Holly Lodge Nursing Home

We assessed 3 quality statements in the safe key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good.

During our assessment of this key question, we found concerns around choking risk management which resulted in a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and around safeguarding which resulted in a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below., although appropriate reporting to the external agencies was not always completed. Staff did not always follow provider’s choking management policy which could put people and risk and was a breach of the regulation in relation to safe care and treatment. Staff did not always ensure least restrictive support measures were considered and decisions were made in the best interests of people who could not consent to have their diet modified. The provider did not always recognise when complaints and incidents included safeguarding concerns. Hence, these were not always appropriately reported to the local authority and investigated timely. This put people at risk of harm and of their rights and liberties not being respected. This was a breach of regulation in relation to safeguarding and protecting people from unnecessary restrictions. The provider took action to address those shortfalls following the site visit.

People overall received safe care and treatment from staff who understood their individual needs and followed people’s care plans. Staff knew how to safely support people around a range of their individual risks and how to recognise and report any concerns to the registered manager.

We assessed 1 quality statement in the well-led key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good.

During our assessment of this key question, we found concerns around the governance in the home which resulted in a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. The provider did not recognise shortfalls around how staff assessed and managed risk of choking and aspiration which could put people at risk. Audits and checks did not identify referrals to healthcare professionals were not always completed when needed and people’s records were not always reflecting the individual risk of choking, least restrictive options to be used to support them to stay safe and the need to assess their mental capacity for modification of their diet. The provider’s audits did not recognise that not all safeguarding concerns were appropriately identified, reported and investigated. The registered manager did not always notify CQC about events in the home when required. The provider was in breach of regulation around good governance. The provider took action to address those shortfalls following the site visit.

Staff were clear about their responsibilities and roles and felt supported by the registered manager and the provider.