The inspection took place on 13 August 2018 and was unannounced. At the last inspection in November 2015, the service was rated Good.

Hollow Oak Nursing Home (Hollow Oak) is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Hollow Oak provides nursing care for up to 27 older people and is an established family run business. The home is in a period house that has been adapted and extended for its present use, including two conservatories and a modern extension. The bedrooms in the home vary in size and layout, are individually decorated and retain many original features. There is car parking available and well kept lawns and gardens to the side and rear with outdoor seating for the people living there. At the time of the inspection there were 22 people living there.

There was a registered manager at the home. 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 this inspection we found the service remained good overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. At this inspection we also found the service was continuing to improve and demonstrated some characteristics of 'outstanding' and that they were continuing to develop the service for the future. The service was particularly skilled at caring for and supporting people and their families at the end of life and responding quickly to people's changing needs.

People told us they were happy and felt safe at the home. People told us that the staff were “so very, very good” and “kind” and they supported them when they needed it. People who lived there told us, “The staff are marvellous and speak to me and my family with genuine feeling and that “Nothing is too much trouble, they always have time to listen.” Relatives told us their loved ones’ care had been “exceptional” and “outstanding" and that staff responded "quickly and compassionately" to people’s needs. We saw staff showed real concern and compassion for people's wellbeing and responded quickly when people required their help. Professionals who visited the service spoke very highly of the service provision and said that it was "very responsive" and "person centred" in the care provided.

People told us they were happy with the variety and choice of the home cooked meals being provided and that there was always a choice at meals. We observed regular snacks and drinks were provided between meals to help make sure people received adequate nutrition and hydration.

The service had an effective safeguarding policy and staff had undertaken safeguarding training and could explain the process. Staffing levels were consistent and flexible to meet changing needs and staff recruitment procedures were robust. The staff team worked well together and had the skills, knowledge and experience required to support people with their care and social needs. Registered nurses were available to support people's day to day nursing needs.

Medicines management systems were safe and staff had undertaken appropriate training in medicines administration. Staff were being appropriately trained for their roles and well supported by the registered manager. Systems were in place to give staff the opportunity to discuss their work and have appraisals.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they worked within the law to support people who might lack capacity to make some of their own de

This unannounced inspection took place on 30 November 2015. We last inspected Hollow Oak in June 2014. At that inspection we found the service was meeting all the regulations that we assessed.

Hollow Oak provides nursing care for up to 27 older people and is an established family business. The home is in a period house that has been adapted and extended to provide suitable accommodation for the people living there, including two conservatories and a modern extension. The bedrooms in the home vary in size and layout and are individually decorated and retained many original features. There is car parking available and well- kept lawns and gardens to the side and rear with outdoor seating for the people living there. On the day of the inspection there were 22 people living there.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

People living in Hollow Oak told us that they felt safe living there and friends and relatives we spoke with told us they were “very happy” and “very satisfied” with the care being provided. We spoke with people living there in their own rooms and those who were sitting in the communal areas. Everyone we spoke with had positive things to say about their home and the staff caring for them and that they “could not fault them”.

On the day of the inspection there was a relaxed atmosphere in the home and we saw how frequently staff interacted with the people living there and in a very calm, friendly and respectful manner. We found that people living there were regularly asked for their views of their home and their comments were acted on to make any changes they wanted. One person told us, “I feel at home here, you know, like a real home”.

We saw that people were supported to maintain their independence and control over their lives as much as possible. People had a choice of meals and drinks, which they told us were good and that they enjoyed. We saw that people who needed support to eat and drink received this in a supportive and discreet manner. The atmosphere in the home was informal, open and people were regularly asked for their views of the home and their comments were acted on to make changes they wanted.

We saw people’s care plans were person centred and clearly described their care, treatment and support needs. These were regularly evaluated, reviewed and updated to reflect any changing needs or preferences. Risk assessments were in place to allow people to keep their independence in ways that mattered to them such as accessing outdoor spaces.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves. The service worked well with local GPs and health care professionals and external agencies such as social services and mental health services to provide appropriate care to meet people’s different physical, psychological and emotional needs.

The staff we spoke with were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home and that they were confident that action would be taken.

Effective systems were in place for the recruitment of staff and for their induction and ongoing training and development. Staff training and development was well organised and staff said they were well supported to access the training they needed and to develop their skills.

We saw nursing staff giving people their medicines. They followed safe practices and treated people respectfully. People were given time and the appropriate support they needed to take their medicines.

There were thorough quality monitoring systems in operation to assess and review the quality of the services provided. We saw from the audits that had been done that the registered manager was identifying areas of service provision that needed to be improved to meet their internal quality standards and to find ways they could continue to improve the service.

During the inspection we gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based upon our observations, discussions with people who used the service, their relatives and the staff who supported them and from looking at the records held in the home. We also observed the interactions between people living there and the staff supporting and caring for them.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The people we spoke with who lived at Hollow Oak told us that they felt safe living there and that staff listened to what they had to say.

We saw that risk assessments had been carried out to help make sure that people who lived there received safe and appropriate care and treatment. This included the important areas of nutrition, personal care, skin care and wound management, mobility and moving and handling and the risk of falls.

We saw that the premises and grounds were being well maintained and were accessible to the people living there. Appropriate measures were in place to ensure the security of the premises to keep people safe. The service had systems in place to manage and monitor the prevention and control of infection and a clean environment.

The home had a range of equipment to support the people who lived there. We saw that all the equipment was serviced and checked regularly to ensure it was safe for people to use.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes and we saw that appropriate policies and procedures were in place. The home had appropriate policies and procedures in regard to The Mental Capacity Act 2005. The manager of the home was knowledgeable about the Mental Capacity Act 2005 and the Mental Capacity Act Codes of Practice. This meant people could be confident that their rights would be protected.

Is the service effective?

We saw that the staff in the home treated people with respect. People were supported to carry out as much of their care as they could themselves, with the care staff assisting them to do the things they couldn't manage on their own. This supported people to maintain their independence and control over their lives.

We found that people’s health and care needs had been assessed with them and they were involved in deciding the care and treatment they wanted, including at the end of life. We saw records that showed staff had undertaken accredited end of life training to give them the skills and knowledge to look after people properly at that time. Where people had been identified as at higher risk due to complex needs, appropriate specialist services had been contacted for advice and support.

Is the service caring?

Everyone we spoke with made positive comments about the staff employed at this home. We were told they were, “Very kind” and “A lovely bunch”. We observed that people living at Hollow Oak were comfortable and confident with the staff on duty.

Where people needed additional time to be able to express their views and wishes we saw staff gave them the time they needed to do this. The staff in the home took the time to talk with people as they went about their duties. We saw many positive interactions between the staff on duty and people who used this service. These positive interactions supported individuals' wellbeing.

Is the service responsive?

We saw that people living there were involved in the way the home was being run. They were able to take part in activities they wanted to inside and outside the home and to decide for themselves how they spent their time.

The care plans and information we looked at about the people using the service was written in a holistic and positive way. We saw from the sample of care plans we looked at that the plans of care, treatments and support were subject to evaluation, review and alteration in response to changes in people’s needs and preferences.

We could see that the manager and staff monitored people’s conditions and made timely referrals to others to access the care people needed. The manager took responsibility for making sure care had been well coordinated between different services involved in people’s care and support.

Is the service well led?

When we visited the home we found there was an effective and verifiable system being used to assess and monitor the quality of the services and records about the care and support people living at the home received. Formal systems were in place to audit the quality of the service provided. We saw that the findings of these audits and the analysis of trends and incidents in the home was used to learn from, inform practices and continually improve the service. This helped to ensure that people received a consistently good standard of care at all times.

We saw that information about the safety and quality of the service was being gathered from different and relevant sources and that this was being recorded and stored securely. People we spoke with told us they were asked their views on the way the home was run at the home’s ‘resident and relatives’ meetings and that their suggestions were welcomed by the manager and provider. We saw that where people had made suggestions about such things as meals and activities inside and outside the home they had been acted upon.

Staff working there told us they felt well supported by the manager of the home and the provider and said their views and ideas about the service were listened to. Staff we spoke with told us it was a good place to work and they were clear about their roles and responsibilities. Staff we spoke with had a good understanding of safeguarding procedures and whistle blowing to report on poor practice. Staff we spoke with said they were confident the manager and provider would support them if they needed to raise concerns.

People living at Hollow Oak Nursing Home told us it was, "A good place to live" and that the nurses were, "Very, very good" and that the care staff were, "A grand lot." People told us that were, "More than happy" and "Very content" with the services and support they received. We did not receive any negative comments about the standard of personal care received, the food served, the cleanliness of the home or the staff approaches and support. People were very complimentary about the food and told us the meals were "Wonderful" and there was a "Good choice of puddings" and "I do like my cooked breakfast."

People living there said that they had not needed to complain about care and told us they had confidence in the manager to support and help them. One person said "I don't have to worry about anything now, I am safe and I have good company so I am a lady of leisure." More than one person told us that they felt they had made the right decision to live there.

From our observations and conversations with people living there we found they received the support they needed and were given choices about their care and their social activities. We observed that staff encouraged people to maintain their independence and control over their lives. All the people we spoke with gave positive feedback about how their privacy and dignity were promoted and how staff asked them what they wanted. We saw that people were comfortable and confident with the staff on duty.

People living at Hollow Oak Nursing Home, who spoke with us during our visit told us that they were "happy", "contented" and "feel safe" living there. They told us they were happy with the services and the support they received.

We spent time talking to people living there privately, in their rooms, and also in communal areas and observing daily life and activities in the home. We did not receive any negative comments from people living there or their visiting relatives about the standard of personal care and individual attention people received, the food on offer to them, the cleanliness of the home or the staff approaches and support.

People told us how clean they felt their home was and that their rooms were cleaned every day and one visitor said "Did you notice there are no nasty smells here... I've been in homes where we came from where the smell hits you as you walk through the door". One person who lived there said, "The cleaners are really good.... they put fresh flowers in my room".

More than one person told us that it was a "homely" place to live and that, "they (staff) make you feel so welcome". One person told us "I could not be better looked after than I am here....I have a lovely view and its so quiet here".

People also told us that they could decide how they spent their days and they told us that they felt they did not have to join in any activity or outing if they did not want to. One person we spoke with was just about to go out for the day with relatives. More than one person said they valued the fact that staff took time and did not rush them whilst helping them.

People we spoke with confirmed that they got up and had their meals when and where it suited them and also went to bed when they wanted. Many of the people we spoke with commented on how they felt staff knew them well and always had time for them. Other people told us how" helpful" the staff were and that they would spend time with them and "chat and share a joke".

People told us the food was "very good" and "excellent" and told us that they were always asked what they liked and that the staff and the cooks knew what they liked or had to have if they had a dietary need.

At the two visits to the service on 16 November 2011 and 20 December 2011 we focused our attention upon monitoring the improvements the service was making to meet the warning notice we issued and the compliance actions made at our first visit. We spent most time during the two visits concentrating upon the practices and systems in place. Progress had been made to make the improvements required and to achieve compliance and to continue to implement changes to improve the quality monitoring systems.

We spoke to people living in the home in a general way as we went about the home and no one had anything negative to say about the service. No one made any complaints or raised any issues that concerned them with us during our visits. The atmosphere in the home was friendly and relaxed and we saw people moving around the home and spending time with family and friends and taking part in meals and activities as they preferred.

At this second visit to the service on 27th September 2011 we focused upon monitoring the compliance actions we had made following the last visit on 29th June 2011 and the progress being made to achieve compliance. At this second visit we spent most time focusing on the practices and systems needing improvement to achieve compliance and looking at what improvements and changes had been made to ensure the quality and safety of the practices and systems in use for the people living there.

We talked with people at this visit generally and informally as we went about the home and as we observed and assessed practices and daily life in the home. People living at Hollow Oak Nursing Home, who talked with us during our visit were happy with the care they received and the atmosphere was friendly and informal. We saw people moving about the home, taking their meals where they wanted to and seeing family and friends or spending time in the communal lounges or their bedrooms.

We did not receive any negative comments from people living there and people engaged in general conversation with us did not raised not specific issues.

People living at Hollow Oak Nursing Home, who talked with us during our visit on 29thJune 2011 told us that they liked living there and were happy with the services they received. We spent a lot of time talking to people living there and observing daily life in the home and did not receive any negative comments at all about the standard of personal care and individual attention they received, the food on offer to them, the cleanliness of the home and the staff approaches and support.

More than one person told us that their care was “excellent” and one that they were “being spoilt in their old age”. They told us, “it’s as good as any home can be, in my opinion” and “I don’t think you could make it much better for me, I am as happy as I can be outside my own home”.

People told us that staff knew them well and “listen and are interested in me” and that “the carers are lovely, nothing is too much trouble”. All the people we talked with commented on how they felt staff knew them well and their “little ways” and preferences.

We were also told how clean and well kept they felt their home was and we could see as we walked around that was the case. One person with a room in the recent extension told us how much they liked their new room and the en suite facilities but especially its location as it allowed them to see “all the coming and goings”. People also talked enthusiastically about the gardens and how attractive they were and how well they were kept. Several people told us they spent time out there “pottering” when the weather allowed.

People told us that they had not felt the need to complain about care during their time there but they all expressed confidence in the nurses and manager to “sort it out” and that any concern would be “sorted quickly”. One person told us “Matron is very good”.

People told us the food was “fantastic”, also “beautiful” and “excellent” and told us that “the cook comes round, asks what I like and has got to know how I like things”. Others confirmed this level of personal attention and visits from the cook to make sure they are happy with the food and that it met with their needs and preferences. People we talked with appreciated that personal attention and gave us examples of the things the catering staff did to provide their food as they liked it.

People also told us that they could decide how they spent their days, saying, “I can do more or less what I want” and “I get involved with what I want to but no one makes me join in if I don’t want to”. People told us that they had made friends whilst living there and another that they felt “safe” living there.

Another person told us how they were supported to attend the church service and communion the home organised and that this was important to them. Others told us how helpful the staff were and that they would spend time with them and “sit and chat”. People we talked with confirmed that they got up and had their meals when and where it suited them and also went to bed when they wanted.

One person commented that they had “always” been made to feel included “like a friend” in the home and more than one that the home had a “family feel” and “it couldn’t be more friendly”, which they liked and appreciated.One person told us that the providers were "fantastic people".