This inspection took place on 30 January 2018 and was unannounced.

At the last inspection in February 2017, the service was rated 'Requires Improvement'. At this inspection we found that the service to be 'Good'. At our previous inspection, we had asked the provider to take action to make improvements and provide people with opportunities to engage in activities. At this inspection we checked to see if the provider had made the necessary improvements. We found that relevant improvements had been made.

The service provides care for up to six people with learning disabilities or mental health needs. At the time of the inspection there were five people living at the service. Holt Farm Care Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service was registered prior to the publication of Registering the Right Support. All but one person have lived there for a number of years. The service reflects values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was in post at the time of our 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.

The registered manager had identified potential risks to each person and had put plans in place to support staff to reduce these risks.

Staff understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns they may have.

Incidents and accidents were recorded and checked by the provider to see what steps could be taken to prevent these from happening again. Staff were trained in the safe management of people’s behaviours that cause harm to people themselves or others.

People were supported to take their medicines safely by suitably trained staff. Medication administration records (MAR) confirmed people had received their medicines as prescribed. The service was clean and well maintained.

The service followed safe recruitment practices that helped ensure only staff who were of good character and suitable to work in care were employed.

New staff completed an induction designed to ensure they understood their new role before being permitted to work unsupervised. Staff received regular support and one-to-one sessions or supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role.

People's needs and choices were assessed and support was delivered in line with current guidance. People’s independence was promoted.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully.

Staff supported people to access the healthcare services they needed to maintain their health and referred people to specialist support when necessary.

People were cared for with kindness and compassion. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

A complaints procedure was in place. Information was available for people and their relatives to make a complaint and relatives were confident the registered manager would respond appropriately if they raised any concerns.

Effective le

We inspected Holt Farm on 8 February 2017. It was an unannounced inspection. The service provides care for up to six people with learning disabilities or mental health needs. At the time of the inspection there were six people living at the service.

There was a registered manager in post. 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, the registered manager was on annual leave at the time of the inspection.

People were not always protected from potential risks to their safety and wellbeing. Some of the risk assessments were out of date.

Safe recruitment practices, such as police identity and character checks, were completed. However, the provider had failed to gather full employment history of their prospective staff members. As a result, people were not properly protected from the risk of being supported by unsuitable staff. The identified gaps in employment history had not been fully examined and explained.

People were not always provided with opportunities to engage in meaningful activities.

Feedback was sought from relatives and stakeholders as part of the provider’s quality assurance system. However, the feedback was not analysed and followed by an action plan to improve the service provided to people.

Quality assurance systems were not always effective and did not identify the shortfalls we found during this inspection.

Staff were knowledgeable about how to protect people from harm. People received their medicines when they needed them.

Records showed staff received the training they needed to keep people safe. The registered manager had taken action to ensure that training was kept up-to-date and future training was planned.

Staff sought people’s consent before providing care and support. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People's needs in relation to nutrition and hydration were documented in their care plans. People received appropriate support to ensure they received sufficient amounts of food and drink. Meals, drinks and snacks provided to people suited their dietary needs and preferences.

People were supported to maintain good health and they either attended appointments or were visited by healthcare professionals. Appropriate referrals were made when required.

Staff told us they felt supported by the management and received supervisions and appraisals, which helped to identify their training and development needs.

The service had prepared appropriate care plans to ensure people received safe and relevant care and support. Each person had a personalised care plan containing information about their likes and dislikes as well as their care and support needs.

Staff knew people well and interacted with them in a kind and compassionate manner. People’s privacy and dignity were respected by staff who supported them.

People and staff had confidence in the manager as their leader and were complimentary about the positive culture within the service.

We found a breach 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.