Holly Cottage

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. We observed people receiving care from staff who understood their needs. However, there were shortfalls found within the care planning documents reviewed which meant there was a risk people might not be supported safely. The provider had invested resources to upgrade the heating system but this had exposed people to the risk of scalding. Other areas of the service were well maintained. Incidents and accidents were not always recorded or reported accurately, and we found some incidents that had not been shared with the relevant external regulatory bodies. The provider was in breach of legal regulation in relation safe care and treatment. There were enough skilled staff during the day, but we were not assured night staffing ensured people’s repositioning needs could always be met.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. We identified concerns relating to consent for care and treatment. The provider had not always ensured people’s capacity to consent had been assessed according to the specified process set out by the Mental Capacity Act (2005). This meant there was a risk people’s rights were not fully protected. We judged this to be a breach of regulation. People’s care was documented within their care plans, although some contained inconsistencies, and staff knew people’s needs. A family member told us that they felt involved in the care of their relative and had good communication with the manager and staff. They said, “The home will contact me if they need to discuss something with me or make me aware of anything”. The care plans contained information on the level of support required to carry out specific tasks or to promote independence but could benefit from more detail in some cases. Deprivation of Liberty Safeguards (DoLS) were in place for those that required them in order to keep safe, and these were kept in date. We found that the provider had good communication with external agencies especially around people’s health assessments.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were supported and treated with dignity and respect; and involved as partners in their care. We observed people being treated with respect and they appeared happy within their home. People’s rooms were personalised, and staff supported people to make choices for themselves. People were supported to create personal space and take control of what happened within their home. People were involved in choosing their meals. The provider had devised creative ways to make people feel part of the home. For example, when a person moved in that suffered with claustrophobia, the conservatory was adapted to provide more space for them, and the service created garden space for them. This meant they felt more at ease within the home. People were supported to access the local community.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s needs were met through good organisation and delivery. We found that issues were dealt with in a timely manner and families were kept informed of what was going on. Relatives spoke positively about the home and its employees. One family member informed us that the provider had always tried their best to accommodate family requests and that they had been particularly impressed by the manager's warmth when they visited their relative in the hospital for an assessment prior to moving into Holly Cottage. The provider had recently completed a family and relatives survey, which showed a general positive impression of the service.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The provider was in breach of legal regulation in relation to the governance of the service. We found several issues which meant we could not be assured that people were always receiving safe and effective care. Care plans sometimes lacked detailed information and there were gaps in recording. Accidents and incidents were not always reported, and the provider had no system in place to capture accidents, incidents and other significant events within the location, or learn from them. New systems had been put in place which exposed people to increased risk from the environment. A business continuity plan was in place but it lacked sufficient detail to ensure it would be effective. There was a leadership structure in place, with the service manager supported by the operations director and a team leader. Staff told us that they had regular supervisions and monthly team meetings. We saw evidence of house meetings. External professionals and relatives told us that there were always prompt responses from the management team, and a good working relationship. Relatives told us that the manager was approachable, knowledgeable and compassionate.