Hollybush House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Hollybush House Nursing Home is a care home with nursing, which can accommodate up to 24 older people, some who live with dementia. At the time of our inspection 15 people were using the service.

At our last inspection in February 2016 we rated the service as good. At this inspection we found evidence that led the key question of Effective to be rated as Requires Improvement. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The inspection visit took place on 12 December 2018 and was unannounced.

There was an acting manager in post who had submitted an application to become the 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 2008 and associated Regulations about how the service is run. The acting manager was not available on the day of inspection.

Training around mental health needs and deprivation of liberty was lacking for all staff, and staff did not have a high level of knowledge in these areas, although this did not affect the general care of people and they were supported by staff in the least restrictive way possible. People were supported to have choice and control of their lives. People were assisted to access appropriate healthcare support and received an adequate diet and hydration.

People continued to receive care that made them feel safe and staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to/follow. Safe recruitment of staff was carried out and adequate numbers of staff were available to support people. People received medicines as required.

The care people received was provided with kindness, compassion and dignity. People were supported to express their views and be involved as much as possible in making decisions. Staff supported people to have choices and independence, wherever possible. People’s diverse needs were recognised and staff enabled people to access activities should they so wish.

The provider had effective systems in place to regularly review people’s care provision, with their involvement. People’s care was personalised and care plans contained information about the person, their needs, choices and cultural needs. Care staff knew people’s needs and respected them. People were able to speak openly with staff and understood how to make a complaint.

The service continued to be well-led, including making detailed checks and monitoring of the quality of the service. People and staff were positive about the leadership skills of the acting manager. We were provided with information about the service where required.

Hollybush House is registered to provide accommodation and nursing care for up to 24 people, who are mainly older people with dementia. The home also provides a respite service where people are supported through a time of rehabilitation prior to returning home. At the time of our inspection 21 people were using the service. Our inspection was unannounced and took place on 18 February 2016. The service was last inspected on the 12 June 2013 where it met all of the standards.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were given appropriately. People were supported to take sufficient food and drinks and their health needs were met.

We observed there were a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs. People told us that they were kept safe.

People told us that they were able to raise any concerns they had and felt confident they would be acted upon. People and their relatives understood the complaints procedure.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. People were encouraged to make their own decisions. Staff interacted with people in a positive manner.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible. Social activities were carried out and people’s preferences acknowledged. The home had a friendly and welcoming atmosphere.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision, allowing staff to understand their roles, and responsibilities were in place.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective.

Quality assurance audits were undertaken regularly and the provider gave the registered manager support.

Notifications were sent to us as required, so that we could be aware of how any incidents had been responded to.

During our inspection we spoke with four people, two relatives, four care staff, the deputy manager and two visiting health professionals.

People told us that they had been involved in the compilation of their care plans. One relative said, “They always ask me and get me to sign for treatment to be given.”

People we spoke with said they were happy with the care and support being provided. A relative said, “Professionally I go to lots of homes, they can’t touch this. It’s excellent.”

Policies were in place in respect of safeguarding people from abuse. Staff had been trained and knew how to identify abuse and what the reporting procedures were.

Staff were well trained to provide care to people and received appropriate support and supervision from their management.

There was an established quality assurance system in place within the home. People were consulted about the quality of care.

People using the service were asked in a number of ways how they wanted their care to be delivered and their dignity and privacy was promoted and maintained. One relative we spoke to said “the staff here will listen to you and respond to your requests”, “I wouldn’t mind staying here myself”

People we spoke with told us positive things about the care and support that they or their relatives had received. We spoke to a relative who’s job entailed visiting a number of care homes, they said “my partner is very happy here they look so relaxed, this place is definitely one of the best I have to go into”.

Evidence we gathered indicated that staffing levels were adequate and people acting on behalf of persons using the service told us that there were enough staff to meet their needs.

There were systems and procedures in place for the safe administering, storage and disposal of medicines.

Systems and processes were in place to receive, handle and respond to complaints made by service users or persons acting on their behalf.

Hollybush House Nursing Home operates one long term unit where eight people live permanently and one temporary unit where up to 16 people stay until permanent accommodation is arranged or until they are ready to return home. We found differences between the permanent and temporary units. We saw that the bedrooms, furniture and flooring in the permanent unit was more homely and in better condition than in the temporary unit and that the temporary unit appeared more clinical. The manager told us that they have already requested replacement furniture and flooring from the provider for the temporary unit. The manager said that there is an ongoing refurbishment programme and we saw a maintenance person discussing colour schemes for redecoration of the corridors with the manager.

We talked with two people who lived at the home, three visitors and four staff about the care delivered to people. All the visitors told us that the care was really good and their only worries were about finding permanent accommodation for their relatives. One visitor said, “I am very pleased with the care here, I wish my relative could stay permanently”. A person living at Hollybush temporarily said, “It is quite nice, I like it here, I can sit and read or chat with my visitors”.

We saw that some people were sitting comfortably in the main lounge reading the paper and other people were enjoying a walk around the building for exercise and chatting to staff in passing. We found that staff were equally knowledgeable about people’s individual needs in both units and we saw kind, thoughtful interactions between staff and people living at Hollybush.