The inspection took place on 6 March 2018 and was unannounced. Holly Cottage is a residential care home providing support to up to 12 people. At the time of our inspection there were seven people living at the service. People living at the service had learning disabilities and physical disabilities.Dons Care Limited, became the registered Provider with the Care Quality Commission for the registered location of Holly Cottage in December 2017.
Holly Cottage 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 Cottage accommodates people in one building, which had been extended and adapted in some areas.
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.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered Provider, 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 this inspection we identified a breach of Regulation 11 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. This relates to obtaining peoples consent within the framework of the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.
Risks to people and the management of these had not been regularly reviewed to ensure that they remained appropriate. When people’s needs had changed, changes had not been made to reflect this. The Provider and registered manager had not identified this as a priority when taking over the running of the service in December 2017.
Staff understood their roles in safeguarding people from abuse and were clear who they would report any concerns too.
There were sufficient numbers of staff to meet people’s needs and the Provider had carried out checks to ensure that staff were suitable for their roles. People received their medicines safely. Trained staff administered medicines and the Provider managed medicines in line with best practice and regularly audited them. The Provider had systems in place to ensure the risk of the spread of infection was reduced and people lived in a clean home environment.
People were supported to access healthcare professionals when required with support from staff.
Staff received one to one supervisions and there was an appraisal process in place. Regular meetings took place that involved staff, people and relatives in decisions about the service.
The management of best interest’s decisions and assessments of people’s mental capacity was not always undertaken in line within the framework of the Mental Capacity Act 2005 (MCA). The registered manager did not fully understand their responsibilities in relation to this.
Staff knew people well and interacted with them with kindness and compassion. Staff were respectful of people’s privacy and dignity when providing care to them. People were supported to maintain relationships that were important to them.
Care plans had not been regularly reviewed and changes in people’s needs had not been identified in them. People and relatives were not routinely involved in care planning.
People had access to a range of activities that suited their needs and interests. The Provider had a clear complaints policy in place and had a proactive approach to feedback to identify improvements.
There was a variety of audits in place to monitor quality but this had not identified shortfalls in the provision of some aspects of care. The Providers’ service improvement plan, implemented when they took over the running of the service, had not identified and prioritised areas which presented the highest and immediate risks to people.
The Provider had notified CQC of important incidents and events. Staff felt supported by the registered manager, team spirit and morale was positive.