how to recognise and report safeguarding concerns. Staff members told us, “Safeguarding is about protecting our residents from harm and abuse, from staff or if other residents are being abusive to them. If I observe a member of staff being rough or aggressive, I have to report this”, “Always be vigilant in looking out for any changes and report it to a senior”, “If there is something going on in the home, we should contact an outside agency like social services and also the CQC.” However, leaders of the service did not always fully understand the local multidisciplinary safeguarding policy and when concerns or incidents required reporting to the local authority. Staff protected people from individual risks but were not always able to explain how the least restrictive options of supporting people were considered when eating and drinking care plans were assessed.

During the site visit, staff, without exception, were smiling and polite and were observed to be extremely kind and caring. Each person was called by their name, and individual likes and dislikes were known and catered for. We did not observe any safeguarding concerns during the visit to the home.

The provider had a safeguarding policy in place but did not always follow appropriate processes to report and investigate concerns. Not all complaints and accidents of a safeguarding nature were appropriately recognised by the registered manager as such and reported to the local authority. Although some actions were taken to protect people, there was limited assurance how these concerns were investigated at the time. This put people at risk of abuse and harm as the processes in place were not always effectively implemented. The provider took action to review their safeguarding systems following the inspection to report all relevant events appropriately and to ensure action was taken and any issues were thoroughly investigated. Audits and checks did not identify referrals to healthcare professionals were not always completed when needed and people’s records were not always reflecting the individual risk of choking, least restrictive options to be used to support them to stay safe and the need to assess their mental capacity for modification of their diet. The provider reviewed people’s records following the site visit.

People and their relatives told us staff knew how to support people safely. One person said, “You are looked after here. [Staff] are very good and there are lots of them.” People’s relatives said, “They look after [person] beautifully, the place is spotless, absolutely first class”, “[Staff] are pretty good at understanding [person’s] needs and assessing their risks.”

Staff knew people’s individual risks and needs and how to provide people with the appropriate care as described in their care plans. Staff were able to give us multiple examples of support measures in place to protect people from avoidable harm. Senior staff members were aware of their responsibilities around keeping all risk management plans up to date and what to do if people’s individual needs had changed. Staff comments included, “One person is at high risk of falls but in order to improve their walking, we continue to encourage and assist them to walk, even though this carries a risk for them. We make it as safe as possible by making sure all mobility aids are within their reach and this has improved their walking greatly”, “When a new resident comes, we speak with them and their family and assess where their risks are. If they need some support e.g. walking, we encourage them to be independent as much as they can be, but we will be there to support”, “With new residents we all see how they are eating and if this takes them some time, we discuss this in handover about how they swallow. We try a different texture and the nurses assess (the person), then we get a speech and language therapist (SALT) assessment.” However, a review of records indicated referrals to SALT were not always made in a timely manner.

People were supported safely and in line with their individual care plans on the day of the site visit.

The provider did not always ensure their risk management policy around choking was followed by staff which could put people at risk of avoidable harm. People who received modified texture diets were not always appropriately referred to the speech and language therapy service to ensure they received safe food and drink . Although action was taken to modify their diets, it was not always clear how this was assessed as an appropriate course of action. Not all people who could be at risk of choking had appropriate risk assessments in place. The provider took action and completed relevant referrals and risk assessments shortly following the site visit. People’s care records included clear guidance for staff on how to manage other risks to people, around their mobility, skin care, personal care, or other individual needs.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us there were enough competent staff to provide good care. One person said, “There are buzzers in the bedrooms if you need them, and they do come fairly quickly, occasionally they may be busy with someone else, but they do come.” A relative commented, “There are plenty of staff around all the time, as you can see.”

Staff told us there were enough of them to be able to provide timely care to people. Staff members told us, “Staffing here is good”, “There is enough staff and if someone is sick, we get cover, most of the time it is our own staff who cover. We get plenty of time to sit and chat with people in the afternoon.” Staff felt supported in their roles and received appropriate training. Staff members said, “I have supervision every 6 months, which works for me. I also have an appraisal once a year and can speak about any career development” and “I have an appraisal and can speak about my career development and more training that I can do.”

There were numerous staff available to support people during the site visit. We saw people received timely support when needed.

The provider had good systems and processes to review and plan staffing in the home. New staff were recruited safely. Staff received training which ensured they were competent in their roles. The registered manager had an oversight of staff training and support needs, roster planning and staff recruitment.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.