About the service: Holly House Residential Home is a care home providing accommodation and personal care to 22 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

¿ People experienced good care however statutory notifications were not always submitted in a timely way.

¿ People and their relatives told us they felt safe at the home.

¿ Potential risks to people’s health and welfare were assessed, effectively monitored.

¿ Safe staff recruitment practices were followed.

¿ Staffing arrangements were sufficient to meet the needs of people at the home.

¿ Medicines were safely managed.

¿ Staff received appropriate training and supervision to perform their roles.

¿ Mental capacity assessments were completed, and any best interests’ decisions were made with the involvement of people’s representatives and relevant health care professionals.

¿ A variety of nutritious meals were provided, and people were supported to eat, and drink sufficient amounts. People and their relatives told us that the food was excellent.

¿ People’s care was personalised to meet their individual needs. Their diversity, cultural and religious needs were promoted and respected.

¿ People’s privacy and dignity was maintained.

¿ Positive caring relationships had been developed between people and the staff team.

¿ People and their relatives were involved in all aspects of care planning where appropriate.

¿ People had opportunities to take part in activities that were of interest to them.

¿ The provider operated an open and transparent culture.

¿ People, relatives and staff were encouraged to ‘speak up’ if they had any concerns.

¿ Systems were in place for people to raise any concerns or complaints.

¿ Systems were in place for people, their relatives and staff to provide feedback and influence service development.

¿ Robust quality monitoring systems and processes were followed. Action was taken where any areas for improvement were identified and lessons learnt from incidents was shared with the staff.

¿ The provider, registered manager and staff team worked well with professionals and external organisations and they effectively used good practice guidance to enhance people’s quality of life.

¿ The service met the characteristics for a rating of "good" in four of the five key questions we inspected and a rating of "requires improvement" in one. Therefore our overall rating for the service after this inspection was "good".

Rating at last inspection: Good (published 18 August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on the 21 July 2016 and was unannounced.

The service is registered to provide care for up to 22 people. The service provides care to older people with a variety of needs including the care of people living with dementia. At the time of our inspection there were 21 people living there.

There was a registered manager in post at the time of our inspection. 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.

We saw that people were well cared for and the home had a relaxed atmosphere. People received care from staff that respected their individuality and were kind and compassionate.

There were appropriate recruitment processes in place which protected people from receiving care from people who were not suitable. People felt safe and secure in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

Staff were supported through regular supervisions and undertook training which focussed on helping them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments if people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People’s needs were assessed prior to coming to the home and individual care plans were in place and were kept under review. Staff had taken time to understand peoples likes, dislikes and preferences. There was a need to improve on the information about people’s life history and past hobbies and interests to enable the staff to develop individualised activities with people, which would enhance people’s daily experiences.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and engaged in conversations with them. Relatives commented positively about the care their relative was receiving and it was evident that people could approach management and staff to discuss any issues or concerns they had.

There were a variety of audits in place and action was taken to address any shortfalls. Management were visible and open to feedback, actively looking at ways to improve and develop the service.

We spoke with three visitors who all said they were welcome to visit 'Holly House' at any reasonable hour. One person said, "The staff always make me very welcome." Both visitors were confident their relatives had consistently received the care they needed.

We spoke with one person in the privacy of their room who said they received "very good care" from staff who were always kind. Some other people we spoke with said they were happy at 'Holly House' and they all confirmed they felt safe and "looked after".

We found that people's privacy, dignity and independence was respected and that as much as possible people were involved and encouraged by staff to make decisions about their care.

We found that people's needs had been assessed and were regularly reviewed. We saw there were care plans were in place to guide staff so they could meet people's needs.

We found 'Holly House' to be clean, comfortable, and free from odour.

Some people were unable to speak with us because their dementia had impaired their ability to communicate verbally with us. We were able to speak with two people in their own room and with four relatives who were visiting. All the people we spoke with were very pleased with the care and attention they received from the staff. One relative said, "Holly House is very homely. The staff really do take an interest in people and they all try very hard to make people happy." One person said, "I have all the help I need. My room is pleasant. The staff are cheerful, always smiling and chatting to people."

Relatives told us they were always made welcome by staff when visiting their loved ones. One relative said, "When I visit the staff always offer me a cup of tea and a biscuit. Staff want friends and relatives to visit so people keep their links with the community and their families. I think that is very healthy and it certainly reassures me. I am able to see how people are being treated and I am very satisfied."

People who lived at Holly House told us they were well cared for and had their needs met by the staff. They were complimentary about the choice of meals provided, support with medical needs and the range of social interests and activities arranged for them.

People were complimentary about the registered manager and staff who looked after them. They felt confident that any concerns they might have would be resolved quickly.

Some of the comments we received from the people who used the service included: “I love it here, staff are friendly and helpful when I need it” and “staff are very kind to me considering I’ve only been here a little while” and “nothing was too much to ask for.”

At the time of our site visit to the service the registered manager and provider were unable to show us evidence to demonstrate that they had effective systems to regularly assess and monitor the quality of services to ensure they provide safe care and support to people who used the service. Following our site visit to the service the provider sent us information to show how they intend to do this and copies of the new policies and procedures that they intend to use to underpin practices.

People living at Holly House, as well as their families and friends, have told us that they like it there. They are happy with the way the home is run and that they get the help and support they need. People tell us they are treated well at Holly House.

This inspection took place on the 27 October and 2 November 2015 and was unannounced.

The service is registered to provide care for up to 22 older people. The service provides care to older people with a variety of needs including the care of people living with dementia. At the time of our inspection there were 22 people living there.

There was a registered manager in post at the time of our inspection. 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.

Staffing levels at night and during parts of the day were not always sufficient to safely meet people’s needs. The number of staff available and the layout of the premises impacted upon staff’s ability to provide an appropriate level of supervision to all people living in the home.

This was a breach of regulation and you can see what action we told the provider to take at the back of the full version of this report.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

Staff were supported through supervisions and undertook training which focussed on helping them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments if people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were considered and relevant health care professionals were appropriately involved in people’s care.

People received care from staff that respected their individuality and were kind and compassionate. Their needs were assessed prior to coming to the home and care plans were in place and were kept under review. Care plans contained basic information and could be strengthened to help build a more comprehensive picture of each person. Staff understood people’s likes and dislikes and enabled people to participate in activities.

People were cared for by staff who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people whilst delivering care. Relatives commented positively about the care their relative was receiving and it was evident that people could approach management and staff to discuss any issues or concerns they had.

There were a variety of audits and risk assessments in place, however management did not always fully utilise the information they collected when deciding on staffing levels within the home.

Management were visible and open to feedback.