The Hollies

We found the following examples of good practice.

The Hollies had systems and processes in place to prevent relatives, professionals and others visiting from spreading infection. All visitors were screened for symptoms of COVID-19 and were required to show negative Lateral Flow Test (LFT) result before they were allowed to enter the service. Visitors were provided with appropriate personal protective equipment (PPE), such as face masks.

The registered manager understood and was meeting staff’s and visitor COVID-19 vaccination requirements. This included checking professionals working in care homes vaccination status upon entering the service.

Staff had an access to multiple PPE stations located in all dwellings. We saw staff wore appropriate face masks throughout our inspection. Staff took part in regular ‘whole home testing’ to ensure they were not infected with COVID-19.

There were no domestic staff working at the service, however staff had cleaning schedules they were required to complete on a daily basis. Cleaning schedules included cleaning of frequently touched points such as light switches or door handles.

The Hollies provides accommodation and care for adults with learning disabilities and autistic spectrum disorder.

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.

The service accommodated people in six purpose-built bungalows and three individual apartments within the same grounds. It was registered for the support of up to 21 people. At the time of the inspection 15 people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

People were cared for by sufficient numbers of experienced and competent staff who were deployed to meet their care needs. Since the last inspection, people’s dependence needs had been reassessed and the deployment of staff reconfigured. This impacted on people receiving consistency and continuity in care from staff they were familiar with. Robust staff recruitment procedures were used to ensure staff were suitable to care for people.

The prevention and control of infections were minimised due to infection control best practice being followed. Since the last inspection, new cleaning schedules had been introduced and the service had been deep cleaned with an additional deep clean booked. However, increased oversight of cleanliness was required to ensure consistency.

The provider used different systems and processes to monitor safety and quality. Since the last inspection a refurbishment plan had commenced with many improvements made to people’s living environment. However, repairs and maintenance reported by staff to the provider had not been responded to in an effectively and timely manner. This had impacted on people’s safety. Staff responsible for health and safety checks had not identified some maintenance issues identified during this inspection.

People in the main had received their prescribed medicines and staff had detailed information of people’s support needs in relation to medicines. Inconsistencies were identified with one person’s medicine administration, but this had not impacted on their health.

Staff were aware of their role and responsibilities to protect people from abuse and avoidable harm. Where safeguarding concerns had been identified, action had been taken to investigate and mitigate risks in conjunction with the local authority external safeguarding team. Incidents were reviewed for themes and patterns and to consider if incidents could have been avoided or managed differently. Staff had detailed information about how to meet people’s behavioural needs and the use of physical intervention had reduced in the last 12 months.

The restrictions placed on people’s freedom and liberty had reduced for some 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 were involved as fully as possible in the care and support they received, this included greater opportunity of accessing the local community and pursuing interests, hobbies and experiencing new opportunities.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. People were supported to identify and achieve personal goals, and this had resulted in a person moving into supported living.

People were involved as fully as possible in the care and support they received, this included greater opportunity of accessing the local community and pursuing interests, hobbies and experiencing new opportunities.

People received effective care and support from staff who were trained, supported and knew them well. Staff moral had improved since the last inspection, they were positive about their role and about the improvements made at the service. People received a choice of meals and drinks and their nutritional needs had been assessed and were regularly reviewed. Staff worked effectively with external health professionals in assessing, monitoring and managing people’s health conditions and needs.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 6 April 2018) and there were three breaches in regulation. 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 improvements had been made and the provider was no longer in breach of these regulations. However, a new breach in regulation was identified. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit at the next scheduled inspection. 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

The Hollies is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Hollies provides accommodation and care for up to 21 people with learning disabilities and autistic spectrum disorder in six purpose built bungalows and three individual apartments within the same grounds. At the time of the inspection 21 people living at The Hollies.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The service had a registered manager who was in the process of de-registering as the registered manager for this service. A new manager had been appointed and had been in post for one week, they were in the process of submitting their registered manager application. We will monitor their progress.

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 last inspection February 2016 the service was rated ‘Good’ in all key questions, at this inspection we found the service had deteriorated to ‘Requires Improvement’ in ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well-led’ and remained ‘Good’ for ‘Caring’.

People were not continuously supported with the required staffing levels to meet their assessed needs. Staff were not always deployed appropriately. Safe staff recruitment checks were followed. Risks to people’s needs and the environment had not always been appropriately assessed and reviewed.

The prevention and control measures for the spread of infections including cleanliness of the service were found to be poor. There was no effective analysis of behavioural incidents or accidents or learning to reduce further reoccurrence. Some inconsistencies were identified in the management of medicines.

Staff had received training in safeguarding and the provider had a policy and procedures to inform practice.

Staff received an induction and ongoing training and support. Staff had not received refresher training in Positive Behaviour Management as required. However, this had been identified and plans were in place for staff to receive this training. Staff were not knowledgeable about all people’s health conditions.

People had their needs assessed and planned for. People received a choice of meals, but some people had undue restrictions placed on them in relation to snacks.

People were not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. Where people lacked mental capacity to consent to their care and support, assessments to ensure decisions were made in their best interest had not been consistently completed. There had been a delay in acting on a condition that had been made on the authorisation of one person’s deprivation of liberty safeguard authorisation. People were supported to access primary and specialist health services.

Staff were aware of people’s needs, routines and what was important to them. Staff overall were kind and caring and supported people ensuring their dignity and with respect. Independence was encouraged and supported. People were supported by independent advocates. It was not clear if or how, people were involved in their care and support.

Staff had information to support them to understand people’s needs, preferences and diverse needs.

People received a lack of structured and meaningful activities, stimulation and opportunities to pursue their interests, hobbies and aspirations. The provider’s complaint policy and procedure had been made available to people who used the service, relatives and visitors. People’s end of life wishes had been considered and discussed with people or their relatives.

Systems and processes in place to monitor and improve the quality and safety of the service were found to be ineffective. People who used the service did not receive opportunities to share their experience about the service. Feedback from quality assurance surveys sent to relatives were not appropriately responded to, when issues were highlighted.

We made one recommendation in relation to improving staff motivation and team building.

This inspection identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

We reviewed a report about the action taken and we visited the service again to ensure records were fit for purpose.

We examined two people's personal records and some of the records relating to the management of the service. We spoke with two of the support staff and the registered manager about record keeping. Overall, we found improvements had been made.

Support staff told us how they continually checked if people consented to their care. Where people did not have the capacity to consent, we found that support staff acted in people's best interests.

People told us they felt safe and comments included, "Happy here." And "They help me".

We performed a partial tour of each of the bungalows and saw a sample of individual bedrooms. We found the premises were mainly well maintained. Action was taken to replace a missing bedroom door during this inspection.

We found that all support staff received planned training and were supported to care for people safely.

The records kept at the service were useful, but we we had minor concerns that some records were not up to date or had not been maintained accurately.

The name of the registered manager was Russell Currie. In this report the names of two registered managers appear who were not in post and not managing regulatory activities at this location at the time of the inspection. Their names appear because they were still on our register at the time.