The Hollies is a residential care home for 10 people who have a learning disability and who are autistic, in Westcliff on Sea, Essex run by Eldercroft Care Home Ltd, rated inadequate by the Care Quality Commission.

CQC inspected The Hollies in February this year, rating it inadequate for the first time.

We carried out an unannounced focused inspection of this service in February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve… We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led.

The wording of this statement, common to many CQC reports, really irks me. The positive framing of things, we’re just popping in to check that they now meet legal requirements… the assumption is that they will. Except they don’t.

On this occasion CQC found there was no registered manager in post, which means there’s no one to be held accountable for the inadequate care. There had been a warning notice issued by CQC after the previous inspection, which had found multiple failures on the behalf of the registered manager, including failing to act in accordance with the Mental Capacity Act 2005.

At the time of our inspection there was not a registered manager in post as they had recently resigned. The
provider had promoted an existing member of staff to manage the service in the interim.

Things had still not improved sufficiently and CQC rated well-led as inadequate for the second time. Here’s what they found at this inspection:

The service’s quality assurance, monitoring and oversight arrangements were not robust and continued to require significant improvement. People did not receive their medicines as they should. Recruitment practices continued to require improvement. We have made a recommendation about recruitment practices. Although there was no impact for people using the service, staff had not received specific training relating to the needs of the people they supported, an induction or formal supervision.

CQC noted that work had started to improve the environment at the home. Why they needed prompting to do so in the first place is beyond me. What else did they find:

Staff understood how to protect people from harm and abuse. However, where internal investigations were completed, improvements were required to ensure these were robust.

People’s care plans reflected their needs and the level of support to be required by staff. However, improvements were required to ensure this information was personalised to the individual and not generic.

‘However’ is doing some heavy lifting there. A lot of copy and paste care plans.

Not all staff had felt valued and supported but this was improving following the involvement of the provider at the service.

Staff were not aware of the ethos and values of the organisation or aware of the ‘Right support, right care and right culture’ principles that should underpin their day to day working practices.

This is an interesting statement, I mean really, it almost deserves a blog post in its own right. Staff will of course be aware of the ethos and values of the organisation, because ethos and values are lived entities, they’re not what the organisation ‘claim’ to be their values and ethos. It doesn’t matter what you have painted all over the walls of head office, it’s what people experience in your services that truly reflect your values and ethos.

In this case CQC found a degree of apathy and carelessness.

The Hollies are no longer in breach of Regulation 12 (Safe care and treatment) due to their “failure to identify, monitor and mitigate risks to people’s safety, including responding to the COVID-19 pandemic” as they were in February. They’d managed to get their act together there. But now there were failings in medicine management that resulted in another Regulation 12 breach.

Whatever the ethos and values claimed, the reality is far from it. When CQC asked about failings in medicine management, and a lack of oversight the provider responded that:

The provider confirmed medication audits had not yet been introduced but this was on their ‘to do list’.

Like I said, apathetic and careless. An indifference.

At the previous inspection they were in breach of Regulation 19 (Fit and proper persons) due to their unsafe recruitment practices. They remain in breach.

Whilst some improvements had been made since our last inspection, further progress to fully meet regulatory requirements was required.

They were in breach of Regulation 18 (Staffing) and that rather optimistic CQC line sneaks into this report, as in so many others:

Although there was no impact for people using the service, staff training records showed not all staff employed at the service had received all mandatory or refresher training. There was little evidence available to demonstrate staff had received specialist training relating to the needs of the people they supported, for example, learning disability, autism, mental health and dementia.

No impact. I think what they really mean is ‘although we observed no impact’ and on the other hand I just don’t see how they can state this. If there is no impact from staff being untrained, then why insist on the training in the first place?

The domain of ‘well-led’ remained rated inadequate at this inspection and The Hollies remain in breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

This domain covers all things leadership, for example whether the service promotes a positive, person-centred, open, inclusive and empowering culture that achieves good outcomes for people (see above re values and ethos, highly unlikely). It also covers Duty of Candour, how the provider understands their legal responsibility to be open and honest when things go wrong, continuous learning and improvements in care.

Considering their last inspection found everything inspected to be inadequate, it wouldn’t be too much of a leap to expect that the providers have been keeping a close eye, and ensuring improvements are made. If only eh. Let’s look at what CQC found this time:

The quality assurance and governance arrangements in place were not effective in identifying shortfalls in the service. Specific information relating to the improvements required is cited within this report and demonstrated the arrangements for identifying and managing these were still not robust. This did not provide assurance that the provider had clear oversight of the service or understood their responsibilities and regulatory requirements.

The provider stated they had been advised by the previous registered manager that all actions highlighted during the previous inspection in February 2022 had been addressed. This did not concur with our findings.

These are the provider’s legal obligations. This is about the quality and safety of people’s lives. Why would you just ‘trust’ a manager whose leadership had been directly criticised, to just fix things? Back to values and ethos of careless apathy.

The provider cited naivety and mistaken trust with what they were told by the previous registered manager.

There was no mechanism or expectation in place for the then registered manager to formally report to the provider on issues relating to the day to day management of the service so they could be assured the service was running smoothly and in line with regulatory requirements.

Wow. Legal responsibility, for care and support to ten learning disabled and autistic people. Paid well for it too no doubt, but they’re operating on naivety and mistaken trust.

Their last inspection report stated:

The arrangements to assess and monitor the service were not effective. This meant there were missed opportunities to mitigate risks, monitor trends and learn from incidents. The provider had failed to identify the concerns and areas for improvement found as part of this inspection from their own quality assurance processes. This lack of oversight meant people did not have consistently good outcomes.

The provider was not ensuring outcomes for people reflected the principles and values of ‘Right support, right care and right culture.’ The provider and registered manager were failing to ensure the service was being run with a focus for people with complex and changing needs.

Who could read that and just ‘trust’ that improvements would be made. It’s way too apathetic. Warning notices were issued after the last inspection.

This time CQC found the following:

No arrangements were in place to enable the provider to have effective oversight of the quality of care and support being delivered. No audits were completed or available to assure themselves, complete and accurate records relating to people using the service and staff employed, were being maintained.

Since our last inspection the provider had employed an external consultant to provide support and advice to them and the previous registered manager. A visit by the consultant was conducted to The Hollies on 23 June 2022 and a subsequent report completed. The report recorded a total of 26 recommendations, many of which are referenced within this report. An action plan had not been implemented detailing progress and how the actions required were to be addressed.

The result, another warning notice.

Remember the social care crisis everyone is constantly talking about, there are a large band of ‘external consultants’ earning good money in this climate. The fact that two months after they’d visited there wasn’t even an attempt at an action plan to ensure things were changed, show it for what it is, performative scrutiny. Ticking a box to say we’ve taken action, without actually taking any action.

This performative scrutiny seems to be a common feature of the home. Maybe it could be adopted into their values and ethos statements:

Staff meetings were held to give the management team and staff the opportunity to express their views and opinions on the day-to-day running of the service. Meeting minutes were poor and there were no action plans completed to evidence how issues raised were to be addressed, dates to be achieved and if actions had been resolved or remained outstanding.

CQC concluded that there was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as systems were still not robust enough to evidence effective oversight of the service or ensure suitable arrangements were in place to assess and monitor the quality of the service.

Multiple breaches. Non-lives. Apathy and carelessness. Now where’s that values statement again.