Holderness House is a residential care home for 33 people, some of whom may be living with dementia. There are five floors altogether, although two were smaller split levels. All are accessed by a lift and stairs. All the bedrooms are for single occupancy and there are communal rooms/areas for people to use throughout the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Staff knew how to safeguard people from the risk of abuse and harm. They completed risk assessments which helped to guide staff in how to minimise risk whilst accepting people liked to be independent. There was sufficient staff employed and they were recruited safely ensuring full employment were in place before they started work.

People’s health and nutritional needs were met. Staff contacted people’s GPs or other health professionals when required and ensured they received their medicines as prescribed. The menus provided people with a balanced diet and they were very pleased with the meals they received.

People’s needs were assessed and care plans produced, which helped to guide staff in how to care for them in the way they preferred. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us the staff were kind and caring and respected their privacy and dignity. They were supported to be as independent as possible and included in decisions such as menus and activities. There were activities for people to join in or simply watch, and the opportunity to access community facilities and events.

Staff had access to training, supervision and support which ensured they had the right skills to care for people. They all said Holderness House was a nice place to work and the registered manager was accessible and listened to them.

Management completed audits and checks so that shortfalls could be identified and addressed. People knew how to make a complaint and felt able to do so. The environment was clean and tidy.

Further information is in the detailed findings below.

Holderness House is registered with the Care Quality Commission (CQC) to provide accommodation and personal care for a maximum of 33 people. The service is a large detached three story Victorian house set in extensive gardens and grounds, which are secured from the main shopping area of Holderness Road. There is good disability access and plenty of parking spaces. All bedrooms are en-suite and for single occupancy. Communal rooms consist of a large sitting room, a library connected to the sitting room which can become one larger room if required for functions, and a dining room. There are also other seating areas within the service. There were 29 people using the service on the day of the inspection. The service is overseen by a Board of Trustees.

The service is required to have a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We undertook this unannounced inspection on the 6 and 7 January 2015. At the last inspection on 1 October 2013 the registered provider was compliant in all areas assessed.

We found the culture of the organisation was one of openness and a willingness to listen and improve the quality of care for people who used the service. There was an organisational structure in place to support and oversee systems.

The environment was safe, clean and fresh. We noted some areas that required attention to ensure good infection prevention and control and these were mentioned to the registered manager to address.

There were assessments for people to ensure specific areas of risk had been identified but we noted two areas had been overlooked. For example, with the use of bed rails for one person and the risk of pressure ulcers for others; we saw the care people required to keep them safe was in place though.

Staff had received training in how to safeguard people from the risk of harm and abuse. They knew the different types of abuse, signs and symptoms and how report any issues of concern.

We found staff were recruited safely and in sufficient numbers to care for people safely and effectively. Staff had access to training and support to ensure they felt confident when supporting people who used the service.

We observed the staff approach to be kind, caring and attentive. Staff listened to people and provided explanations and information to them. We saw people were treated with respect and dignity and their independence was maintained as much as possible. There was an activity co-ordinator who arranged meaningful occupations and stimulation for people.

We found people were supported to make their own decisions. When people were assessed as not having capacity, the registered provider acted within the law when making decisions on their behalf.

We saw people who used the service received their medicines as prescribed. Staff were aware of people’s health care needs and how to recognise when this was deteriorating; their health needs were monitored and met. People had access to health and social care professionals in the community when required.

People liked the meals provided. Their diet was varied with choices and alternatives available to them at each meal to ensure their nutritional needs were met.

People knew how to make a complaint. They told us they would feel able to complain to staff or management and this would be addressed for them.

We found quality monitoring took place and checks were completed to make sure any areas of improvement were addressed quickly. People were able to make suggestions and we saw they were listened to and actions taken when required.

The assistant manager told us that appropriate consent was obtained by talking to family members or holding a best interest meeting. They went on to say that where people do not have the capacity, key workers reviewed and read the care plan arrangements to the people who used the service.

We observed the lunchtime experience and saw that the food was well presented and was plentiful. Food was presented on shared warm trays and allowed people to serve themselves which promoted independence.

We looked at medicine administration records (MAR) that was accurate with the amount of drugs that remained in stock and the amount of drugs that was administered. These records were found to be accurate, precise and transcribed in a clear and consistent manner.

We spoke with three members of staff who told us they had been on a range of training courses and that their personal development was supported. They also told us management was really effective about supporting their career progression.

People we spoke with said they knew how to make a complaint and felt assured that if they needed to make a complaint they would be satisfied the service would deal with it effectively .

People who lived in the home told us they felt respected and were involved in making everyday decisions. They also told us they had nothing to complain about but understood how to if the need arises and commented, "The staff can’t do enough for me, I am sure they have the wings of an angel" and "It's a wonderful place to live."

People told us they felt safe in the home. They also said they liked their room and the

home was clean and tidy. During our visit we also spoke with visiting relatives who confirmed the home offered excellent care and support for their relatives in the home. A relative commented that, "My mother feels safe here and personal care could not be better."

We saw from documentation that people had their needs assessed and were involved in the planning of their care. We looked at staff appraisal records which showed us staff had not undertaken an appraisal to ensure that staff training and development needs were assessed.

People we spoke with told us they were happy with the care they received and the staff were very kind and caring. One person told us “The staff are very kind and nothing is too much trouble,” and another person told us “Staff are always on hand to help me when I need them.”

People told us they knew who to raise concerns with and were confident that the manager would take any concerns seriously.