This inspection took place on 1 March 2017 and was unannounced.

Holly Bush Nursing Home provides care and accommodation for up to 12 people with learning disabilities, sensory impairments and physical disabilities. It is located in Stanmore. At the time of the inspection the home was fully occupied.

Some people who lived at the home had mobility difficulties, which affected manual dexterity and coordination and some had sensory impairment, which meant they could be highly sensitive to sound and touch. Others did not speak verbally, and could only speak by way of communication aids, as well as hand gestures and facial expressions. These impairments meant they could not cope living independently.

The home’s vision was to ‘promote people’s independence and well-being’ by ensuring they maintained and respected people’s rights, dignity, privacy, independence and personal choice. In order to achieve this goal, the home had a set of objectives which defined steps that they needed to take. These objectives included: empowering people to make informed choices; treating people with respect at all times; upholding the human and citizenship rights of all people; and, working in partnership with support services and relatives to ensure that the best interests of people were met. At this inspection we saw that the home had exceptionally addressed these objectives. This was also confirmed by professionals and relatives we spoke with.

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

Staff understood the needs of people. We saw that they closely monitored these needs to ensure they were met. In some instances this had led to marked improvements in people’s conditions since moving to the home. This was evident where people had been admitted to the home because their previous placements could no longer fully support their needs. We received some exceptional feedback from professionals who had previously worked with some of the people using the service. They were able to tell us about people’s journeys and how Holly Bush Nursing Home had transformed their quality of life. For example, some people had been prone to frequent hospital admissions due to complex medical needs. However, since moving to the home, the hospital admissions had significantly reduced due to support and treatments which suited them.

Staff were resourceful in finding ways to meet people’s needs. They did not give up on trying new things with people even when evidence suggested otherwise. In one example, staff had managed to support one person to go on holiday. This had been their first holiday in many years. Previous homes had not been able to do so. This is one of many good examples of personalisation that we saw.

People were treated with kindness and compassion. Staff consistently went out of their way to meet their needs. Professionals involved in people’s care and people’s relatives were also complimentary about the kindness and empathy displayed by staff. One person had enthusiastically given an account of how a particular member of staff had gone out of their way to support them with their preferences. Their account was consistent with another act of kindness shown by staff to another person. A relative of this person could not stop praising the kindness shown by staff.

Risks to people were minimised because the home had procedures to protect people from harm. Their risks had been assessed, identified and well managed. Staff understood how to keep people safe. They had received training on how to identify abuse and understood procedures for safeguarding people.

The home followed safe recruitment practices. Therefore people were protected from

We undertook this unannounced inspection of Holly Bush Nursing Home on 23 February 2015. At our last inspection in February 2014 the service was meeting all the regulations we looked at.

Holly Bush Nursing Home provides accommodation and nursing for 12 people with learning disabilities.

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

The service worked closely with funding local authorities and other healthcare providers, including the local hospitals and general practitioners. People had access to healthcare professionals when required.

People were supported to make choices about their care. Care plans included information about people’s likes and dislikes and a description of daily routines and personal preferences. Care plans explained how people would like staff to help them meet their needs, encourage their independence, respect their lifestyle and help them meet their goals.

There were suitable arrangements for the recording, storage, administration and disposal of medicines in the home.

There were enough staff employed to meet people’s needs and recruitment procedures were robust, ensuring that only people who were deemed suitable worked in the home. Staff were provided with support and training to help them carry out their roles.

Staff understood the needs of people and we observed care was provided with kindness and compassion. People’s relatives told us they were happy with the care people were receiving.

The registered manager assessed and monitored the quality of care consistently. The provider encouraged feedback from people, their relatives, staff and professionals involved in care. There was evidence feedback was used to make improvements.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people’s rights in relation to this were properly recognised, respected and promoted.

Most of the people living at the home were not able to tell us about their care because of their learning disability or medical condition. We spoke to people's representatives and relatives and saw that they had provided consent for care to be provided where people were not able to do this themselves.

We saw that people appeared well cared for, comfortable and relaxed at the home.

We saw that people's care plans were drawn up to take account of their assessed need and that care was provided in a way intended to ensure the safety and welfare of people although there was some inconsistencies between care plans and support and treatment provided.

The planned menus were based on standard English cuisine. We saw that people were provided with nutritious and well balanced meals. Care had been taken to provide for people who needed a special diet for medical reasons.

Staff had been trained in safeguarding and were familiar with safeguarding policies and procedures. The provider had systems in place to audit procedures for ensuring the safety of the services and to assess and monitor feedback about the quality of the services provided.

During our last inspection we found that staff were not always able to understand the needs of people due to lack of appropriate training and they did not always receive regular supervision. We judged this to have a moderate impact on people using the service and the provider sent us a plan as to how they would improve the service.

The staff said they had been on training to understand the needs of people who have autism and told us they found the training, "Extremely beneficial" and, "We can better understand people's needs"

We found that staff were able to communicate with people and understand their needs. We saw that the provider had arranged appropriate training for staff. The provider told us they carried out regular supervision of staff every 2 months and this was confirmed by the staff.

People using the service told us that they enjoyed living at the home, that they felt safe and were well cared for.

We found that people were involved in the planning of their care. The provider was making improvements to ensure people who were not able to verbally communicate were more involved in the decisions that affected them by developing new ways of working.

Care plans gave sufficient information to staff so that people's assessed needs could be met. We also found that staff had a good working knowledge of people's care needs.

We found that people were protected from abuse because the provider had made arrangements to prevent abuse. We also found that staff were appropriately recruited to work in home because the provider had appropriate reference and criminal checks carried out prior to people commencing work.

We did find that the service was not meeting standards regarding staff training. Although staff had basic care training they did not always understand the needs of people using the service because they had not received training in areas such as communication and Autism.