This inspection took place on the 30 April and 3 May 2018 and was unannounced.

Following the last inspection, the provider wrote to us to show what they would do and by when to improve the key question of ‘Safe’ to at least good. We found that the provider was now compliant with the previously identified breach of Regulation 15 (premises and equipment) of the Health and Social Care Act 2008 (regulated Activities) 2014. Legionella and water quality monitoring, as well as, electrical equipment testing were all completed. Despite these improvements we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Hollymead House is a ‘care home’ which accommodates a maximum occupancy of 35 people. At the time of this inspection, 29 people were living at the 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.

There was a registered manager at this 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.

People told us they were happy living at this service. A person said, “It’s a very homely atmosphere. You can choose to be on your own in your room or if you want company there’s the lounges.” Another person told us, “It’s friendly and there’s plenty of room. If there’s something going on in one lounge you can go to another. There’s lots of windows to look out and see what’s going on. I like my room and my bed.”

People received a safe service and were protected from the risks of abuse. Staff received appropriate training and knew how to raise concerns if they felt people were at risk of being abused or mistreated.

People’s individual needs, choices and preferences were assessed and known by a caring, consistent, well trained staff team who knew people well. People and their representatives, as appropriate, were involved in their care plans and review of their plans of care by staff who were well trained to meet their individual needs. No external agency staff were used at this service at the time of this inspection. Individual risks for people were assessed and managed. Medicines were given to people safely and infection control procedures including correct use of protective equipment and robust cleaning schedules kept the home clean and free from any unpleasant odours.

People received care from staff who had undertaken training to be able to meet their individual needs and preferences, which included having enough to eat and drink. Snacks and drinks were available whenever people wished to have them. Meals were home cooked in line with people’s choice, preferences and needs, by well-trained kitchen staff. Specialist diets were catered for appropriately for people.

Staff were recruited safely. Checks were completed by senior staff which ensured staff performance and competence was closely monitored. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People told us that staff were caring and kind in their approach and that staff treated them with dignity and respect. Staff were aware of how to protect people's privacy which ensured this was maintained. People were supported to access healthcare in a timely manner and we were told by relatives that the management team were “proactive” and ensured healthcare professionals were contacted without delay when people needed this.

System

The inspection took place on 14 November 2016 and was unannounced.

Hollymead House provides care and accommodation for up to 35 people and there were 33 people living at the home when we inspected. These people were all aged over 65 years and had needs associated with old age and frailty.

Thirty four bedrooms were single and there was a double bedroom which was occupied by one person at the time of the inspection. Thirty bedrooms had an en- suite toilet. There was a communal lounge and dining area which people were observed using. There was also a conservatory which people were using for craft activities. A passenger lift was provided so people could access the first floor.

The service had a registered manager who was also one of the registered providers. Another staff member was also working in the role of manager and had applied for registration with the Commission. 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. There was an acting manager who had been in post since July 2015 and had not applied to register with the Care Quality Commission.

At the last inspection we found, staff did not receive adequate supervision, appraisal and training in certain areas. This was in breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan of how this was to be addressed. At the inspection we found improvements had been made to the supervision, appraisal and training of staff. This regulation was now met.

At the last inspection we found the provider had not taken steps to consult people about the use of CCTV in the home. This was in breach of Regulation 10 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan of how this was to be addressed. At this inspection we found people had been consulted and had agreed to the use of CCTV in communal areas. This regulation was now met.

The environment was generally well maintained, clean and free from any unpleasant odours. Equipment was serviced and maintained with the exception of testing of the electrical wiring, the hot water supply and measures to protect people and staff from any risks from possible legionella.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

There were sufficient numbers of staff to meet people’s needs. Staffing levels have been increased since the last inspection. Staff recruitment procedures were adequate which ensured only suitable staff were employed.

People received their medicines safely.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s capacity to consent to their care and treatment was assessed. At the time of the inspection each person living at the home had capacity to consent to their care and treatment and their choices were respected.

There was a choice of food and people were complimentary about the meals. The food was wholesome and nutritious. The provider consulted people about the food and meal choices.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular checks such as dental and eyesight checks.

Staff were observed to tre

During our visit to Hollymead House, there were 27 people living there and we spoke with ten of them. We spoke with the manager, the owner, visitors, members of staff, the cook and read through six personal care files. There was a homely and relax atmosphere with people getting on with their daily routine without hindrance. We found that people were treated in a dignified manner.

People we spoke with told us the following: “we are well cared for in here”, “I have no concern and I am free to do what I like”, “the food is very good and there is plenty”, “you can always depend on the manager and the staff”, “my mum is well looked after, I have no concern”. We read through personal care files and found that people were thoroughly assessed before admission and their care plans were reviewed in a timely fashion. There were risks assessments in place and we also found that people were in involved in their care planning. We looked at the rota and found that there was the right amount of staff on duty on each shift with a good skill mix. We looked at the menus and found that they were varied with a wide choice for people who use the service. Special diets were taken into consideration.

There was a complaint procedure and comment box in the reception area and people we spoke with were conversant with the procedure in place. We found that records management were appropriate and the manager told us that they were looking at moving on to a computerised management system.

We spoke with five people during our visit to the home. Everyone told us that they were happy with the care and support they received. One person told us, "I came here for a weeks respite care, but I have decided to stay here permanently now. The staff are kind and lovely. I'm very satisfied".

We gathered evidence of people’s experiences of the service by indirectly observing the care they received from staff. We also listened to how staff spoke to people. Staff acted promptly to meet people's care needs and spoke to people in a kind and respectful way.

People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the home and that they would be listened to if they raised any concerns. As one person explained, "I've been here for two years and I don’t think that anything could be better, we do what we like and we have everything that we need".

Our evidence gathered during this inspection supports the comments made by people who were receiving a service.

We spoke with people living in the home who told us they were generally very happy with the care provided in the home and that they were consulted on life in the home. They told us they were treated with respect.

Changes to the menu occur following consultation and people told us they enjoyed the food.

People told us that the staff seemed very busy and sometimes they have to wait when they ring their call bells.

One person told us that feedback is sometimes slow following surveys.

One relative told us that the admission process, care in the home and meals were very good.

We spoke with two professional who told us that there was never a problem with the service and that staff were organised when they visited. They were very satisfied with the care offered in the home.

The inspection took place on 29 and 30 September and 6 October 2015 and was unannounced.

Hollymead House provides care and accommodation for up to 35 people and there were 29 people living at the home when we inspected. These people were all aged over 65 years and had needs associated with old age and frailty.

Thirty four bedrooms were single and there was a double bedroom which was occupied by one person at the time of the inspection. Thirty bedrooms had an en- suite toilet. There was a communal lounge and dining area which people were observed using. There was also a conservatory which people were using for craft activities. A passenger lift was provided so people could access the first floor.

The service had a registered manager who was also one of the registered providers. Another staff member was also working in the role of manager but had not applied for registration with the Commission although this was their intention. 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. There was an acting manager who had been in post since July 2015 and had not applied to register with the Care Quality Commission.

Staff supervision and appraisal was inconsistent and training in the management of diabetes was not provided for one staff member who took a lead role in this.

People said they were afforded privacy and they were treated with respect but we noted closed circuit television (CCTV) cameras were used to observe and record visitors and people in the car park, the communal lounge and dining areas. Whilst there was a sign at the front door to say CCTV was in operation this did not specify which areas. The use of CCTV in the home had not been discussed with people.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures were generally adequate to ensure only suitable staff were employed.

People received their medicines safely. Whilst staff were trained in medicines procedures this did not include a direct observation of staff handling and administering medicines which was recorded as part of a competency assessment.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s capacity to consent to their care and treatment was assessed. At the time of the inspection each person living at the home had capacity to consent to their care and treatment and their choices were respected.

There was a choice of food and people were complimentary about the meals. The provider consulted people about the food and meal choices.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular checks such as dental and eyesight checks.

Staff were observed to treat people with kindness and dignity. People were able to exercise choice in how they spent their time. Staff took time to consult with people before providing care and showed they cared about the people in the home.

People said they were consulted about their care and care plans were individualised to reflect people’s choices and preferences. Each person’s needs were assessed and this included obtaining a background history of people. Care plans showed how people’s needs were to be met and how staff should support people.

There was a wide range of activities for people and a schedule of activities for the week was displayed in the entrance hall. These included arts and crafts as well entertainment from visiting musicians and singers.

The complaints procedure was available and displayed in the entrance hall. People said they had opportunities to express their views or concerns. There was a record to show complaints were looked into and any actions taken as a result of the complaint.

Staff demonstrated values of treating people with dignity, respect and as individuals. People’s and stakeholder professionals’ views about the quality of the service were sought. Staff views were also sought and staff were able to contribute to decision making in the home.

A number of audits and checks were used to check on the effectiveness, safety and quality of the service.

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