CQC report explained · a residential care home
What the CQC found at The Hollies
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found gaps in medicines records, medicines given late, and missing instructions for some medicines given when needed. Staffing, recruitment, safeguarding, risk assessments and general infection controls were otherwise described positively.
- Effective?
- Good
- Staff had received relevant training and support, and people had their food, healthcare and personal needs met. Some staff had variable understanding of the Mental Capacity Act, and best-interest records were not always complete.
- Caring?
- Good
- This key question was not inspected during this focused visit. The previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused visit. The previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Management systems had improved, but audits had not identified the medicines errors found by inspectors. The provider no longer breached Regulation 17, but management oversight was still not reliable enough.
What inspectors found, March 2023
The Hollies is rated Requires Improvement; medicines were still not managed safely, although improvements meant it left special measures.
This was an unannounced, focused inspection on 1 March 2023. Inspectors checked Safe, Effective and Well-led. They spoke with people, relatives and staff, and reviewed care records, staff files, medicines and quality checks.
The home had enough staff and people received kind, personalised support. Staff were trained, risks were assessed, infection controls were mostly effective, and people were supported with food, healthcare, activities and choices.
The main problem was medicines. Records had gaps, some medicines were not given at the prescribed time, and some instructions for medicines given when needed were missing. The quality checks had not found these problems. This remained a breach of Regulation 12.
The overall rating changed from Inadequate to Requires Improvement. The home is no longer in special measures. However, Safe and Well-led remained Requires Improvement, meaning there was still limited assurance about safety and management.
Enough staff
Inspectors found enough staff to provide one-to-one support and help people take part in activities and visits when they wished.
“The service had enough staff, including for one-to-one support for people to take part in activities and visits how and when they wanted.” from the report
Personalised support
Staff focused on what people could do and supported their interests, choices and aspirations.
“Staff focused on people's strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.” from the report
Staff training
Staff had relevant training covering people's learning disabilities, autism, communication and positive behaviour support.
“People were supported by staff who had received relevant and good quality training in evidence-based practice.” from the report
Respectful care
Inspectors found that staff treated people with compassion and respected their privacy, dignity and individual needs.
“Staff spoke respectfully about people and treated them with compassion. Staff respected people's privacy and dignity.” from the report
Family involvement
Relatives were welcomed and could visit without restrictions. Families were also asked for feedback about the service.
“When we visit we are always welcomed. It feels very welcoming when we arrive and we are able to visit [relative] whenever we wish to.” from the report
Medicines were not always safe
seriousSome medicines were not given at the prescribed time. Records had gaps and some instructions for medicines given when needed were missing. This was a continued breach of Regulation 12.
“Not all people using the service had received their prescribed medicines in line with the prescriber's instructions.” from the report
Checks missed errors
seriousThe medicines audit did not identify the problems found by inspectors. This meant managers did not have clear oversight of medicines safety.
“The registered manager did not have clear oversight of the safe management of people's medicine's.” from the report
Best-interest records
needs fixingRecords did not always show who had been involved when important decisions were made for people who lacked capacity.
“Where people had been assessed to lack capacity to make significant decisions about their health and welfare, records did not routinely reflect who had been involved to make decisions in their best interests.” from the report
Incomplete bowel records
minorA daily bowel chart was not completed regularly as required. The manager said this would be addressed immediately.
“However, a daily bowel chart was not completed regularly, as required.” from the report
Some infection training incomplete
minorInspectors were assured that protective equipment and premises hygiene were effective, but not all staff had completed COVID-19 training.
“However, not all staff had completed training in relation to COVID-19.” from the report
- 01What changes have been made to prevent missed, late or incorrectly recorded medicines?
- 02How are medicines audits now checked to make sure they identify errors?
- 03What is the timescale for completing and reviewing missing instructions for medicines given when needed?
- 04How are best-interest decisions recorded, including who was involved?
- 05How will you show families that the improvements required by CQC have been completed and are lasting?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings were used to calculate the overall rating. This explanation was written from the published report of 10 March 2023 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, November 2022
Rated Inadequate and placed in special measures; inspectors found serious problems with medicines, staff support and management oversight.
This was an unannounced focused inspection on 26 and 30 August 2022. One inspector spoke with five people and five staff, reviewed care and staff records, and checked medicines, training, recruitment and quality monitoring.
The home had improved staffing levels and safeguarding arrangements since the previous inspection. People were treated kindly, supported to access healthcare, and positive comments were made about the food. However, medicines were not always given or recorded correctly. Some staff had not received suitable training, induction or supervision, and recruitment checks were incomplete.
Management oversight remained a major concern. Audits and action plans were not effective, and problems found at the previous inspection had not all been addressed. The front page gives an overall rating of Inadequate. The home was placed in special measures and a warning notice was served for poor governance.
Kind care
People were described as receiving kind and caring support. Staff were observed interacting with people in a relaxed and comfortable way.
“People received care and support that was kind and caring.” from the report
Improved staffing
Staffing levels had improved since the previous inspection and were considered enough to meet people's needs. Staff carried out checks on people who stayed in their bedrooms.
“Staff told us staffing levels were much improved and appropriate to meet people's needs.” from the report
Food and healthcare
People spoke positively about the food. Staff supported people to access healthcare and involved specialists when there were concerns about nutrition.
“The meals provided were in enough quantities, looked appetising and reflected their individual choices and preferences.” from the report
Clean environment
The home was clean and free from unpleasant smells. Inspectors found that staff used protective equipment safely.
“The service was clean and odour free.” from the report
Medicines were not reliably managed
seriousMedicine records for six people were blank, and some medicines were not given at the prescribed time. Not all staff administering medicines had suitable training or competency checks.
“We found omissions in the records made when medicines were administered.” from the report
Weak management oversight
seriousThe provider's checks did not identify important problems. There were no effective audits, and actions from an external consultant's report had not been put into a clear action plan.
“The quality assurance and governance arrangements in place were not effective in identifying shortfalls in the service.” from the report
Staff training and supervision
seriousSome staff had not completed mandatory or specialist training, a full induction or regular formal supervision. This included training relating to learning disability and autism.
“Suitable arrangements were not in place to ensure all staff employed received appropriate training, a robust induction or regular supervision.” from the report
Recruitment checks
needs fixingSome staff files did not contain the required references, photographs or interview records. The inspectors made a recommendation for the provider to improve its recruitment practices.
“Not all records as required by regulation were in place.” from the report
- 01How are you checking that every medicine is given at the right time and recorded correctly?
- 02Which staff have completed medicine training and competency checks, and how do you stop untrained staff from giving medicines?
- 03What specialist training have staff completed for supporting people with learning disabilities and autistic people?
- 04What action plan is in place to address the 26 recommendations made by the external consultant?
- 05Who is currently responsible for managing the home, and when will a new registered manager be appointed?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not rated at this inspection and the previous overall rating was published as Inadequate in June 2022. This explanation was written from the published report of 17 November 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.
Every inspection of The Hollies
4 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- March 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2022Inadequatestayed InadequateSafe: Requires improvementEffective: Requires improvementWell-led: Inadequate
- June 2022Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- August 2018GoodSafe: GoodEffective: GoodWell-led: Good
- May 2017
Registered with the Care Quality Commission on 22 May 2017.
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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51 live-in carers within about an hour of Southend-on-Sea
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Most charge £960 to £1,200 a week. 44 can care for a couple. 12 years' experience on average.
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