Holly Bank Care Home

Holly Bank Care Home is a residential care home for to up to 25 people who require support with personal care needs, some of whom are living with dementia. The service does not provide nursing care. There were 24 people living at the home at the time of our inspection. Bedrooms are situated over four floors and there are three lounges and a dining room on the ground floor.

Since the last inspection the registered manager has also become the provider of the service. We refer to them as ‘the provider’ throughout this report.

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

There were safe systems of recruitment in place. Staffing levels had been increased to make sure people’s needs could be met safely at all times. Medicines were managed safely. Staff received safeguarding training and knew what to do if they thought someone was at risk. Risks to people and the environment were identified and well managed. People’s needs were assessed, and clear risk assessments were in place to guide staff.

Everybody we spoke with said they, or their relative, felt safe. One person who lived at the home when asked if they felt safe said, “Absolutely, spot on no bother.” A relative said, “Yes, indeed. I know the staff well and know them by name. I know that they work to the highest standards and I trust them. I am very grateful for the care (relative) receives there.”

People’s relatives gave examples of how accidents and incidents were managed well and how they were kept informed, where appropriate, of what was happening with their family member.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. Risks associated with COVID-19 were well managed.

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 said the service was well led. The provider had ensured the service continued to improve since the last inspection. We found systems to assess, monitor and improve the service were established and effective. The provider and deputy manager had good oversight of the service and demonstrated passion and commitment to the continued development of the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 September 2019). 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 regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holly Bank Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Holly Bank Care Home 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.

Holly Bank provides residential care to a maximum of 25 people. There were 21 people living at the home at the time of our inspection. The service does not provide nursing care. Bedrooms are situated over four floors and there are three lounges and a dining room on the ground floor.

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

At our last inspection of Holly Bank Care Home in April 2018 we said there were not enough staff available at all times to meet people’s needs safely. We told the provider they had to address this. On this inspection we found the provider had not taken any action and people told us there were not enough staff during the night. This meant the provider was still in breach of regulations.

Risks to people’s health and welfare were assessed and managed well. Staff knew what to do if they thought someone was at risk.

Medicines were managed safely, and staff made sure the home was clean and infection control risks were managed well.

Staff were recruited safely and received appropriate training and support.

People enjoyed the food and adaptations were made to meet people’s individual needs. People were asked for their input into menu planning, but their suggestions were not always included in the menus.

People were confident that staff would involve appropriate healthcare professionals as the need arose. A visiting professional was complimentary of how people’s healthcare needs were managed.

People were supported to have maximum choice and control of their lives and staff supported supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were kind, caring and friendly in their approach to people. One visitor described staff as “Brilliant”.

People were supported with discretion and their privacy and dignity needs were considered and met.

Care was planned and delivered with a person-centred approach. People and, where appropriate, their families were involved in the development and review of their care plans. One person told us staff knew and respected their chosen routines. They said this was important to them.

People told us the opportunity to engage in meaningful activities had improved since the appointment of the new manager. People enjoyed social events.

People told us the registered manager listened to and acted upon any concerns they might have. However, people did not find the provider to be responsive to concerns.

The registered manager had good systems in place to audit safety and quality in the service. However, improvements were needed at provider level to make sure issues identified during audit were addressed.

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

Rating at last inspection and update.

The last rating for this service was requires improvement (published 26 July 2018).

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified two breaches of regulation in relation to staffing and good governance at this inspection.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can see what action we have asked the provider to take at the end of this full report.

Holly Bank Care Home 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.

Holly Bank provides residential care to a maximum of 25 people. There were 22 people living at the home at the time of our inspection. The service does not provide nursing care. Bedrooms are situated over four floors and there are three lounges and a dining room on the ground floor.

A registered manager was in place. 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.

We saw Holly Bank Care Home provided a comfortable and pleasant home for people and was clean and tidy throughout. There was a relaxed friendly atmosphere and we observed caring, respectful and friendly interactions between staff and people who lived at the home.

Systems were in place to make sure staff were recruited safely but some improvements were needed to make sure staff received the training and support they needed.

There were not enough staff available at all times to safely meet the needs of people living at the home.

An analysis of peoples dependencies had been completed but this concentrated on personal care needs and did not take into consideration the support needs of people living with dementia or peoples social and recreational needs.

Systems were in place to manage medicines safely but further improvements were needed in relation to recording application of topical medicines and managing ‘as required’ medicines.

We made a recommendation about some aspects of medicines management.

People told us they felt safe at Holly Bank Care Home and we found systems were in place to report and analyse incidents which may affect people’s safety and welfare.

People we spoke with said they received good care and support. People were very complimentary of the staff.

People told us they very much enjoyed the meals at the home and had plenty of choice. There was no dedicated cook, and we saw care staff took it in turns to cook meals. We saw meals were appetising and nutritious and plenty of choice was available. We saw the dining experience was well organised and enjoyable for people. People’s nutritional needs were assessed and met.

An electronic care planning system was in place. We saw assessments of need and perceived risks were up to date and under continuous review. Care plans were in place but varied in the detail they provided and in demonstrating a person centred approach.

People had access to healthcare professionals as and when the need arose.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staffs’ understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) was variable and there was a lack of reporting to demonstrate how the condition on one person’s DoLS was being met.

We made a recommendation about management of DoLS.

Although the service did not have an activities programme, we saw people were supported to engage in activities or pastimes of their choice.

People told us that any concerns they had were addressed immediately. However this was not routinely recorded.

Some systems in relation to governance and for auditing the safety and quality of the service were not always robust or effective.

We identified two breaches of regulation during the inspection. You can see what action we have told the provider to take at the back of the full version of this report.

As a result of the June 2016 inspection the service was placed in ‘Special measures’. This meant we kept the service under review and if no further action was needed, would return to inspect again within a six month period.

On this inspection we found sufficient improvements had been made to take the service out of ‘Special Measures’.

This inspection was to check improvements had been made and to review the ratings. We found a number of significant improvements had been made and plans were in place to further improve. Whilst some further improvements were needed, we did not find any regulatory breaches.

Holly Bank Care Home is situated on the outskirts of Halifax town near Manor Heath park. It is registered with the Care Quality Commission to provide personal care for a maximum of 25 people. Nursing care is not provided. The accommodation is arranged over four floors and there is a passenger lift available. Bedrooms are on all four floors, there are two doubles and 21 single rooms. Five bedrooms have en-suites toilets and 13 have en-suites showers and toilets. Car parking is available at the front of the building. On the day of the inspection there were 22 people using the service.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found the service provided a comfortable and pleasant home for people and was clean and tidy throughout. There was a relaxed friendly atmosphere and we observed caring, respectful and friendly interactions between staff and people who lived at the home.

We found staff were being recruited safely although documentation was not in place to show how poor references had been followed up. Duty rotas had been improved to show which members of staff were on duty or in what capacity they were working. An analysis of peoples dependencies had been completed which included a detailed evaluation of staffing levels and details about how staff were deployed to meet the needs of people living at the home. This was an improvement since the previous inspection.

Improvements had been made to the way medicines were managed in the service. Although we found the systems to be safe, further improvements were needed.

Staff were receiving training which was relevant to their role although new staff were not included on the training matrix. Improvements had been made to the systems for supporting staff and a new system was in place to ensure each staff member received quarterly supervisions and an annual appraisal. These looked at the support staff required as well as addressing any performance issues.

People told us they felt safe at Holly Bank Care Home and we found improvements had been made in the way the service reported and managed incidents which may affect people’s safety and welfare.

All of the people we spoke with said they received very good care and support. They told us staff were always available when they needed them. People were very complimentary of the staff.

People told us they very much enjoyed the meals at the home and had plenty of choice. There was no dedicated cook, and we saw some of the care staff took it in turns to cook meals. We saw meals were appetising and nutritious. People’s nutritional needs were assessed and the dietician was involved in people’s care if required.

A new electronic care planning system was in place. We saw assessments of need and perceived risks were up to date and under continuous review. Care plans were detailed and up to date. The new system incorporated a way for all staff to be informed of changes to people’s needs and alerted them to revised care plans. This was an improvement since the last inspection.

People had access to healthcare professionals as and when the need arose.

Improvements had been made to make sure the service met the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). Where a DoLS was in place detail of this and any conditions was included in the care plan and we observed staff taking actions which complied with conditions. Staff understanding of the Mental Capacity Act (MCA) and DoLS was variable but this had been recognised and plans in place to provide further training and support.

People told us there was plenty to occupy their time although no activities programme was in place.

People told us they had no need to complain, but they felt able to raise minor issues with the registered manager or staff and these were always taken seriously.

The home had received recent management support from another home run by the same provider. This support had been focused around improving governance and audits systems within the home. We saw this extra support had been effective and since the previous inspection a number of improvements had been made. Some further improvements were needed to ensure the audit system was robust and effective.

Although some improvements are still required, we did not identify any regulatory breaches.

Holly Bank Care Home is situated on the outskirts of Halifax town near Manor Heath park. It is registered with the Care Quality Commission to provide personal care for a maximum of 25 people. Nursing care is not provided. The accommodation is arranged over four floors and there is a passenger lift available. Bedrooms are on all four floors, there are two doubles and 21 single rooms. Five bedrooms have en-suites toilets and 13 have en-suites showers and toilets. Car parking is available at the front of the building.

On the day of the inspection there were 22 people using the service and one person was in hospital.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found the home was well decorated, comfortably furnished, clean and tidy. There was a relaxed friendly atmosphere and people looked well cared for. However, we identified a number of areas where improvements were required.

We found staff were being recruited safely, however, the duty rotas did not always show which members of staff were on duty or in what capacity they were working. The registered manager was not using any formalised tool to calculate how many staff were needed, based on the dependencies of people using the service. This meant we could not assure ourselves there were always enough staff on duty to met people’s needs.

Staff were receiving training which was relevant to their role and they told us they received regular supervision. There was no appraisal system in place to ensure staff performance and developmental needs were being identified and addressed.

People who used the service and their relatives told us staff were helpful, polite, professional and caring. We saw people were treated with respect and compassion.

Although people told us they felt safe at Holly Bank Care Home we found some incidents had not been reported to the safeguarding team and the Commission. This meant the procedures to keep people safe were not being followed.

There was no dedicated cook, the registered manager told us some of the care staff took it in turns with the catering. They also told us they had no intention of employing a chef or cook in the future. Although people told us the meals were good, we saw the menus did not incorporate people’s preferences, which had been discussed at a residents’ meeting.

Care plans were not up to date, did not detail exactly what care and support people needed and were not personalised. Risk assessments were in place however, these were not always accurate and action had not always been taken to mitigate identified risks.

People’s healthcare needs were being met, however, we found medicines were not being stored or managed safely. Staff were not always signing medicine records to confirm they had administered medicines and there was no guidance for staff regarding the administration of ‘as required’ medicines.

We found the service was not meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). We found one DoLS had expired and there was no evidence the conditions which had been in place for someone who had left the service had been met.

Some activities were organised by the care staff to keep people occupied.

People told us their visitors were made to feel welcome and if they had any concerns they would speak to the one of the staff.

We found checks being made on the overall operation and quality of the service were poor and were not identifying areas which required improvement. The registered manager had had been given advice from the local authority contracts officer about this, but had not followed their advice.

The registered manager had not always informed us about events in the home, as they were required to do. We found they were not following the Commission’s current guidance or legislation which meant they were not up to date with current requirements.

Overall, we found significant shortfalls in the care and service provided to people. We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The registered manager told us about the difficulties they had in trying to recruit suitable nursing staff and told us they were going to stop providing nursing care because of this. They have informed the commissioners of their decision and said they would be working with them to ensure the best outcomes for people living at Holly Bank.

"I can do whatever I like"

"I would like a bit more choice of food but I'm happy with what I get"

"The staff are good and kind"

"Some staff are better than others"

"They are marvellous"

" I have everything I need here"

Both of the visitors we spoke with told us that they were happy with the care their relatives had received. One person told us that if they had any issues at all they discussed it with management who resolved the issue immediately.

We found the home provided people with a pleasant environment in which to live and saw that further improvements, including easier access, to the building were underway.

Staff were attentive to people's needs and told us they enjoyed working at the home.

We saw that staff managed safeguarding issues and complaints/concerns well.

Care documentation, although of an acceptable standard, was in need of some improvement to make sure people's clinical needs were met.

The visiting social care professional told us staff appeared happy and they had no concerns with the care of the person they were supporting.

Staff spoke highly of the care standards at Holly bank Nursing Home. They told us that they do not use unsafe moving and handling techniques such as drag lifting. One person told us, "We would get sacked." All the staff we spoke with told us they would be happy for a relative to be cared for at this nursing home. They told us they felt very supported by the management who were always available.