This inspection took place on 31 January and 3 February 2017 and was announced. We gave the registered provider two hours’ notice to ensure someone would be available at the service.

Holicote provides respite care for adults from the Darlington borough who have a learning disability and some may also have physical disabilities.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 last inspected the service in August 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Staffing was provided at safe levels and any staff absences were covered by the registered provider’s own permanent and bank staff.

Accidents and incidents had been appropriately recorded and risk assessments were in place for people who used the service and staff.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

One person and carers we spoke with told us they felt safe at Holicote. Staff were aware of procedures to follow if they observed any concerns.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.

Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

One person who used the service and family members were complimentary about the standard of care provided by the staff at Holicote.

Care records showed that people’s needs were assessed before they started using the service, they were supported to transition to the service at their own pace and care plans were written in a person centred way.

Staff supported people who used the service with their social needs. We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with staff members and there was a warm and positive atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and relatives and people told us that staff were kind and professional.

People who used the service and family members were aware of how to make a complaint.

Staff felt supported by the registered manager and home manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Holicote and actions plans and lessons learnt were part of their on-going quality review of the service.

At the last unannounced, comprehensive inspection on 15 December 2014, we identified breaches of the Care Quality Commission Registration Regulations 2009. We asked the registered provider to take action to make improvements. We asked the registered provider to ensure they were preventing the risk of cross infection by having the appropriate equipment and policies in place. We asked the registered provider to ensure they had up to date policies in place for staff to follow. We asked the registered provider to improve their quality assurance process and management visits. We also asked the provider to deliver staff training on the Deprivation of Liberty Safeguards process and Mental Capacity Act.

The registered provider wrote to us to say what they would do to meet legal requirements in relation to these breaches.

We undertook this focussed inspection to check that the registered provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to the previously identified breaches of regulation.

We inspected Holicote on10 August 2015. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. This was a follow up visit to our inspection on 15 December 2014.

Holicote is registered to provide accommodation for people who require nursing or personal care. The service provides respite care for up to five people with a learning disability who live in the Darlington area. The service is situated in the local community and is part of a housing complex.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission 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.

At the last inspection we saw that there was no guidance in place for “as required” medicines and we requested that this be put in place as soon as possible to ensure these medicines were administered safely. We saw on this visit the recording of medicines had improved with “as required” protocol’s now in place for each person along with their photograph and other important information such as allergies and their GP contact details. This meant staff had clear and consistent guidance on the use of medicines for people.

At our last inspection we saw appropriate policies and procedures were not in place for the management of infection control. The service did not have an infection control policy, and Measures were not in place to reduce the risks of contamination by safe methods of transporting contaminated items. We saw on this visit the service had immediately sought the appropriate equipment for moving soiled linen and a new policy was put in place. This meant that staff had the equipment, knowledge and support to minimise the risk of cross infection at the service.

On our previous visit in December 2014, concerns were raised by a staff member about the quality of cleaning at the service. With additional training, support, new policies and procedures and new equipment we saw and was told that the cleanliness of the service had much improved.

On our last visit we found that staff did not all understand about the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We were told that all staff had received training from the local authority’s lead person for the MCA and DoLS processes.

At our last visit we found not all policies that were needed were in place at the service. There was no infection control policy or Deprivation of Liberty Safeguards policy. This meant staff could not be expected to follow correct and safe procedures if guidance was not in place for them to access. On this visit we saw new policies were in place and the service had taken measures to ensure staff had read and understood them. The service had also implemented a more robust monthly registered manager’s audit that took a wider view of quality at the service.

We inspected Holicote on 15 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Holicote is registered to provide accommodation for people who require nursing or personal care. The service provides respite care for up to five people with a learning disability who live in the Darlington area. The home is situated in the local community and is part of a housing complex. On the day of the inspection there were four people who were using the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission 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.

Staff were trained and understood the principles and processes of safeguarding.

We found people were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

People using the service and staff were not protected against the risk of exposure to a health care associated infection. This was a breach of Regulation 12 (Cleanliness and infection control); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Appropriate policies and procedures were not in place for the management of infection control. The home did not have an infection control policy, and measures were not in place to reduce the risks of contamination by safe methods of transporting contaminated items. Although the home had domestic staff in post there was issues raised by all care staff members we spoke with about the quality of their work. The registered manager agreed to address all these issues and following the inspection provided CQC with an action plan to remedy these areas.

There were positive interactions between people and staff. We saw that staff were kind and respectful. Staff were aware of how to respect people’s privacy and dignity. It was evident staff knew people who they supported and cared for well. Relatives and carers told us that they were happy with the care and service provided.

The registered manager had been trained in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood when an application should be made, and how to submit one although talking to staff they said they weren’t always sure what the process involved.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were also supported to use equipment they may need to maintain their independence whilst staying at the service such as adapted plates and cutlery.

People were supported to maintain good health and had access to healthcare professionals and services. Staff were aware of processes to follow should someone using the service become unwell.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information and set out how each person should be supported to ensure their needs were met. We found risk assessments were sufficiently detailed and had been updated using a red, amber, green system that was easy and clear for staff to follow.

We saw people were involved in a wide range of activities whilst staying at the service. We saw staff engaged and interacted positively with people. We saw people were encouraged and supported to take part in activities.

Appropriate systems were in place for the management of complaints. Relatives told us the service manager and staff were approachable. Relatives we spoke with did not raise any complaints or concerns about the service.

There were effective systems in place to monitor and improve the quality of the service provided. Not all policies that were needed were in place at the service. There was no infection control policy or Deprivation of Liberty Safeguards policy. This meant staff could not be expected to follow correct and safe procedures if guidance was not in place for them to access. The service manager told us they were working through current policies to update them and to make them more relevant to the service provided.

Staff told us the management were approachable but it was apparent from issues such as the cleaning and recent emergency admissions that although management were aware of staff feelings, perhaps they had not acted quickly enough to allay staff concerns in these areas.

We spoke with one person who was the only person in receipt of care and support at Holicote at the time. The two staff members on duty had a positive attitude and we saw good interaction with the person being supported to undertake various activities such as going out for a walk. Staff told us they received training and supervision on a regular basis.

There were systems in place for checking the safety and quality of the service and we saw that staff members had a good knowledge of infection control procedures. We saw the environment whilst still being homely, had equipment available to reduce the risks from poor infection control.

Menus were planned in advance and we saw that photographs were used to show people the choices of meal available. Staff had training in food handling and hygiene duties.

Records were held securely and we advised the members of staff on duty to ensure fire record checks continued to be recorded by the home and that some records such as cleaning checks were implemented and that some people’s care files needed review.

We were unable to speak to people using the service at the time of the visit as there was one person staying at the home who was out doing activities at the time. However we gathered evidence of people’s experiences of the service by reviewing the care records and speaking to staff.

When we visited the home we were unable to communicate directly with the two people who were using the service.