This inspection took place on 22 July 2016 and was unannounced. At our previous inspection in February 2014 we found the provider was meeting regulations in relation to the outcomes we inspected.

Holkham House is a 10 bedded care home for adults with a learning disability. At the time of our inspection there were nine people living at the service. The premises are spacious and comprise ground floor and first floor accommodation.

There was a registered manager in post, who has managed the service for three years. 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.

There were systems in place to protect people from harm or abuse. Staff had received appropriate safeguarding training and understood how to protect people. People’s care and support plans showed that risks to their safety were identified and plans were put in place to mitigate the risks.

We observed that there were sufficient numbers of staff deployed to support people with their personal care and social interests at home, and to go out for activities. Robust recruitment practices were used to ensure that staff had suitable qualifications and experience to meet the needs of people who use the service.

Medicines were stored, administered and disposed of safely. Staff received medicines training and understood their responsibilities in relation to the safe management of prescribed medicines.

Arrangements were in place to make sure that people were provided with a comfortable, hygienic and safe home. This included up to date risk assessments for the environment and regular checks to ensure that equipment was in good working order.

People were supported by staff with suitable knowledge and skills to meet their needs. Staff were provided with training sessions and one to one supervision, which included training and guidance about how to meet people's individual needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), and to report on our findings. We found that the management team had received applicable training and presented a competent understanding of the MCA and (DoLS). Staff had also received training and demonstrated an awareness of the principles of MCA. People’s rights were protected by staff who ensured that any restrictions on people’s freedom and liberty were in accordance with legislation.

People were offered choices about their food and drinks. The care and support plans demonstrated that people were supported to meet their nutritional needs, and follow instructions from dietitians and speech and language therapists where applicable. People were promptly referred to healthcare professionals and supported to attend appointments and treatments.

People had developed positive relationships with staff, who showed a proficient understanding of people’s individual and complex needs. Staff spoke with people in a gentle and kind manner, and respected their rights to privacy and dignity.

Care and support plans reflected people’s needs, interests and wishes, and were regularly reviewed. People were supported to be as involved as possible in the planning and reviewing of their care and support plans, and relatives confirmed they were consulted about their family member’s care and support. People were offered a varied range of activities at home and in the wider community.

Systems were in place to encourage people to express their views, concerns and complaints about the quality of their care and support. People told us they would tell the registered manager and/or a staff member if they were not happy about their care and support, and relatives said they were

Our visit was at 7:25am and unannounced and we found the building fresh and clean and people were treated with respect and dignity. For example, staff closed people’s doors immediately when going in to support them, and any personal care was so discreet that there were no signs of it in the home’s communal areas. We noted people were happy and laughed and joked a lot. Some people who use the service offered us tea and others to pull their finger in humour.

People told us they liked the staff, got enough food and could choose what they wanted to eat. One person said they didn’t like the food.

People also told us they liked the home and their rooms. They said their rooms were warm enough and their taps worked properly.

One of the people who use the service showed us their room and how they had individualised it.

Other people who use the service wanted to be involved in the inspection and were supported by staff to do so where appropriate, for example, showing us their diet plan and progress or a photograph of a meeting, or how shopping was decided.

A relative of people who use the service told us they thought their relative got enough food and had put on weight and that the building and bedroom was suitable. They said the staff kept their relative stimulated and entertained and that they knew their relative was happy at Holkham House because they were always happy to return there after visits.

Staff offered choices and sought consent before offering care and information was included in formats and languages people would understand better so the person’s consent would be better informed. However, where people did not have capacity to consent the provider did not always act in accordance with legal requirements.

We saw that people were supported to be able to eat and drink sufficient amounts to meet their needs.

We found that people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We used a number of different methods to help us understand the experiences of people using the service. We spoke with three people using the service. We also spoke with a relative of person using the service.

We gathered evidence of people’s experiences of the service by reviewing feedback questionnaires, which had been completed by relatives of people using the service.

Three people using the service we spoke with said that they had meetings with staff to discuss their care. A relative of a person using the service said that they were invited to attend care review meetings. People using the service told us that staff supported them with attending activities. One person said that staff helped them to attend college.

Three people we spoke with said that they were happy living in the service. One person said,’ The staff were very nice and kind’.

We observed staff administering people’s medication to them in their preferred way. A person using the service said that staff supported them to visit the doctor for medication reviews.

Relatives of people using the service said that the home was clean. They said that the general décor in the home was suitable. A person using the service said that they were able to choose their preferred colour scheme for their bedroom.

A relative we spoke with said there was enough staff who had the right skills to support people.

Two people using the service said that there were house meetings. One person said that the staff listened to their views.

Two people told us they knew who they could speak to if they were unhappy. Relatives said that were aware of the service’s complaints procedures.

We observed good relationships between people using the service and staff. Three people we spoke to said that they were happy living in the home. Two people said the staff are nice.

Three people using the service told us that they were happy living in the home.

During this visit we observed some people leaving the service to attend activities. In the evening some people went to the cinema with staff. Two people using the service told us that they go shopping, they like going to the cinema and visit their family.

A person’s representative told us that people do participate in some activities but they are still spending a lot of time each day in the home with very little to do.

Three people using the service told us that they enjoy their meals. A person using the service told us that their favourite meal is fish and chips.

We received information from a person’s representative who told us that overall things are being done well, however a more open approach of the management would be beneficial.