CQC report explained · a residential care home
What the CQC found at Holly Tree Lodge Residential Home Derby
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, February 2022
Inspected but not rated; inspectors found good infection control arrangements during a COVID-19 outbreak.
This was a targeted, announced inspection on 9 February 2022. Inspectors gave the home two hours' notice. They checked infection prevention and control arrangements and asked about staffing pressures linked to COVID-19.
Inspectors found screening, testing, protective equipment and enhanced cleaning were in place. Staff were observed using protective equipment correctly. The home had an up-to-date infection control policy and risk assessments for people and staff.
Visits were restricted during the outbreak, apart from essential visits and visits for people receiving end of life care. People were supported to keep in touch with relatives by video and telephone calls.
The home was inspected but not rated. This means the report does not give an overall quality rating or a usual rating for all five areas of care.
Protective equipment
The home provided protective equipment and staff were observed wearing it properly.
“Staff were observed wearing PPE appropriately.” from the report
Cleaning and hygiene
Enhanced cleaning included frequently touched areas such as handrails and door handles.
“Enhanced cleaning schedules included regular cleaning of touch areas such as handrails and door handles.” from the report
Visits and contact
During the outbreak, non-essential visits were stopped, but essential visits and end of life visits continued in line with guidance. People could also use video and telephone calls.
“People were supported to contact their relatives and friends through video calls and telephone calls.” from the report
Inspectors raised no specific concerns in this report.
- 01How are visits being managed now that the COVID-19 outbreak arrangements described in the report have ended?
- 02How often are staff and residents tested if someone develops symptoms or has a positive test result?
- 03How will you support contact with relatives if visiting has to be restricted again?
- 04How do you keep individual COVID-19 risk assessments up to date?
- 05How do you manage staffing pressures during an outbreak?
This was a targeted inspection of infection prevention and control during a COVID-19 outbreak, with questions about staffing pressures; it did not provide ratings for the other care areas. This explanation was written from the published report of 25 February 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2021
Inspected but not rated; inspectors found unsafe moving and handling practices that were quickly corrected, with infection controls in place.
This was an unannounced, targeted inspection on 19 May 2021. Inspectors looked mainly at concerns about moving and handling, rather than the whole service. They also checked infection prevention and control.
Inspectors found that some moving and handling risk assessments lacked important details. Staff used the wrong-sized sling for one person, and walking frames were not always allocated to individuals. This meant people could have been at risk of injury.
The home acted quickly after the inspection. It reviewed risk assessments, retrained staff and said equipment was being allocated according to individual needs. Inspectors also found that staff were using protective equipment appropriately and that infection control arrangements were in place.
The home was inspected but not rated at this visit. Its previous overall rating was Good, published on 5 February 2020. The other key questions were not assessed and will be reviewed at the next comprehensive inspection.
Prompt action after concerns
The management team acted quickly to review risk assessments and retrain staff after the inspection.
“Following our inspection, the management team took action to review and improve all moving and handling risk assessments and retrain all staff in moving and handling.” from the report
Protective equipment used
Inspectors saw staff wearing appropriate personal protective equipment and found that infection control guidance was available.
“Staff had access to personal protective equipment which we observed staff wearing appropriately.” from the report
Infection outbreak arrangements
The report says the previous infection outbreak had been managed under an up-to-date infection prevention and control policy.
“There had been only one outbreak in February 2021, this was managed by the provider's infection prevention and control policy which was up to date.” from the report
Moving and handling risks
seriousRisk assessments did not always contain enough information about people's individual needs or the equipment staff should use. Staff used the wrong-sized sling for one person, creating a risk of injury.
“We observed staff using the wrong size sling to move a person therefore exposing them to a risk of injury.” from the report
Equipment was not always allocated
seriousWalking frames were not always allocated to individual people. This created a risk that someone could use equipment that was the wrong size.
“We found walking frames were not allocated to individuals which posed a risk a person may use the wrong sized frame.” from the report
Missing supplies in one toilet
minorOne toilet did not have aprons, sanitiser or soap when inspectors visited. The registered manager took immediate action after this was raised.
“We observed that in one toilet, there were no aprons, sanitiser or soap.” from the report
- 01How have you checked that every person's moving and handling risk assessment contains the right equipment and instructions?
- 02How do you make sure staff use the correct sling and walking frame for each person?
- 03When was moving and handling training last completed by all staff, and how is their practice checked?
- 04How do you check that toilets and other areas always have soap, sanitiser and protective equipment?
- 05What progress has been made since the inspection, and when will the changes be reviewed?
This was an unannounced targeted inspection of specific moving and handling concerns and infection control; the whole service and all five key questions were not assessed. This explanation was written from the published report of 2 July 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Holly Tree Lodge Residential Home Derby
2 rated inspections over 3 years: the service has held its Good rating throughout.
- February 2022Inspected but not ratedcurrent ratingSafe: Inspected but not rated
Read what inspectors found at Holly Tree Lodge Residential Home Derby →
- July 2021Inspected but not ratedSafe: Inspected but not rated
Read what inspectors found at Holly Tree Lodge Residential Home Derby →
- February 2020Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2015
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 8 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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