This inspection visit took place on 1 and 7 March 2017 and was unannounced. We spoke with relatives via telephone on 7 March 2017.

Hollyhurst provides care and support with nursing for 16 people with a learning disability who may also have other complex needs such as mental health issues, epilepsy or behaviour that may challenge. The service has the main house and also a two person bungalow in the grounds for two individuals on the autistic spectrum.

The service had a registered manager in place. 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.

We last inspected the service in 16 February 2016 and rated the service as ‘Requires Improvement.’ At that visit we found breaches of regulations in relation to staffing levels and also in relation to staff supervision and support. At this visit we saw improvements had been made and the service was compliant with all Regulations at this time.

On this visit we saw staffing was now provided at safe levels and any staff absences were covered largely by the registered provider’s own permanent and bank staff. Where the service had on occasions to use agency staff, we saw this was provided by consistent staff who had been well inducted into the service.

Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

People, staff and relatives we spoke with told us they felt safe at Hollyhurst. Staff and people were aware of procedures to follow if they observed or were aware of any concerns.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner. People were also supported to manage their medicines themselves with support from staff and subject to appropriate assessments.

The home was clean, spacious and suitable for the people who used the service and people were enabled to access the spacious garden area. Improvements had been made in relation to putting in ensuite bathrooms, décor and furnishings. Appropriate health and safety checks had been carried out on the building.

Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals and told us they felt supported.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA). People are were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists to people’s physical health was supported.

Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service as smoothly as possible.

Staff supported people who used the service with their social and emotional needs. We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with staff members and there was a warm and positive atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and relatives and people told us that staff were

The inspection visit took place on the 15,16 and 18 February 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

The service had undergone major changes since our last inspection. The service had developed a two person service called Hollyhurst Lodge in a bungalow in the grounds. This service had transitioned two people with complex needs who had moved there from a hospital environment. The service had worked with the NHS to ensure this transition was managed with the minimum of impact for the two people concerned and some of the staff who had worked with these people in hospital, now supported them at Hollyhurst Lodge and were employed by the provider. The service also de-registered from providing hospital care in 2015 although it still provides nursing care to people with a learning disability. As a result of this change, some people left the service as they continued to require hospital care and other people who remained at the service were re-assessed and consulted about this change. There were currently 15 people using the service.

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 manager of the service took over in January 2016 and they had already applied to be registered with the Care Quality Commission.

Four people who used the service told us they felt safe at Hollyhurst and we observed care and support for people who were not able to communicate with us. This support was provided in a caring and dignified manner. We discussed safeguarding with staff and all were knowledgeable about the procedures to follow if they suspected abuse. Staff were clear that their role was to protect people and knew how to report abuse, including the actions to take to raise concerns with external agencies.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene, as well as condition specific training, such as working with people who had behaviour that may challenge. We found that the staff had the skills and knowledge to provide support to the people who lived at the service. People and the staff we spoke with told us that there were sometimes not enough staff on duty to meet people’s needs. We saw that the service had suffered with extreme staff shortages from before Christmas due to unfortunate staff sickness but was now actively recruiting and staff were returning to work from their sick leave. During the course of our visit there were sufficient staff on duty to meet the needs of the people and the staff team were very supportive of the manager and of each other.

Due to several key staff members being off sick at the latter part of 2015, staff supervision had not been carried out consistently. Many staff were new to the service and spoke to us about their induction and support which they said was good but records were not always in place to evidence this. We saw there was now a regular programme of staff meetings where issues where shared and raised with the manager but this had not been consistent in 2015.

Staff were aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) which meant they were working within the law to support people who may lack capacity to make their own decisions. Records in relation to DoLS were well maintained.

The service encouraged people to increase their independence. People were supported to be involved in the local community as much as possible. People were supported to use public transport and in accessing local amenities such as the local G.P, shops and leisure facilities, as well as using the facilities in the serv