Hollybank Care Home

Hollybank is a residential and nursing care home providing care and support for up to 49 older people some of whom are living with dementia. No nursing care was being provided by the service at the time of this inspection. Accommodation and support were provided on two floors which were accessible by passenger lifts. At the time of the inspection there were 40 people living at the home.

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

The service had a range of audits and checks to help monitor standards within the home. However, these were not sufficiently robust in helping to identify the shortfalls found at the inspection. Records also showed where shortfalls had been identified, action required had not been identified and implemented.

Good staffing levels were provided. However, not all information and checks were completed prior to new staff commencing employment. Staff spoken with felt supported in their role and the team worked well. Staff were able to demonstrate a good knowledge and understanding of the people’s individual needs and wishes, interactions were respectful and caring.

Servicing and maintenance checks were carried out to ensure the premises and equipment were kept safe. Outstanding checks regarding gas safety and profiling beds were being addressed. Suitable aids and adaptations were available to aid people's mobility and promote their safety.

People were provided with spacious, comfortable accommodation. The home was clean and well-maintained. Immediate action was taken with regards to the storage of slings and pressure aids to help minimise the risk of cross infection. We received mixed feedback about visiting arrangements due to COVID-19. We were assured that open visiting in and away from the home had resumed.

The management and administration of people’s oral medicines were managed safely. Improvements needed to the records for topical creams, when required medication and fridge temperatures were addressed immediately following the inspection visit.

Positive feedback was received from people, their relatives and third parties about the care and support provided. People told us they were happy living at Hollybank and were seen to enjoy a good rapport with staff. People followed routines of their own choosing and were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Further activities and opportunities were being explored following the lifting of COVID-19 restrictions.

Good systems in place with regards to safeguarding people, end of life care, handling of complaints and concerns and care planning.

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 good (published 17 October 2019).

Why we inspected

We received concerns in relation to staffing levels, medication and risk management. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. 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 good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to quality monitoring systems and staff recruitment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hollybank is a residential and nursing care home providing care and support to older people some of whom are living with dementia. The service can support up to 49 people. No nursing care was being provided by the service at the time of this inspection. Accommodation and support was provided on two floors which were accessible by passenger lifts.

People’s experience of using this service

People and relatives spoke positively about their experiences and the quality of care and support offered. We were told and saw that staff were kind and were aware of the individual needs and preferences of people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The home promoted people’s choice and independence and ensured they had access to a range of activities and opportunities for engagement with the local community had increased. The monitoring of nutrition and hydration had significantly improved, and people enjoyed the homemade food offered. The home was visibly clean and tidy.

When taking on new staff the service ensured appropriate checks were carried out to check candidates’ suitability to work with vulnerable people. Ongoing training was provided to staff both face to face and online to help ensure they had the knowledge and understanding of their care and support responsibilities. Staff thought team work was good and were complimentary about the visible management team and felt they were supported in their role.

More information is in the full report.

Why we inspected: This was a planned inspection based on the rating of good at the last inspection undertaken in November 2016.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in accordance with our re-inspection programme.

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

Our last comprehensive inspection took place on 15 and 16 September 2015. At this inspection, we found the service had not complied with all the regulations we reviewed. We found breaches in the regulations relating to risk management, the management of medicines, and not receiving all the notifications we required. The home had not had a registered manager for some time. We returned to the service on 25 February 2016 and found that action had been taken to ensure compliance with the regulations.

Hollybank Nursing Home is registered to provide nursing and residential care for up to 49 older people. Twenty one people were using the service at the time of our inspection. At the time of our visit there were no nurses employed at the home and no-one who used the service was receiving nursing care.

There was a registered manager in place at the home. 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.

It was clear from the paperwork we reviewed and discussions with other managers that the registered manager, who was also the registered manager for the providers’ sister home, Oak Lodge, had not been involved in the day-to-day running of the home. We were aware that the registered manager had handed their notice in and the group manager had started the interview process to appoint a new manager, who would be registered with us.

It was noted that the service also had a home manager. Although not registered with us the home manager took responsibility for the day-to-day running of the home with the support of the group manager.

People who we spoke with told us they felt safe at the service. Care staff we spoke with knew what action to take if they were concerned about a person who used the service being at risk of harm or the practices of a colleague.

Recruitment and selection procedures were in place to help protect vulnerable people from people who may be unsuitable to work with them. People and staff thought there were enough staff on duty to meet their needs.

There were procedures in place to ensure people received the appropriate support to manage their medicines. People were cared for in a safe and clean environment.

The premises had been through a major refurbishment. The providers had put in a great deal of thought into the refurbishment, which had been finished to a high standard incorporating up to date equipment.

Staff had an understanding of how to keep people safe and protect their rights should they be unable to consent to the care and support they required.

People were provided with a choice of suitable and nutritious food.

People had access to health and social care professionals to support them if required.

The atmosphere at the service was calm, relaxed and friendly. People who used the service spoke positively about the staff team who supported them.

People were able to participate in activities if they wanted to. This helped to ensure their emotional health and wellbeing.

There was a system in place for handling and responding to complaints. People told us that they were confident that the home manager would deal with any concerns that they raised.

People, relatives and staff spoke highly about the home manager. They said that they were approachable and supportive.

The breaches in regulations related to there being no manager registered with Care Quality Commission (CQC) since April 2014 and we had not received all the statutory notifications we should have from the home. The providers of Hollybank Nursing Home are legally obliged to report any incidents, which may affect the well-being of people to us as a statutory notification.

We also found breaches in safe working practices in relation to the administration of medicines, the use of equipment and risk assessments.

Hollybank Nursing Home is registered to provide nursing and residential care for up to 49 older people. The home was still being refurbished and at the time of our visit. No one who lived at the home was receiving nursing care and no nurses were employed at the home.

Before our inspection, we saw from our records that there was a manager now registered with CQC. 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. The registered manager was also the registered manager for the services ‘sister’ home Oak Lodge. The registered manager was not in attendance at this inspection visit.

Our records showed and clarification at this inspection confirmed that we had received all the statutory notifications we should have from the service.

We checked the shower areas in use at the Orchard Mews unit at the location. We saw that there were no shower chairs in place that could cause entrapment. In people’s bedrooms where bedrails were being used we saw that bedrail covers were in place to help prevent entrapment. Although detailed bed rail risk assessments were in place they had not yet been updated to reflect current practice and legislation. It was also noted that all the beds in the home were profile beds and had bedrails fitted as standard. We recommended the service considers current guidance and legislation in relation to the risk assessments of the use of bedrails to include profile beds.

We saw that a new medicines trolley had been purchased so that medicines could be stored securely during administration in communal areas of the home. There was no one taking ‘as required’ (PRN) medicines to help manage their behaviours at the time of this visit. The group manager and the home manager were aware of their responsibilities to ensure that clear guidance was in place for staff to follow when this type of medicine was to be administered in the future.

We found that people were asked for consent and the provider acted in accordance with peoples' wishes. People who use the service received care in a way that met their needs and preferences.

The people we spoke with told us they felt the home was clean and well maintained. They told us their rooms were regularly cleaned. We found that the provider did not have suitable arrangements in place to ensure the appropriate standards were being followed in relation to the provision of hand wash sinks and the storage of reusable items and linen.

The people we spoke with told us they were happy with the staff. They told us the staff were friendly and did what was asked of them. They also told us they had no concerns about the services they received and they would speak to the staff if they had any concerns.

We found that people were cared for by staff that had been through the appropriate recruitment checks. There was an effective complaints system available, in case anyone wished to raise a complaint.