This unannounced inspection took place on 1 December 2016.

Holland House is registered to provide accommodation and personal care for up to 4 people and there were 3 people living in the home on the day of inspection. The service had been closed for some time, it re-opened in September 2016 and now specialises in supporting adults with a range of complex needs and behaviours associated with Prader-Willi Syndrome (PWS). This is a genetic condition that predominantly manifests with early years onset of Hyperphagia, an unrelenting desire for food, driving the person towards excessive eating, which, if left unchecked can result in life threatening obesity. Other characteristics of PWS include learning disabilities that may range in severity, and challenging behaviours.

The service is required to have a registered manager. At the time of inspection a manager was in post and they were in the process of registering with the Care Quality Commission as the registered manager for the service. 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.

People felt safe in the home and relatives said that they had confidence in the ability of staff to keep people safe. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. There were sufficient staff to meet the needs of the people and recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received a thorough induction and training in areas that enabled them to understand and meet the care needs of each person.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe but also enabled positive risk taking. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

Care plans were written in a person centred approach and detailed how people wished to be supported and people were involved in making decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with the people who lived at the house and people told us that staff were caring and respectful. Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to. There was a stable management team and effective systems in place to assess the quality of service provided.

We carried out this inspection to check if the provider had made the improvements we asked them to make, when we inspected in May 2014. Our inspection was carried out by one inspector who visited the service unannounced on 2 September 2014. We found that the manager named on the front of this report had left some weeks prior to our inspection visit; therefore details relating to the registered manager are not correct.

The summary is based on our observations during the inspection, speaking with staff supporting people who used the service, the area manager and from looking at records. At the time of our inspection there were three people living in the home. Because of the nature of their disabilities, they were not able to tell us about their experiences. If you want to see the evidence supporting our summary please read the full report.

During the inspection we sought answers the five key questions below.

Is the service safe?

The provider had taken action since our last inspection to reduce the risk of unsafe care by providing staff with training to help them understand the specific conditions of people who used the service. We found that incidents of staff, and sometimes people who used the service, being hit by someone who used the service continued. However, arrangements had been made for staff to receive advice and support to try and identify effective strategies to reduce the risk of incidents and injury to staff and other people who used the service.

Is the service effective?

We found the atmosphere within the home was calmer than during our last inspection. Opportunities for activities outside the home for one person requiring additional support had increased since our last inspection, improving their quality of life.

Is the service caring?

Discussions with staff demonstrated that they were committed to helping to ensure that people received the care and support that met their individual needs. We also heard staff speak to people who used the service with respect and approach people in a caring manner.

Is the service responsive?

We saw that staff were available to support people who used the service and that they were responsive to signs that they may need assistance.

Is the service well-led?

During our inspection we found that the registered manager had left several weeks previously. The provider had not notified the Care Quality Commission of this. Staff told us that they received management support from the manager of another service who visited approximately twice a week. They confirmed that they were able to contact managers if they needed advice or support. This was confirmed by the area manager’s arrival to support staff with the unannounced inspection. We saw that one of the senior staff had signed incident records to confirm that they had reviewed these. In addition the area manager told us that since our last inspection these were also reviewed by a member of staff within Consensus Care who was working with staff to help reduce risks.

Due to the communication difficulties that people had, we only briefly spoke with one person. He said that staff helped him, he was happy in his room, the food was good and he had no complaints.

We also spoke with a relative of a person living in the home. They told us that they had no problems with the service. They said staff had been helpful and supportive: ‘’staff could not be better’’.

This was a positive inspection. The person we spoke with said he had been satisfied with the care he received. The relative we spoke with said that care was very good. The essential standards we inspected were also found to have been met.

There were small number of comments made; that a person living in the home now had fewer opportunities to go out. The manager said this was because the person needed two staff to ensure safety. However, she was working on this issue to ensure his preferences to go out were met. The company needs to review this issue and increase staff availability as needed.

As most people had communication difficulties we only spoke with both one person. We also spoke with a relative about her views of the care provided.

The person we briefly spoke with confirmed he was satisfied with the home’s care. He saw staff as helpful, friendly and caring. There were no complaints about the service.

The relative we spoke with praised the service: '’Staff are always friendly. I have no complaints at all. I think they do a very good job’’.

Our inspection was carried out by one inspector who visited the service unannounced on 2 May 2014. The manager was not present on the day of our inspection visit and a further visit was made by arrangement on 7 May 2014. During the inspection we sought answers to five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found:

The summary is based on our observations during the inspection, speaking with staff supporting people who used the service, the manager and from looking at records. Because of the nature of the disabilities of people living in the home, two people were not able to tell us about their experiences. A third person chose not to speak with the inspector. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by the staff. Some staff had worked with people for several years, while others were relatively new. Our observations showed that all staff demonstrated a commitment to keeping people safe.

Staff training included safeguarding vulnerable adults. Staff were aware of their responsibilities for reporting any concerns about the treatment of people who used the service. We saw that small amounts of money were held on behalf of people who used the service which enabled staff to purchase items such as toiletries for peoples as and when needed. We saw that robust systems were in place for the management of this money.

The lack of robust analysis of incidents, delivery of care to meet individual needs and lack of staff training in the specific conditions of people who used the service, created a risk of unsafe care.

Is the service effective?

We saw that advice and support had been obtained from a range of professionals including healthcare professionals. We found that some advice had not been fully implemented and therefore had not been effective in meeting individual’s needs.

Is the service caring?

We saw staff approach people who used the service in a caring manner. Staff knew about people’s individual preferences, interests, and needs and where possible supported these.

Is the service responsive?

We saw that staff were available to support people who used the service and that they were responsive to signs that they may need assistance.

Is the service well-led?

We found that the provider had systems in place to gather information about the quality of the service. However we found that staff were not adequately supported. They had not received training in the diagnosed conditions for people who used the service and there was no formal process for debriefing or supporting staff following incidents.