We carried out an unannounced comprehensive inspection on 24 and 25 July 2018.

Holly Cottage is home to five people with a learning disability and at the time of the inspection there were no vacancies. The single story premises provides good access for people with low mobility. The service is set on Highlands Farm near the village of Woodchurch, Kent. Each person has their own personalised bedroom, there is a communal bathroom and additional wet room. To the rear, there is a fenced garden with a large summer house.

Holly Cottage 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. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service good and we found that the evidence continued to support the overall rating of good with no evidence of serious risks or concerns. However, since the last inspection the service had not remained well-led. The registered manager had not worked at the service for over six months and had now left. During the interim period, the service had been managed by a deputy manager with oversight from the quality and compliance manager, however, staff development and service planning had decreased over the period leaving the team feeling less supported. A new manager had been appointed and had been in post for three weeks it was their intention to apply for registration, but during their induction they were being supported by the registered provider. Following the inspection, the manger provided an action plan with a focus on supervision and staff support.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

People had continued to receive a good service from the provider and the deputy manager praised the support and dedication the team had shown over the six-month period, when the service was without a registered manager.

People were protected from abuse by trained staff who understood how to keep people safe from situations that might harm them. Safeguarding procedures and personalised risk assessments provided staff with clear information to reduce and manage risks. There were sufficient numbers of staff rostered to ensure the flexibility to support people’s activities and appointments.

People received their medicines on time from staff that had been trained to administer medicines safely and the service worked closely with their local pharmacist to ensure that medicines were delivered, stored, recorded and audited regularly.

The service had remained clean and people had been protected from the risk of infection and cross contamination. Incidents had been recorded and appropriate measures put in place to ensure learning and follow up.

Staff had assessed and reviewed people’s needs holistically. Care plans were updated regularly to reflect changes to people’s choices and wishes in line with national best practice guidelines

Statutory checks and robust recruitment procedures ensured that staff had demonstrated the required level of suitability for the role. Staff received induction training along with ongoing monitoring and support from the experienced staff.

People were supported to eat and drink regularly throughout the day. Staff encouraged people to take an active involvement in planning and preparing their meals and assisted them to maintain a balanced diet and stay healthy.

People’s changing health needs were reflected in their care plans. Staff had supported people to att

Care service description

Holly Cottage is registered to provide accommodation and personal care for up to five people. Holly Cottage is a bungalow situated near Woodchurch village and has views over countryside. People living at the service had a range of learning disabilities. There were three people living at the service at the time of the inspection. The kitchen, dining room and lounge, as well as five single bedrooms and bathrooms are all on one floor.

Rating at last inspection

At the last inspection, the service was rated good overall and rated requires improvement in the ‘safe’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 September 2015. Two breaches of regulations were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, medicines management and Regulation 19 recruitment.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Holly Cottage on our website at www.cqc.org.uk

At this inspection we found the service remained good overall and is now rated good in the ‘safe’ domain.

Why the service is rated Good

The service had improved since the last inspection and the breaches of regulations had been met.

People were happy with the way their medicines were managed. There were now clear guidelines about people’s creams and about medicines taken ‘as and when’ needed. Medicines records were up to date and accurate.

The registered manager had checked all of the staff recruitment files and all records relating to staff were now up to date.

Staffing was organised around people’s activities and appointments. People said the staff were always there when they needed them.

Risks continued to be well managed so that no one was restricted and everyone enjoyed a full range of activities and experiences.

People said they felt safe and were supported to raise any concerns. Staff knew about different types of abuse and who to report any concerns to.

The inspection took place on 22 September 2015, and was an unannounced inspection. The previous inspection on 6 November 2013 was a follow up inspection to check on breaches found during an inspection on 8 May 2013. The inspection found no breaches in the legal requirements.

The service is registered to provide accommodation and personal care to five people who have a learning disability. There were five people living at the service at the time of the inspection. The service is a purpose built bungalow with accommodation provided on one level. It is set in a rural area on the outskirts of Woodchurch village on Highlands Farm, which is a tourist attraction and where the provider has other registered services located. Each person has a single room and there is a communal bathroom, separate wet room, kitchen and lounge/diner. There is a garden with a paved seating area at the back of the bungalow.

The service has a manager who took up post on 1 July 2015. They had submitted an application to register with the Commission and had their ‘fit person’ interview the same week as the inspection. 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 2008 and associated Regulations about how the service is run.

People told us they received their medicines safely and when they should. However we found some shortfalls relating to medicine management.

People were not fully protected by safe recruitment procedures, as records required by legislation were not always present on staff files. New staff underwent an induction programme and shadowed experienced staff, until staff were competent to work on their own. Staff received training relevant to their role. Staff had opportunities for one to one meetings, staff meetings and appraisals, to enable them to carry out their duties effectively. Staff had gained qualifications in health and social care. People had their needs met by sufficient numbers of staff. Rotas were based on people’s needs, activities and health appointments.

People felt safe living at Holly Cottage. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

Risks associated with people’s care and support were assessed and people were encouraged to be as independent as possible and participate in household tasks and access the community safely.

People benefited from living in an environment and using equipment that was well maintained. People’s needs were such that they did not need a lot of special equipment. There were records to show that equipment and the premises received regular checks and servicing. People freely accessed the service and spent time where they chose.

People were involved in the planning of their care and support. Care plans contained information about people’s wishes and preferences and some pictures and photographs to make them more meaningful. They detailed people’s skills in relation to tasks and what help they may require from staff, in order that their independence was maintained. People had regular reviews of their care and support where they were able to discuss any concerns or aspirations.

People were happy with the service they received. They felt staff had the right skills and experience to meet their needs. People felt staff were very caring and kind.

People told us their consent was gained through discussions with staff. People were supported to make their own decisions and choices and these were respected by staff. Staff had received training in the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The manager understood this process.

People were supported to maintain good health and attend appointments and check-ups, such as doctors, dentist and opticians. Appropriate referrals were made when required.

People planned their meals and had adequate food and drink. They liked the food and enjoyed their meals. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

People felt staff were very caring. People were relaxed in staff’s company and staff listened and acted on what they said. People said they were treated with dignity and respect and their privacy was respected. Staff were kind in their approach and knew people and their support needs well.

People had a varied programme of suitable activities in place, which they had chosen. People participated in work based activities, such as horticulture and art and craft, which they enjoyed as well as leisure activities. People’s family and friends were very important to them and contact was well supported by staff.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs. Some staff had worked at the service for some considerable time and had built up relationships with people and were familiar with their life stories and preferences.

People felt comfortable in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided both informally and formally. Feedback received had all been positive.

People felt the service was well-led. The manager adopted an open door policy and sometimes worked alongside staff. They took action to address any concerns or issues straightaway to help ensure the service ran smoothly. Staff felt the manager motivated them and the staff team.

The provider had a vision, to be a leading organisation providing quality care and support for adults with learning disability. Their mission was to provide a safe and fulfilling life for adults with learning disabilities. Staff were very aware of these and they were followed through into practice.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

On 8 May 2013 we inspected Holly Cottage and found non-compliance in the area relating to management of medicines. This was a follow up inspection to check compliance against that area.

During this inspection we spoke with three people who used the service, the registered manager and one member of staff.

People spoken with told us they continued to be satisfied with the service received. People said they got their medication when they should.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still the Registered Manager on our register at the time.

We spoke with four people who used the service and the new manager, who was the staff member on duty during our inspection. We also spoke with the previous manager who had very recently transferred to another Canterbury Oast Trust location, but assisted during this inspection. We made observations of interactions between the people who used the service and the managers (referred to in this report as staff).

People told us they could spend time as they pleased and were encouraged to do things for themselves. People said they knew about their care plans and had signed them after staff had read and explained their content. People said they were happy living at Holly Cottage and satisfied with the care and support they received. People told us they “liked living here” and that “everyone got on”. People talked about attending appointments for health concerns with the support of staff. People said they usually got their medicines when they should. Although we found shortfalls in medicine management. People benefited from the service having a robust recruitment procedure. People’s records were generally detailed and stored individually and safely.

We spoke with three people who used the service and two staff. We made observations of interactions between the people who used the service and staff.

People told us they knew about their care plans and had signed them after staff had read and explained their content. People said they were happy living at Holly Cottage and satisfied with the care and support they received. One person told us “I like living here, I like doing my cleaning and my favourite activities are craft and computers”. People knew who to speak with if they had any concerns, which they didn’t. One said, “We have meetings where we talk about what we are going to do and what’s happening”. People said they liked the meals and were able to choose what they had. People told us they like their rooms, the home was well maintained and always clean and tidy. People told us they thought there were sufficient staff on duty and that staff helped them when they needed it.

People told us they were treated with kindness and respect, and their independence was encouraged. They were happy with the care and support received and felt safe living in the home. People told us staff were nice and caring. People felt confident any concerns would be sorted out and they had a say in what happened in the home.