Hollie Hill Care Home

We found the following examples of good practice.

Staff had access to the PPE they needed and used it correctly. This helped prevent the spread of infection. Staff had also completed IPC training and had access to advice and support. Some staff had received specialist training and had been identified as IPC champions, to help spread good practice.

The home was clean and tidy, some areas had recently been redecorated. The home had good cleaning practices which had been enhanced to help manage infections.

People were supported to maintain contact with relatives in various ways.

At our last inspection in February 2017 we rated the service as good overall. We found a breach of Regulation 12; this was regarding the application of people’s topical medicine (creams applied to the skin). At this inspection we found the evidence continued to support the overall rating of good. Improvements had been made in respect of people’s topical medicines and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were cared for in a safe environment. Regular checks were undertaken to ensure fire safety systems in the home were working. Health and safety audits were also carried out.

Staff had training in safeguarding and told us they felt able to raise any safeguarding concerns about people in their care.

People and their relatives had different view about the staffing levels. The manager was using a dependency tool and had increased the staff levels in one area of the home. At the time of our inspection there were sufficient staff on duty to meet people’s needs.

Individual and personal risks to people using the service were identified and actions had been put in place to mitigate them.

The provider carried out appropriate checks on staff before they began working in the home. Staff were then supported to carry out their respective roles through induction, training and supervision.

Before people came to live at Hollie Hill staff carried out an assessment of their needs. Care plans to give guidance to staff on how to care for people were compiled which reflected their personal needs and preferences. These were regularly reviewed and updated if a person’s needs changed. The service worked in partnership with other professionals to meet people’s needs. Their advice was incorporated into people’s care plans.

Kitchen staff were aware of people’s dietary needs. They provided fortified food to prevent people from losing weight. Staff had involved dietitians to assess people’s needs and suitable diets were provided.

There was a regular activities programme displayed throughout the home interspersed with events and other individual activities. People were engaged with the programme and chose what they wanted to do.

Care was provided by staff who were kind and patient with people. Staff knew people’s backgrounds and engaged them in meaningful conversations. We found staff delivered people’s personal care behind closed doors to protect their dignity and privacy.

People knew there was a complaints policy in the home. The registered manager had responded to the complaints and provided an outcome for the complainant. During our inspection the registered manager took seriously concerns raised with her and sought to immediately resolve them.

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.

Effective systems were in place to monitor the service. Actions were identified to improve the service using audits by the regional manager and the registered manager. The registered manager had an overall plan in place to make improvements which they monitored on a regular basis.

The registered manager held regular residents and relative’s meeting to engage people in the service.

Further information is in the detailed findings below

This inspection took place on 16 and 17 February 2017and was unannounced.

At the last inspection in November 2014, we rated the service as overall “Good” and found the home was meeting the regulatory requirements.

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 who used the service and their relatives told us they felt safe in the home. We saw there were regular checks to ensure the building was a safe place to live. Where a person’s individual risks had been identified then actions had been put in place to mitigate those risks.

We could not be reassured that people’s prescribed topical medicines (creams applied to the skin) had been applied in the manner they were prescribed. A new audit had been introduced by the registered provider had had been used by the registered manager. It showed action needed to be taken to improve the use of topical medicines in the home and reduce the risks to people where they were not receiving their topical medicines as prescribed.

The registered manager showed us the, “CHESS” tool; this is designed to enable the registered manager to calculate the number of staff hours required. They demonstrated to us they were providing more hours that required. However people in the home and their relatives experienced the need for more staff. We therefore recommended the home review the level of dependency needs.

We found appropriate checks were carried out on staff before they started working in the home. This meant people were being cared for by staff who were able to do the work and had been considered safe to work with people living in a home.

People told us they liked the food in the home and we observed staff offering to support people to eat. We found the catering staff understood about people’s dietary needs.

We found the service adhere to the principles of the Mental Capacity Act 2005 and where people were unable to make decisions for themselves best interests’ decisions had been put in place. These had involved family members and other professionals.

Staff were supported to carry out their duties through supervision, training and appraisal.

People living in the home and their relatives during the inspection told us staff were caring. We saw thank you cards and letters from people which thanked staff for their levels of care. Some of these were from relatives who had experienced the loss of a family member whilst being a resident at Hollie Hill.

We saw examples throughout our inspection of people being treated with respect and dignity. Staff closed people’s bedroom doors before attending to people’s personal care needs.

Staff were able to give us detailed information about people’s needs, backgrounds likes and dislikes. This meant staff knew and understood the people for whom they were providing care.

We found people had detailed care plans in place which guided staff on what actions to take to meet people’s care needs. These were reviewed on a regular basis to ensure they were up to date. Staff had also completed care documents required by the commissioners for people requiring intermediate care. These were for people who had been discharged from hospital who required a period of further care before they went home or alternative accommodation was found.

People were given a choice about being involved in activities. We observed people making Easter cards and two people were taken out to a luncheon club. Other activities in the home included bingo and knit and natter. We saw one person had taken up exercise and people had been supported to attend a local swimming session for people with dementia care needs.

The service constantly gathered feedback on the home through electronic systems. We saw the registered manager had access to the feedback outcomes and was able to analyse the information at any given point. We found this feedback was largely positive.

Audits were carried out in the home by the registered manager to look at the quality of the service. We saw actions had been put in place to improve the service.

Staff felt supported by the registered manager. Although one relative felt unhappy with one response they had received from the registered manager the majority of relatives felt they had experienced a positive working relationship and were complementary about the registered manager’s skills and abilities to manage the home.

The registered manager had developed positive relationships with local community groups. This had enabled the home to receive funding for activities and a group of young people had transformed the garden making it more suitable for people to use.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

People appeared happy with the care provided. Comments included, 'We are over the moon, the staff talk to (relative's name) all of the time', 'They are all lovely people, I would not change a thing' and 'The staff are very nice indeed.'

When we visited there were 52 people living in the home. We found there were sufficient numbers of staff on duty to meet people's needs.

People who used the service, their relatives and staff told us they were asked for their views on the care and treatment offered. One person told us, "They encourage me to speak to the manager if I have any problems."

We found people's care plans were kept in offices which were locked when not in use. All documents we asked to view were provided immediately on request. This meant records were kept securely and could be located promptly when needed.

We talked to people who lived at the home, visitors and staff, to find out what they thought about the home. Whilst some people said they thought there should be more staff, most people gave positive feedback. Comments included 'Yes, I think there's enough staff', 'Yes, there's no problems' and 'They come running if I need anything.'

We spoke with a number of people who used the service. One person said 'we looked at a few places and decided on here', another said 'we came to have a look around before (relative's name) moved in'.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke with relatives of people who used the services at Hollie Hill Care Home who told us they were confident their relatives were safe there. One relative said "I have peace of mind when I leave (relative's name) here".

We talked to people who lived at the home, visitors and staff, to find out what they thought about the home. Several relatives said they thought that at times there didn't appear to be many staff, one person said 'sometimes, they're rushed off their feet', another said 'sometimes there's not enough staff, they can't do everything'.

The provider had a clear policy on obtaining feedback from people using its services. This included information from sources such as comments, complaints and survey questionnaires. We saw numerous thank you cards throughout the home that had been sent from relatives expressing their gratitude for the care that had been delivered.