Hollyhurst

Updated 25 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors.

Service and service type

Hollyhurst is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hollyhurst is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 31 January 2022 and ended on 2 February 2022. We visited the service on 31 January 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who used the service. Some of the people who used the service had complex needs or limited verbal communication. This meant they could not always tell us their views of the service or did not wish to engage with us. Including the 5 people we spoke with, we observed 9 people who used the service interacting with staff. We also spoke with 2 relatives by telephone.

We spoke with 13 staff including; the registered manager, deputy manager, clinical lead, senior support staff, 4 support workers, an agency support worker, psychologist, speech and language therapist, assistant psychologist and the activities co-ordinator.

We reviewed a range of records. This included 3 people's care records and multiple medication records. We looked at a variety of records relating to the safety and management of the service, including policies and procedures, staff recruitment, risk assessments and safety checks.

Updated 25 February 2023

About the service

Hollyhurst is a residential care home providing personal and nursing care to 13 people at the time of the inspection. The service can support up to 22 people under its registration but would currently not admit more than 18. Hollyhurst provides accommodation across two buildings with a two-person bungalow and a large two storey house with bedrooms and communal areas.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Based on our review of key questions of safe, responsive and well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The environment of a large (more than 6 people) living in one communal home does not meet the principles of Right support, right care, right culture. Despite the large environment consideration had been given to the principles and meeting these, as follows:

Right Support:

People lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well. This had improved since the last inspection. Where restrictions were imposed these were robustly reviewed, by the staff who knew people best and relevant professionals, to see if these were appropriate or could be reduced. Infection control measures were in place, people were supported by staff to keep their home safe and clean. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. There were effective staff recruitment and selection processes in place. There were enough skilled and experienced staff who knew people well to safely meet people's needs, for example their communication needs. Staff recruitment and retention was a priority in the service, as there were vacant posts. Management had developed induction processes to help them find and keep staff that were right for the needs of the service.

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.

Right Care:

People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. Despite the large environment, people did not have their support dictated by the routines of the service. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so.

Right Culture:

Since the last inspection there was a new registered manager. They and staff were working to a development plan with a strong focus on improving the culture and positive outcomes for people. Many of the people and staff we spoke with told us they saw an improvement in the service and the culture. People commented on the positive atmosphere and caring attitudes of staff. People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. The registered manager recognised the importance of sharing information in an accessible way so people understood it and could respond. Staff had worked closely with the professionals in the service to develop meaningful engagement and increase opportunities for people to have their say.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. The service had strong links with other organisations, and the wider community, for the benefit of people who used the service. This included sharing best practice and organising events to increase the wider communities understanding about learning disabilities and autism.

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 08 December 2021).

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.

At an inspection in July 2019 we made a recommendation about person-centred care, the service had sustained improvement in this area.

Why we inspected

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.

We carried out an unannounced inspection of this service between 26 October 2021 and 05 November 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve processes to assess, monitor and manage risk.

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, Responsive 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 Hollyhurst 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.