Background to this inspection
Updated
19 September 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 12 and 13 July 2018 and was unannounced on day one. The inspection team consisted of two adult social care inspectors, a specialist nurse advisor and an expert- by- experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service
Before the inspection, we looked at any notifications received and reviewed any information that had been received from the public. A notification is information about important events, which the provider is required to tell us about by law. We received a Provider Information Return (PIR) from the registered manager, before our inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make.
We contacted the local authority and they shared their current knowledge about the home. We checked to see whether a Health Watch visit had taken place. Health Watch is an independent consumer champion created to gather and represent the views of the public. They have powers to enter registered services and comment on the quality of the care. The latest visit was in 2015 and was positive about the service.
During the inspection we spoke with 13 people who lived at the home and five relatives/visitors, to seek their views. We also spoke with 12 members of staff including two nurses, five carers, one nurse assistant, the registered manager, the regional manager, the well-being coordinator and the maintenance person.
As some people living at Hollymere House were not able to tell us about their care experiences, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.
We looked at the care records of six people who lived at the home and inspected other documentation related to the day to day management of the service. These records included, staff rotas, quality audits, training and induction records, supervision records and maintenance records. We toured the building, including bathrooms, store rooms and with permission spoke with some people in their bedrooms. Throughout the inspection we made observations of care and support provided to people.
Updated
19 September 2018
The inspection took place on 12 and 13 July 2018 and was unannounced. The service was last inspected on 14 July 2015 when we rated the service ‘good’ overall and in all the five key questions. At this comprehensive inspection we have rated the service 'good' overall but rated the safe question as ‘requires improvement.’
Hollymere House 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.
Hollymere House provides accommodation and nursing care for up to 48 people. At the time of our inspection there were 42 people living at the home.
There was a registered manager 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.
People were complimentary about the care they received at Hollymere House.
There were mixed views about staffing levels. We found that people were receiving appropriate care, however staff were very busy and there were sometimes delays in meeting people's needs. The management team were reviewing staffing levels and the deployment of staff. Recruitment of new staff was underway.
Checks were carried out during the recruitment process to ensure only suitable staff were employed.
Risks associated with people's care and support needs were assessed and guidance was in place to support staff to keep people safe. However, we noted that people did not always have access to their call bells.
Overall medicines were managed safely. However, we found some minor shortfalls in medicines management.
Staff understood their duty to protect people from harm and abuse. Appropriate procedures were followed to report any safeguarding concerns.
The home was clean and well maintained.
People were supported by staff who were suitably trained and supervised.
The registered manager and staff were aware of their responsibilities and acted in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. (DoLS).
People's nutritional and healthcare needs had been assessed and were met. People were positive about the food on offer and staff supported people to have sufficient to eat and drink. Staff were responsive to changes in people’s physical and mental health needs.
Overall, staff were caring and treated people with dignity and respect.
We found that people's oral hygiene needs had not always been addressed.
Care plans addressed each person's individual needs, including what was important to them, and how they wanted to be supported. However, daily records were not always complete and accurate. This was being monitored by the management team.
People could take part in a range of activities. They were cared for in a way that took account of their diversity and values. People's end of life wishes were discussed and recorded.
People told us that they felt able to raise any concerns or complaints, however the provider’s complaints procedure was not clearly displayed at the home.
The registered manager understood his responsibilities and had built effective links with other professionals. He had a vision for the service and told us that since coming into post a number of changes have been implemented to make improvements to the care provision.
Staff told us that the manager was approachable and supportive, but some staff felt their concerns were not always acted upon. People and relatives were positive about the management of the home.
The provider had effective systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addressed.