The inspection took place on 28 and 29 July 2016 and was unannounced. At our last inspection of the service in March 2014, the provider was compliant in all areas inspected.

Holly Bank house is registered to provide accommodation and personal care to people with physical disabilities and sensory impairments. The service provides care to people both within Holly Bank House and within their own homes. At the time of the inspection, there were 20 people receiving short term care within the residential unit and 126 people receiving support in their own homes.

There were two registered managers in post. One manager was registered to provide support to people within the residential unit and a second manager had been registered to oversee the provision of personal care to people within their own 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.

Staff understood how to report concerns about people at risk of harm and were able to manage risks to keep people safe. Staff had been recruited in a safe way and there were sufficient numbers of staff available to meet people’s needs.

People had their medication needs met by staff that had been trained in how to do this. People were supported to take their medication independently where possible.

Staff had access to regular training and supervision to enable them to support people effectively. Staff understood how to uphold people’s rights in line with the Mental Capacity Act 2005 and ensured that people’s dietary needs were met.

There were strong links with healthcare professionals and people had access to support from a variety of healthcare and social care services.

People were supported by staff who were kind and treated them with dignity. Staff encouraged people to maintain their independence and regain skills they had previously lost.

People had their needs assessed prior to receiving support and had their progress reviewed regularly. Records held personalised information about people’s needs and staff knew people well.

There was a clear complaints procedure in place and complaints made had been fully investigated by the registered manager.

The registered managers had sought people’s feedback on the service and used this feedback to make improvements to the service. There were systems in place to monitor the quality of the service.

This was a follow up inspection, to check the service's compliance with a warning notice that was issued following our inspection undertaken on 19 December 2013. The warning notice required that there were suitable arrangements in place to support staff to provide safe and appropriate care.

During our visit we spoke with three people who were receiving care and treatment at Holly Bank House, three relatives, nine staff members, a senior manager employed by Walsall Metropolitan Borough Council and the manager.

People we spoke with were positive about the care they or their relative had received. One person said: "I have had excellent care and support and am getting more independent". Another person said: "I cannot fault them I just wish I had come here earlier".

During this inspection staff confirmed that there were improved arrangements in place to ensure they received supervision and training to deliver safe and appropriate care. Records we looked at confirmed this.

We found that there were suitable arrangements to check the quality of service provided.

We found that the service had met the requirements of the warning notice and was compliant with the regulations.

We last visited Holly Bank House in January 2013 following concerns we received about changes to the service, poor medication practice and a failure to respond appropriately to allegations of abuse or poor practice. We found that required information about the service did not reflect the services provided and needed to be updated. After our inspection the provider of the service sent us an action plan that detailed the improvements that would be made. As part of this inspection we checked that the stated actions had been undertaken to ensure that risks to people were minimised.

During this inspection we spoke with six people who were staying and receiving care and support at Holly Bank House. People we spoke with were positive about the care that they received. One person told us: "I was told I was going to a care home and I must admit I was worried. I need not have worried it's a marvellous place the staff are very helpful". Another person said: "It can be noisy at night but it so much better than hospital".

People who were staying at Holly Bank House at the time of our inspection told us that they were asked about the care they needed and were kept informed about their progress.

We found that there were appropriate systems in place to identify, respond and report safeguarding concerns and protect people from the risk of abuse.

Medication practices required improvement to ensure that people were adequately protected against the risks associated with unsafe or inappropriate practice in relation to medicines.

People we spoke with told us that staff were helpful and caring. However systems to support staff including supervision and training required improvement.

Required information was available which accurately detailed the service provided.

Checks about the quality and effectiveness of the service were unavailable. This meant that we were unable to determine if the service had an appropriate audit system.

We visited the service following concerns we received about poor medication practice and possible a failure to adequately protect people from harm.

Holly Bank House had recently changed the service it provided following the integration of two services and two staff groups. We were told before we visited that the changes had resulted in shortfalls which had put people at risk of harm.

The service provided support to enable people to be more independent and when possible return to their own home or support them to find more suitable accommodation. Required information was not available which detailed the service which would be provided and how it to would provided.

We found that we had not been informed about all safeguarding concerns and action was needed to ensure that staff respond and report all concerns as they should.

Medication practices required improvement to ensure that people were adequately protected against the risks associated with unsafe or inappropriate practice in relation to medicines.

Improvement was needed to ensure that the service is compliant with the regulations and people receive safe and appropriate support.

We carried out this review to check on the care and welfare of people using this service. We spoke to two people who used services, two relatives and four staff employed by the service about the quality of care. Everyone we talked with told us it was a good service. One relative told us they were happy with the arrangements and another relative said, "I am so happy that X is doing so much more".

We found that people had an individual person centred care plan. We were told that people’s support needs were agreed before they transferred to Holly Bank from hospital. One member of staff we talked to said, “It is about supporting people to be more independent".

We found that staff were appropriately trained and supported to meet people’s needs. We found that staff met regularly with their manager and had regular staff meetings where developments for the service and people's needs and how they should be met were discussed.

We last visited Holly Bank House in June 2013 as part of our scheduled programme of inspections. This inspection found that: improvements were needed to ensure that people were protected against the unsafe practice in relation to medicines; staff did not receive appropriate training, evidence of supervision and appraisal and checks about the quality and effectiveness of the service were unavailable.

After our inspection the provider of the service sent us an action plan that detailed the improvements that would be made. As part of this inspection we checked that the stated actions had been undertaken to ensure that risks to people were minimised.

Our Pharmacy Inspector visited on 11 December 2013 and checked arrangements that were in place to ensure that the management of people's medicines was safe and appropriate. We found required improvements had been made and people's medicines were managed safely and appropriately.

We visited the service again on 19 December 2013 to check that staff were supported to deliver care and treatment to people who used the service safely and to an appropriate standard. We found that the service had again failed to meet this requirement and we are currently considering what action will be taken against the provider.