This comprehensive inspection took place on 15 and 16 June 2017 and was unannounced. At our last inspection in December 2016, we conducted a focused inspection visit to check whether the registered provider had made improvements, following concerns and breaches of regulations that we had identified in April 2016. During our focused inspection in December 2016, we had found that the registered provider had made improvements. At this inspection, we found that although these improvements were ongoing, progress had not always led to robust care planning and risk management to help ensure all people’s needs were always met and understood at the home. The registered provider and registered manager had not upheld all of their responsibilities to the Commission to ensure that all breaches of regulation were met.
Hollywood Rest Home Limited is registered to provide personal care and accommodation for up to 36 older people. At the time of our inspection, 30 people were living at the home.
There was a registered manager in place who was present throughout our inspection. 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 told us that they felt safe living at the home. Staff told us that they had received safeguarding training and showed an understanding of how to report safeguarding concerns.
All people’s risks were not always managed effectively to help learn from incidents that had occurred and to promote people’s safety at all times. Health and safety checks were in place although they did not always cover all possible risks in the environment.
We could not be confident that staff were always effectively deployed to meet all people’s needs and wishes. The registered provider told us that recruitment processes were followed and overseen by an external service to help ensure that people were supported by staff who were suitable.
We identified some areas of positive practice in respect of how people’s medicines were managed. Audits had not always identified possible areas of improvements to ensure that people would always receive their medicines as prescribed.
People spoke positively about the support they received. Staff told us that they felt supported in their roles. Whilst we observed some areas of positive practice, we observed that staff did not always demonstrate a consistent understanding of all people’s needs. Care planning had not always provided clear guidance to help inform staff of people’s needs and how these should be met.
We observed that people’s consent was sought before they received support from staff and their decisions often respected. We found that processes were not always clear however to ensure that all people’s and rights would always be met in line with the requirements of the Mental Capacity Act (2005).
People had been involved in menu planning at the home to help meet their needs and preferences and we saw that people were given meal options. We observed that further improvement was required however to ensure that all people could enjoy mealtimes at the home. People were supported to access healthcare support when needed.
We observed some positive, caring interactions and relationships between people living at the home and staff. We found however that this was not always the consistent experience for all people living at the home. Shortly following the inspection, the registered manager told us that they were recommencing the keyworker system which would give all people and staff opportunity to spend time together and explore people’s care needs and wishes. Visiting relatives were welcomed at the home and we saw that they had a positive rapport with staff.
People often spoke positively about their care and support they received. Care planning processes however had not always ensured that all people would always receive care and support in line with their needs. We saw that people’s access to activities had improved although ongoing planned improvements would help ensure that this was a consistently positive experience for all people living at the home.
There was a complaints process in place and guidance about how to use this was on display at the home. Relatives told us that they would feel comfortable raising issues with the management. Some people had raised concerns which had been addressed although the home had received no formal complaints.
People and relatives had welcomed improvements they had experienced at the home and spoke positively about the registered manager. Planned improvements were ongoing and we saw that systems were being developed to help capture people’s experience of the home. Although we welcomed these findings and some ongoing improvements at the home, at the time of our inspection, audits and records were not always robust. We found that care planning and risk management processes had not always been effective to ensure that people’s needs could always be met. The registered provider and registered manager did not always uphold all of their responsibilities to the Commission.
You can see what action we told the provider to take at the back of the full version of the report.