Holly Tree Lodge provides personal care and accommodation for up to 27 people. On the day of the inspection the registered manager informed us that 26 people were living at the home.

This inspection took place on 15 and 19 December 2016. The inspection was unannounced and was carried out by one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert for this inspection had experience of the care of older people and older people living with dementia.

A registered manager was 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 and associated Regulations about how the service is run.

People using the service and their representatives we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and generally understood their responsibilities in this area.

People's risk assessments provided staff with information of how to support people safely.

Staffing levels were, in the main, sufficient to ensure people were safe.

People using the service and relatives told us they thought medicines were given safely and on time.

There were systems in place to ensure that the premises were safe for people to live in.

Staff were subject to checks to ensure they were appropriate to work with the people who used the service.

Most staff had been trained to ensure they had the skills and knowledge to meet people's needs though more training was needed on relevant issues in order there was assurance to meet all the needs of people.

Staff generally understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives, and the service had obtained legal approval for limiting people's choices when necessary for their best interests.

People had plenty to eat and drink, everyone told us they liked the food served and people were assisted to eat when they needed help.

People's health care needs had been protected by referral to health care professionals when necessary.

People and their representatives told us that staff were friendly and caring and we saw many examples of staff working with people in a kind and compassionate way.

There was some evidence that people and their representatives were involved in making decisions about their care, treatment and support, though evidence was lacking in some care plans.

Care plans were individual to the people using the service and covered their health and social care needs.

There were sufficient numbers of staff to ensure that people's needs were responded to in good time.

Activities were organised to provide stimulation for people, though activities tailored to people's needs had not been frequently provided.

People and relatives told us they would tell staff if they had any concerns and were confident they would be followed up to meet people's needs.

People, their relatives and staff were satisfied with how the home was run by the registered managers.

People, their representatives and staff all said that this was a well led and well run service.

Management carried out audits and checks to ensure the home was running properly to meet people's needs.

At the time of our inspection the provider did not have a registered manager in post.

There were 24 people using the service on the day of our visit. Due to people’s level of dementia the majority of people were unable to give us their views on the care provided. However people that were able to give their views told us that they were happy with the support they received from staff. Comments included, “the staff are very good, lovely people.” And “I like them all, they are lovely.”

We saw that staff were responsive to people’s needs and wishes, for example we observed staff offering choices at the lunch time meal and supporting people with their meal in a caring and patient manner.

We found the home was well led by the acting manager and comments from people also confirmed this. A visiting professional told us, “the care here is very good, including end of life care, we know if we get a call from the staff the information we get will be accurate and there’s a good relationship between staff and residents.”

Visitors spoken with also confirmed they were happy with the care their relatives received. One visitor told us, “I’m more than happy with this home, the staff here are very caring.”

Sufficient numbers of staff were on duty to ensure people’s needs were met effectively.

An on-going maintenance programme was in place to ensure a safe and comfortable environment was maintained.

This was a follow up visit. Please see previous report for full information and comments.

Peoples care plans now contained personal information about the person who used the service. There was also evidence that families had been involved with decisions about care. One person we spoke with told us that they were very happy with the care provided.

The provider had revised their recruitment and selection policy to ensure that all staff would be subject to full pre employment checks before they commenced work.

On the day we inspected there were 24 people who used the service. We spoke with four people who resided at the home who were able to communicate with us, four relatives, one visiting health professional and three members of staff.

One relative stated "Everyone's very welcoming. Staff take an interest in you, as well as the person and other resident’s". Another stated that their relative was "treated very well". One person told us that "they do care, they really do care".

All the people we spoke with felt that the staff were very helpful. One person told us that staff are "very considerate" and show "true dedication to their job". A person using the service stated “anything you want you either get, or they (staff) will give you a reason why you cant get it”.

One family member told us that their relative’s room was "lovely".

One person told us that they liked the way people who used the service could walk about in the home and that residents spoke with each other and also visitors.

We found that there was some concern with care plans and pre-employment checks on staff members.

We were told by a relative that staff always act quickly when somebody becomes unwell.

One relative told us that she leaves some money for her mother each week and that they were happy the money is correctly managed. This person also said "I feel mum is safer here than before."

"I do think the residents are bored, fed up. She has told me she's fed up and that it's a long day. I think she gets up and wanders around for a change."

One visitor told us "I find the home clean, the domestics clean when the residents go for their meals."