Holly Tree Cottage

Holly Tree Cottage is a care home providing personal care for up to six people with a learning disability and/or autistic people. At the time of the inspection six people were living at the home.

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.

Right Support: Staff recognised signs when people experienced emotional distress. Each person’s care and support plan explained how staff should respond and how to avoid the need for restricting people’s freedom. One person’s plan had not always been followed by staff. This had placed both the person and staff at risk.

Right Care: The care and support provided was effective in supporting most people at times of distress. However, it was evident 1 person’s current and changing needs, in relation to their distress, could not be safely met at Holly Tree Cottage. The manager and the provider were taking action to address this issue.

Right Culture: Staff recognised incidents and reported them appropriately and managers investigated incidents and shared lessons learned. Staff took part in post incident reviews, after they had supported people experiencing emotional distress.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 13 August 2022).

Why we inspected

We undertook this targeted inspection to check a concern we had about how people who experienced emotional distress were supported by staff. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Holly Tree Cottage is a residential care home providing personal care for up to six people with a learning disability and/or autistic people. At the time of the inspection six people were living at the home. The service is a residential property based on the outskirts of Burnham on Sea. Local shops, the beach and the town are within a close proximity to the home.

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

At this inspection, we found improvements had been made in response to the warning notice we issued previously. The provider had worked with the fire service and commissioned a contractor to undertake required fire safety work. Work had been completed to ensure the environment was safe for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 13 August 2022).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Holly Tree Cottage is a residential care home providing personal care for up to six people with a learning disability and/or autistic people. At the time of the inspection six people were living at the home. The service is a residential property based on the outskirts of Burnham on Sea. Local shops, the beach and the town are within a close proximity to the home.

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.

Right Support

The service did not always give people care and support in a safe and well-maintained environment. People were not always able to pursue their chosen interests because of staffing shortages at the service. Some improvements were required to ensure people were supported to make decisions following best practice in decision-making. People had a choice about their living environment and were able to personalise their rooms. The service supported people to have choice, control and independence. Staff supported people to achieve their aspirations and goals. People were supported to access their local community. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care

People could take part in activities and pursue interests that were tailored to them. Staff promoted equality and diversity in their support for people. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

Staff turnover had been high, which meant people were supported by agency staff. Permanent and regular agency staff knew and understood people well and were responsive to their needs. The provider and the manager had failed to implement a robust system to monitor the quality of the service. Improvement in areas of risk management had not been fully implemented in respect of the property and fire safety. People and those important to them, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Staff valued and acted upon people’s views.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for the service under the previous provider was good, published on 08 February 2020.

Why we inspected

This was the first inspection for the service under the new provider (registered 01 December 2020) to rate the service.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safe staffing, premises and equipment and good governance at this inspection.

We made recommendations that the provider reviews their processes to ensure people’s capacity assessments are reviewed in line with the principles of the Mental Capacity Act 2005.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.