This unannounced inspection took place on 05 and 06 February 2018.

Holly Bank Care Home is a care home in Arnside. It is registered to care for up to 31 people assessed as needing residential care. The building comprises a pair of semi-detached Victorian villas that have been combined, adapted and extended for its current use as a care home. The home has three floors with a lift for access between floors. At the time of the inspection visit 23 people were receiving care and support at the home.

Holly Bank Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was 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. The registered manager was supported at the home by a manager. The manager had responsibilities for the day to day running of the home.

Holly Bank Care Home was last inspected December 2016 and was rated as requires improvement. During that inspection process we made recommendations in regards to staff training and requirements relating to the Mental Capacity Act.

We used this inspection visit carried out in February 2018 to check to see if the recommendations had been acted upon to ensure improvements had been made. We found some but not all improvements had been made. Work was on-going to ensure documentation maintained in relation to MCA reflected good practice. The registered provider had reviewed staff training and had invested in an on-line training package so that staff training could be provided and monitored. In addition staff had been provided with face to face training.

Although we noted some improvements we found staffing levels and deployment of staffing was not always effective to ensure the safe care of people who lived at the home. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We found recruitment procedures were not robust. Pre-employment checks had not been consistently carried out to ensure fit and proper people were employed. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We found that paperwork maintained by staff at the home was not always accurate, complete and up to date. Auditing systems implemented at the home were sometimes ineffective and had failed to pick up concerns we identified during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Arrangements were in place for managing and administering medicines. However these were not always consistently carried out to ensure good practice guidelines were followed. We have made a recommendation about this.

People’s healthcare needs were monitored and managed appropriately by the service. People told us guidance was sought from health professionals when appropriate. We saw evidence of partnership working with multi-disciplinary professionals to improve health outcomes for people who lived at the home.

People who lived at the home and relatives told us relationships with staff were sometimes limited due to staff not having time to respond to people’s needs and due to communication barriers.

There was an emphasis on promoting indepen

This comprehensive inspection took place on 8 December 2016 and was unannounced. We last inspected Holly Bank Care Home on 13 January 2015. At that inspection we found a breach of Regulation 18 Notification of other incidents, of The Health and Social Care Act 2008 (Registration) Regulations 2009 because the registered person did not always notify the Commission about serious injuries that had occurred.

During this inspection we found that notifications required to be provided to the commission had been made when necessary.

Holly Bank Care Home provides accommodation for up to 31 people who need personal care. The home is situated in the village of Arnside on the coast line of Morecambe Bay. The building has been adapted and extended for its current use as a care home. Accommodation is provided on two floors and there is a passenger lift to help people to access the first floor.

There was a registered manager. A registered manager is a person who has registered with the (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. The provider had made arrangements for the home to be supported by a manager that was registered with CQC from another of their homes pending registration of a new manager.

The numbers of staff on shift during the day had not always been consistent this was because some of the care staff had been covering the role of a full time cook. The provider was in the process of recruiting more staff to work at the home.

We found a bedrail that was in use that was not being safely managed. The type of bedrail in use was not specific to the bed it had been attached to and we could not see any safety checks had been regularly completed. The provider immediately rectified this during the inspection by removing the bedrail from use.

Staff told us they had received regular supervision to support them in their roles. However records provided relating to staff training indicated that some staff required elements of training to be updated to refresh their skills and knowledge. Some topics of refresher training in cores skills such as health and safety, food handling and hygiene, first aid and the safeguarding of adults for some staff had expired.

We have made a recommendation that the provider ensures that staff receive refresher training in the identified timescales.

Decisions made in people’s best interests and the consent required about the use of restrictive measures that may deprive people of their liberties had not always been obtained appropriately.

We have made a recommendation that the provider review their best interest decision making and obtaining consent process to ensure it follows guidance outlined in the Mental Capacity Act 2005 when using any restrictive measures.

We observed staff displayed caring and meaningful interactions with people and they were treated with respect. We observed people’s dignity and privacy were actively promoted by the staff supporting them.

People living in and visiting the home spoke highly of the staff and told us they were very happy with their care and support.

The recruitment procedures demonstrated that the provider operated a safe recruitment procedure to ensure that fit and proper persons had been employed.

Medicines were being administered and recorded appropriately and were being kept safely.

A varied range of activities were made available to people living in the home.

This inspection took place on 13 January 2015 and was unannounced. Holly Bank Care Home provides accommodation for up to 31 people who need personal care. The home is situated in the village of Arnside on the coast line of Morecambe Bay. The building comprises a pair of semi detached Victorian villas that have been combined, adapted and extended for its current use as a care home.

There was 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.

At our last inspection in December 2013 we found that the provider was compliant with all five of the regulations of the Health and Social Care Act 2008 that we looked at.

We found that some aspects of the service were not responsive to people’s needs. When changes had occurred in peoples needs or incidents had happened we did not see that the review of their care plans always reflected this. Some information in people’s care records was inaccurate, this meant care staff did not always have accurate information about how to support people.

People knew how they could raise a concern about their safety or the quality of the service they received. There were enough staff to provide the support that people needed. People were provided with meals and drinks that they enjoyed. People who required support to eat or drink received this is a patient and kind way.

A designated area in the home had been decorated and furnished to mimic being in the village square. People living with dementia could wander safely and be stimulated by the staged environment.

People told us they were very happy at the home. They said they felt well cared for and safe. People we spoke with knew how to make a complaint and we saw that procedures for managing complaints were in place.

Throughout our visit we observed caring and supportive relationships between people living at Holly Bank Care Home, their relatives and the care staff. People were treated in a caring way that demonstrated a positive, caring and inclusive culture existed in the home.

Care staff had received training that enabled them to appropriately support people. On the day of the inspection senior staff attended external training to update their knowledge in infection control.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made. For example, to GPs and Speech and Language Therapist (SALT). People received support from the community nurses as required with regards to their health needs.

The provider is required by law to notify the Commission of injuries to people who use the service. We found two incidents which should have been reported to CQC were not. This was a breach of the Health and Social Care Act 2008 (Registrations) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with a range of people about the home. They included the registered manager, staff, people who lived at the home and a visiting relative. This helped us to gain a balanced overview of what people experienced living at Holly Bank.

Some people had limited verbal communication and understanding and were unable to hold a conversation with us. To help us understand their experiences of living in the home we observed the care they received and the interaction by staff. Those people we did speak with told us they liked living at Holly Bank. Comments included, “I have been here for a few years. I love living here it’s very relaxed”. Also, “I love it here at this time of year. All the Christmas decorations and parties it’s great”.

In order to gain a general overview of how care was being delivered around the home, we spent time in all the communal and dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We were shown around the building and checked maintenance records for fire, water, gas, equipment and electrical safety. They met with statutory requirements. We spoke with told us they liked the facilities available to them at the home. This included comments about individual rooms. One person said, “I have everything I need in here its home from home”. Another person told us they loved spending time in the lounge as the views over the bay were beautiful.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional.

People told us they enjoyed living in Holly Bank and really apprecited the care they received. They told us, "We are well looked after and I wouldn't change a thing". We were told that every one enjoyed their meals and that the chef was "on of the best". Other comments included, "We have a good choice of dishes and there is always plenty".

People told us how good the staff were and that they were encouraged to do as much as they could but to call the staff as soon as they needed assistance.

People were given choicse about where they spent their time but some told us, "I can sit quietly in my room if I want to. I love looking out of the window".

People living in Holly Bank Care Home and their families told us the home provided a good standard of care.

People said they made decisions about their lives in the home and told us they enjoyed the activities and meals provided.

People told us:

“The staff are very good”

“I choose how I spend my time and my family are made very welcome when they visit me”.

One person said,

"It’s the best home in this area, I recommend this place to everyone.”