Archived: Hollybank House

The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and we looked at both during this inspection.

Hollybank House provides accommodation and personal care for up to five adults with a learning disability or autistic spectrum disorder. Nursing care is not provided. At the time of our inspection five people were living at the home.

At the last inspection in July 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good 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.

The registered provider of the service was also the manager and was responsible for the day to day operation of the service. There was no regulatory requirement to have registered manager in post. Registered providers are ‘registered persons’ and have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Records showed that staff had been recruited safely. The staff we spoke with were aware of how to safeguard people from abuse. There were safe processes in place for the management of people’s medicines.

People’s relatives/representatives and staff told us they were happy with staffing levels at the home and people received support from staff when they needed it.

People told us they liked the staff who supported them. Relatives/representatives told us that staff were kind and respectful. They told us staff respected people’s right to privacy and dignity and encouraged them to be independent. We observed this during the inspection.

Records showed that staff received an effective induction and appropriate training which was updated regularly. People’s relatives/representatives felt that staff had the knowledge and skills to meet people’s needs.

People received appropriate support with eating, drinking and their healthcare needs. Appropriate referrals were made to community health and social care professionals, to ensure that people’s needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice.

People were treated as individuals and received care that reflected their personalities, needs, risks and what was important to them.

Staff communicated effectively with people. They supported people sensitively and provided explanations when needed to ensure that people understood what was being discussed.

People were supported to take part in a variety of activities both inside and outside the home. Some people attended activities and clubs outside the home as part of their regular routines and told us they enjoyed this. This provided people with the opportunity to develop new skills and socialise.

Relatives/representatives and staff were happy with how the service was being managed. They found the staff, deputy manager and provider approachable. No-one we spoke with had made a complaint.

A variety of checks of quality and safety were regularly completed by the provider and the deputy manager. We found the audits completed were effective in ensuring that appropriate levels of quality and safety were maintained at the service.

The provider regularly sought feedback from people living at the home and their relatives through meetings and satisfaction surveys. A high level of satisfaction had been expressed by people living at the home, about all aspects of the care and support provided.

Further information is in the detailed findings below.

Hollybank House is a small care home registered to provide personal care and accommodation for up to five adults. The property is an older type end terraced house close to Bacup town. The interior facilities include conservatory, lounge, and dining kitchen. The bedrooms are single occupancy and two of them have en suite facilities. There is a garden area to the back of the property.

The service was managed by the registered provider who has a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection on 4 September 2014 we found the service was meeting the regulations which were applicable at the time. During this inspection we found the service was meeting the current regulations.

People were cared for by staff that had been recruited safely. Appropriate checks had been carried out to make sure staff employed were of good character. People using the service were involved in recruiting staff.

There were sufficient numbers of suitably qualified and experienced staff to support people.

Staff felt confident in their roles because they were well trained and very well supported by the registered provider to gain further skills and qualifications relevant to their work. They were highly motivated and committed to provide a high quality of care.

People’s medicines were managed safely and were administered by staff who were trained and competent.

There were good systems and processes in place to keep people safe. Staff had a good understanding of risk management. Risks to people had been identified, assessed and managed safely. People were encouraged to live their lives the way they chose and were supported to recognise this should be done in a safe way.

We found the premises to be clean and hygienic and well maintained. Regular health and safety checks were carried out.

The service liaised with other service sector professionals such as GP’s, care co-ordinators and psychiatrists. This helped to make sure people received co-ordinated and effective care and support.

The registered provider and staff understood their responsibilities in promoting people's choice and decision-making under the Mental Capacity Act (MCA) 2005. Staff followed the principles of the MCA 2005 to ensure that people’s rights were protected.

People’s nutritional needs were met and they were involved in menu planning as well as basic food preparation and cooking. Healthy food options were promoted.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. Care plans were written with sensitivity to reflect people’s needs and to ensure basic rights such as dignity, privacy, choice, and rights were considered at all times.

People told us they had their privacy and were respected by all staff. Each person had an individual care plan that was sufficiently detailed to ensure they were at the centre of their care. Care files contained a profile of people’s needs that set out what was important to each person, their wishes and future hopes.

People’s individual needs were assessed and care plans were developed to identify what level of care and support they required. People’s care and support was kept under review and people were regularly consulted to ensure their wishes and preferences were met and their independence was promoted.

People were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed.

Staff were knowledgeable about people’s individual needs, backgrounds and personalities and supported people to maintain their relationships with their friends and relatives.

Activities were varied and appropriate to individual needs and people were supported to live full and active lives and to use local services and facilities. People were valued and treated with respect..

People told us they were confident to raise any issue of concern with the registered provider and staff and that issues they raised would be taken seriously. They had meetings to discuss any matter that affected them and current issues. They also had contact details for other agencies they could approach to help them raise complaints.

People had also been encouraged to express their views and opinions of the service through regular meetings, care reviews, and during day to day discussions with staff and management.

People said the management of the service was very good. There were opportunities for people to give formal feedback about the service, the staff and their environment in quality assurance surveys. Recent surveys showed overall ‘good satisfaction’ with the service provided.

There were systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being and evidence the findings supported business planning and development. We found regular quality audits and checks were completed to ensure any improvements needed within the service were recognised.

This is a summary of what we found:

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff had been made aware of who may be at risk of challenging behaviours, issues of vulnerability, and exploitation, and they had a plan of care to deal with this.

People's care and treatment was planned and delivered in a way to protect them from any unlawful discrimination within the home and wider community.

Staff were trained in emergency procedures such as fire and first aid.

People were protected from the risks of inadequate nutrition and dehydration.

Care had been taken to make sure people were kept safe by only employing people who had proven good character records. Staff contractual arrangements prevented them from gaining financially from people they cared for.

Staff had been trained and understood their obligation to apply the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.

People were supported to manage their own finances. Strict financial procedures were followed to prevent any misuse of people's monies.

There were no unnecessary rules or restrictive practices in place and people told us they felt safe with staff and they were treated very well. They commented, 'The staff are very good. They don't tell us what to do, we please ourselves.' And 'We are like family here. We choose what we want to do."

Health and safety checks were carried out at regular intervals and all essential services such as fire, gas, electric and water were certified as being safe. Safety locks were fitted as standard on bedroom doors.

Systems were in place to make sure the provider continually checked the service was safe. This reduced the risks to people and helped the service to continually improve.

Is the service caring?

People told us they were happy with the care they received and the staff team. They said, 'I really like it here. We do what we want and when we want. I don't need much help. If I have any appointments at the hospital or doctors, staff will come with me. I visit my dad and see my sister. There is always plenty to do. Saturday is our 'chill out' day'.' 'I'm always going somewhere. My keyworker goes out with me sometimes, although I'm well able to go out on my own. Our holiday was fantastic. We are looked after very well.'

Catering arrangements were good in providing a balanced diet. There was no strict budget set and people could choose what food they wanted and enjoyed.

People said they were treated well. They indicated they felt safe with staff and said staff spoke to them properly and they were respectful.

We saw routines in the home were flexible and people were supported and encouraged to get involved in activities they enjoyed.

Staff worked to care plans that were person centred, well written and sufficiently detailed on how best to meet individual needs. Daily records showed staff responded to people's needs as required. Staff showed a good understanding of the varying needs of the different people we had discussed with them.

People were able to make choices regarding their lifestyle. They had the opportunity and scope to express their wishes for daily living and social activity, and this was respected. This helped to make sure that they were supported in a way that did not inappropriately restrict their freedom.

Is the service responsive?

People were involved in planning their care and support. They had a key worker who supported them in making decisions that were important to them. Care plans were regularly reviewed to make sure the level and type of support people had met with their needs and expectations.

A pro-active approach had been taken to support people's future care and changing needs by training staff to deal with this. For example, staff had been trained in dementia care.

Activities were planned for, and people were encouraged and supported to do the things they liked to do. Social and recreational activities were enjoyed by everyone and they had enjoyed a summer holiday of their choice in Scotland. Staff were available to accompany people where needed.

House meetings were held and people could say what they wanted and they felt listened to. They said, 'We talk about different things at our meetings and I can say what I want. Whatever we want we get.'

A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.

Is the service effective?

People told us they were happy with their care. They had their own preferred routines, likes and dislikes that the staff knew about. Staff were always available to accommodate individual needs and preferences.

People's health and well-being was monitored. Staff supported people to attend health care appointments and liaised with other health and social care professionals involved in peoples care and support. For example mental health and learning disability services and social services when necessary.

Staff worked to a key worker system to oversee people's care. Staff had been trained to care for people properly.

People told us they were consulted with and listened to. Quality monitoring was carried out.

Is the service well led?

The service was managed by the registered provider who took responsibility for the day to day management of the home. People told us the management of the service was very good. If they had any concerns they knew who they could talk to. 'I can talk to my keyworker if I need anything or if anything is bothering me.' 'I really like it here. It's the best place I've ever lived in. I can talk to the staff if I feel worried about anything and they help me sort it out. It's good here and everyone is kind.' "It's comfortable and I have everything I need."

Staff were clear about their role and responsibilities. They were given a job description and contract of employment. Staff were able to give their views and they were supervised well and had appraisals. Training was provided and meetings were held for staff and people using the service.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. Staff knew when to consult with health and social care professionals when required. This meant decisions about people's care and support was made by appropriate staff at the appropriate level.

We saw people were fully involved in the decisions made about their routines and what they did each day. They were also involved in choosing new staff. We saw evidence of discussions about how people wanted to spend their time and that people had signed "agreements" for various things such as their care plans and leisure activities.

We saw the improvements to the premises that we required last year had been maintained and all areas of the home we looked at were safe and decorated and furnished to a satisfactory standard. The premises were also clean and odour free, and people's medication was managed safely.

There were improved systems in care planning, staff development and auditing. We found that staff recruitment procedures would help to protect people living in the home from unsuitable staff.

The provider submitted an action plan which told us how and when the service would be compliant with the regulations concerned. We judged the action plan to be satisfactory, and at our recent inspection in February 2013 we checked to

see whether or not the action had been completed according to the plan.

We spoke to the registered manager, three members of staff, looked at the relevant records and looked round the premises. We found the service had taken sufficient action to comply with the regulations concerned. All the work required to the premises as stated in the warning notice had been completed. The written instructions to staff about how to support and protect people had been improved and staff had a better understanding of how to manage risk and difficult behaviours. We saw the residents were well cared for and supported.

However whilst people told us they were happy in the home and staff treated them well, we had concerns about the way the home was run and which could affect people's well being and safety. We were concerned people with complex needs were living in the home for which the staff had not undertaken training or acquired the necessary skills to help them understand these needs and provide the support required.

We were also concerned that some improvements required from the last inspection a year ago had not been fully implemented. Staff were still not clear about the action they needed to take to protect people under 'safeguarding' procedures and some parts of the premises were still of poor appearance and badly maintained. There were also some areas in the home which were unsafe.

The provider was not taking the right steps to assess the quality of the service and the facilities, or to develop an effective plan to improve the service.