About the service: Hollin Bank House is a residential care home that was providing personal care to 10 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

• The service had deteriorated in some domains since our last inspection.

• The service met the characteristics of requires improvement in three out of the five key questions.

• We found two breaches of the regulations in relation to recruitment and consent.

• People were not always assisted to have maximum choice and control of their lives.

• We have made four recommendations in relation to risks, pureed meals, the environment and audits.

• We also found shortfalls in relation to the recording of controlled drugs, lessons learned, infection control and training.

• There were also good practices within the service.

• People liked living in the service. We observed a homely and friendly atmosphere.

• People were protected against abuse, neglect and discrimination. Staff ensured people's safety and acted when necessary to prevent any harm.

• Staff spoke passionately about their roles and wanting to provide quality care.

• There was good evidence that equality and diversity had been considered, in particular around those with protected characteristics.

• Staff knew people well. They had developed good relationships with people. People clearly enjoyed the presence and attention from the staff.

• More information is in the full report.

Rating at last inspection: At our last inspection the service was rated good overall. Our last report was published on 17 October 2017.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: Information relating to the action the provider needs to take can be found at the end of this report.

Follow up: We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates. We will follow up on the breaches of regulations and recommendations we have made at our next inspection.

We carried out this inspection on the 5 and 6 September 2017. This was the first rated inspection for the service and was unannounced on the first day.

Hollin Bank House is registered with the Care Quality Commission to provide personal care and accommodation to 14 people. Hollin bank house is situated on the outskirts of Accrington. There were nine people using the service on the day of our inspection.

At the time of our inspection the service had a registered manager in post. 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.

During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to restrictions being placed on people without the correct authority in place.

Staff members had received safeguarding training and were aware of their responsibilities to report any concerns. Safeguarding policies and procedures were in place to guide staff. A whistleblowing policy was also in place to protect staff should they report poor practice.

Risk assessments had been completed on an individual basis for people who used the service, such as moving and handling, medication, bathing, dressing and accessing the community. The risk assessments were person centred and provided staff with guidance to minimise the risks. Further risk assessments needed to be put in place in relation to the environment which the registered manager commenced on the second day of our inspection.

Records showed that robust recruitment processes were followed by the service when employing new members of staff. We saw references and identity checks were carried out as well as Disclosure and Barring Service checks.

Medicines were managed safely. We saw that only those staff members trained to do so were permitted to administer medicines to people. Competency checks were regularly carried out to ensure staff members remained competent. Whilst temperature checks of the medicines cabinet were being undertaken, these were not being recorded on a daily basis. The registered manager assured us this would be actioned immediately.

Staff told us and we observed they had access to personal protective equipment (PPE) such as gloves and aprons and confirmed they had received training in infection control. There was a nominated individual responsible for infection control within the service.

Staff members we spoke with and records we looked at showed that when commencing employment at Hollin Bank House, all staff were to complete an induction. The induction covered training the provider deemed necessary for the role and shadowing more experienced members of staff.

Staff had been trained in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and policies and procedures were in place to provide guidance. However, on the first day of our inspection we found some people were being restricted without the correct authorisation in place. We discussed this with the registered manager. On the second day of our inspection the registered manager had commenced making the relevant DoLS applications.

Records we looked at showed that staff members received regular supervisions and appraisals to support them in their roles.

We saw some areas of the service required refurbishment. The service had a programme of refurbishment and we saw some areas had already been improved, such as a new wet room on the ground floor. However, we found the flooring cover in the dining room was creating a trip hazard to people who used the service. The provider was dealing with this on the second day of our inspection.

People who used the service told us staff members were kind and caring. We observed kind and caring interaction