The inspection took place on 25 April 2017 and was unannounced.

Hollywynd Rest Home is a residential care home, which provides accommodation for up to 40 older people. At the time of our inspection there were 27 people living at the home. Nursing Care is not provided. Hollywynd Rest Home is a large, detached, older style property situated close to the town centre of Worthing. Communal areas included a large sitting room, open planned dining room with another sitting area and a conservatory which looked out on the garden. There was a sitting area on the ground floor corridor to allow people to sit and rest when needed. The home provides accommodation over two floors with a passenger lift and stair lift available to access all floors.

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 and associated Regulations about how the service is run. Both the registered manager and provider were available on the day of our inspection.

The last inspection took place on 22 and 23 December 2015. As a result of this inspection, we found systems were in place but not consistently used to identify risks. Guidance for staff on how to reduce risk was, at times, limited. This was a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that care plans were being updated at the time of that inspection; however this was a work in progress and not all people had a care plan which reflected their needs. We also found that activities were available however; these were not scheduled in a way that ensured people’s social needs were always met. This was a breach of Regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, the provider wrote to us with their action plan to confirm that they had addressed these issues. At this visit, we found that the actions had been completed and the provider has now met all the legal requirements.

At this inspection, people described staff as kind and caring. People told us they felt they were treated with respect and dignity. Most observations reflected this. However, we observed examples where staff were not always caring, respectful or people’s dignity and this was not consistently maintained. This is an area requiring improvement.

Systems were in place to identify risks and protect people from harm. Care records contained guidance and information to staff on how to support people safely and mitigate risks. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required. Accidents and incidents were accurately recorded and were assessed to identify patterns and trends. Records were detailed and referred to actions taken following accidents and incidents.

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 told us they felt safe at the home. Policies and procedures were in place and medicines were managed, stored, given to people as prescribed and disposed of safely.

There were sufficient staff in place to meet people's needs. The registered manager used a dependency tool to assess that staffing levels were based on people's needs. These were up to date and reviewed monthly. Robust recruitment practices ensured that new staff were vetted appropriately and checks were undertaken to confirm they were safe to work in a caring profession.

Staff received an induction into the service and senior staff checked competencies in a range of areas. Staff had received a range of

During our visit we spoke with the assistant deputy manager of the service, the administrator and members of staff. We spoke with five people who used the service. They all told us that they had received information about the home before they moved in.

We used a number of different methods to help us understand the experiences of people using the service. People who lived in the home all told us "it’s a great place to live" and "I like all the staff".

We looked at a selection of care records. We noted in four records that there was a lack of health monitoring to ensure that people's needs were being assessed and care planned appropriately. One relative told us "I've never been asked to be involved in the care plan".

We spoke with one relative who said "The care here is superb, the staff are amazing". Another said "they are very caring". One person who lived at the home told us "As far as care homes go, this one's great".

We viewed records relating to staff recruitment and found that the provider was operating effective recruitment procedures.

We found the lack of consistent recording systems meant that there was a risk that information may not be kept up to date and people may not be protected against the risks of unsafe or inappropriate care and treatment.

We found people expressed their views and were involved in their care and treatment. We found people's views were clearly documented and there was a system in place to address unforeseen emergencies which arose at the home.

People and their relatives told us they were happy with the care they received while living at the home. One person told us ''we get a cup of tea before breakfast, that's lovely.''

We found people were protected from the risk of abuse as staff were trained to recognise abuse. Staff told us they knew how to raise a safeguarding concern if they needed to.

We reviewed the training records and found staff received appropriate training for their roles. The training provided staff with the knowledge and skills to deliver care that was safe and appropriate for people living in the home.

We found people has personalised care plans and risk assessments. We found for every identified risk there was a plan in place to address the risk. We saw people had daily preference lists that were used to meet their preferences.

We found the provider had a system in place to monitor the quality of the service they provided.

People who use the service told us that they were happy with the care they receive and said that staff helped them to do things for themselves. They told us that any help is given in the way that they want. People said that they liked living at Hollywynd Rest Home and they said that they felt safe in the home. People told us that they like all the staff that supports them and said that the staff are nice and they told us that there was always someone around to help when needed. One person told us “don’t worry about me I am well looked after and very happy here”.

We spoke with 4 care managers from Worthing Social Services who support people who live at Hollywynd Rest Home and they told us that they visit the home regularly. They said that they were satisfied with the care and support provided people and that they have no concerns about the service.

Health and social care professionals who we spoke with told us that the staff are very friendly and they had no concern as to the efficiency and knowledge of staff or the care provided to people.

We spoke with a number of relatives and they told us that they were happy with the care and support their relatives were receiving and said that they were always made welcome when they visited.

Staff told us that they would always respect people’s wishes and said that people who use the service are involved in all aspects of their lives and that people are actively encouraged to express their views and opinions. Staff spoken with told us that the staffing levels were about right.

Hollywynd is a residential care home which provides accommodation for up to 40 older people. At the time of our inspection there were 27 people living at the home. Some of the people at the home were living with dementia. This inspection was unannounced and took place on the 22 and 23 December 2015.

There was no registered manager in place at the time of the 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. However a new manager was in post and was in the process of registering with the Commission.

The home was previously inspected on the 27 January 2015 and we identified breaches of regulation in relation to staffing levels, people not being treated with dignity and respect at all times, care planning and delivery, meeting people’s nutritional and hydration needs and ensuring that the premises were suitable for purpose. We found that improvements had been made and action taken by the provider to address the concerns from our previous inspection. However we identified new concerns and breaches of Regulations at this inspection.

At this inspection we found that the provider had taken action to address to improve staffing levels and there were sufficient numbers of staff on duty to keep people safe and meet their needs. We reviewed the rota and the numbers of staff on duty matched the numbers recorded on the rota. Relatives felt that there were enough staff on duty and we were told “I have to say last year it was a noticeable problem but I have to say that it seems a lot better”. We observed that people were not left waiting for assistance and people were responded to in a timely way.

With regard to treating people with dignity and respect we found that the provider had taken action to improve. Relatives spoke positively of the manner and response of the staff. One relative told us “the one’s I’ve seen are kind and caring, some are brilliant; (named member of staff) has never not got a smile on her face”. We spent time observing the care practices in the communal areas and saw that people’s privacy and dignity were maintained.

With regard to the planning and delivery of people’s we found the provider had taken action to address concerns raised at the last inspection. However care was not always provided in a way that met their needs and ensured their welfare because not all care plans had been accurately completed or updated. People and relatives told us that people had a choice in the support that they received and preferences around the gender of care staff was respected. Relatives told us that people had choices in decisions about their daily routine such as what time they got up in the morning and when they went to bed.

The previous inspection identified concerns that people were not supported to follow their interests and take part in social activities. The provider had taken steps to address this issue and activities were now in place. However we identified issues with the frequency of the planned activities. People told us they did not feel there were enough activities on offer. One person told us “I get so bored here. I get sick and tired of sitting and staring into space”. Health care professionals told us they had concerns about the lack of meaningful activities available for people.

The manager was in the process of updating people’s care plans to ensure that they were reflective of people’s needs and included their preferences. We saw that seven people’s care plans had been updated however other people’s care plans contained limited information or guidance for staff on how to meet their needs. This meant that people’s needs and preferences may not have been reflected in the care and support which they received.

The previous inspection raised concerns that people’s nutrition and hydration needs were not being met. We saw that the provider had taken action to address this issue and people spoke highly of the quality of the food. People told us they had enough to eat, enjoyed the food and were offered choices. People told us “the food is good, I’ve got nothing to complain about the food”. People’s dietary needs and nutritional requirements had been assessed and recorded. Weight charts were seen and had been completed appropriately on a monthly basis.

The previous inspection identified concerns around the raised entry into the showering/bathing facilities within people’s room. While the provider had not taken action to address this issue the impact on people was minimal as there were alternative bathing and showering options for people.

At this inspection we identified new concerns relating to the systems in place to identify risks and protect people from harm. We found that risk assessments were used inconsistently. From the care records reviewed risk assessments were in place for some people but not for others. The manager told us that they were in the process of updating the risk assessments for everyone and this “was a work in progress”.

Staff had undertaken appropriate training to ensure that they had to skills and competencies to meet people’s needs. One member of staff spoke with us about the increase in the training they had received since the new manager started they told us “(manager) has really gone to town on our training”.

People were supported to maintain good health and had access to health professionals. Staff worked in collaboration with professionals such as doctors, specialist dementia teams and the falls prevention team to ensure advice was taken when needed and people’s needs were met.

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 end of the report.