Holt House provides personal care and accommodation for up to 32 people, some of whom are living with dementia. At the time of our inspection there were 27 people living in the home. At the last inspection, in July 2015 the service was rated Good. At this inspection we found that the service remained Good.

The care that people received remained safe. There were enough staff to provide support to people to meet their needs. People were protected from the risk of harm and received their prescribed medicines safely. Staff had been safely recruited to ensure they were fit to work with people who used the service.

The care that people received continued to be effective. People made decisions about their care and staff sought people’s consent. Where people lacked capacity they were helped to make decisions. People received support to stay well and had access to health care services and were able to choose what to eat. Staff received training to meet the needs of people who used the service.

The care people received remained good. People were treated with dignity and staff were caring and kind. Staff helped people to make choices about their care and their views were respected. People's wishes to be cared for in the future and make advance decisions were recorded.

The care that people received remained responsive. People were involved in the planning and review of their care and support and there was a wide range of hobbies and activities available for people. Where people had any concerns they were able to make a complaint and this was responded to.

The service continued to be well-led. Systems were in place to assess and monitor the quality of the service. People and staff were encouraged to raise any views about the service on how improvements could be made. The manager promoted a kind and compassionate value base which put people at the heart of the service.

This was an unannounced inspection which took place on 16 July 2015. The service was last inspected on 06 August 2013 when we found it to be meeting all the regulations we reviewed.

Holt House is situated in a quiet residential area of Prestwich. It is close to public transport and the motorway network. The service is registered to provide personal care for up to 32 elderly people. There were 31 people living in the service on the day of our inspection.

The service had a registered manager in place 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.

During our inspection staff told us and records confirmed that all staff had received training in safeguarding and were able to tell us what actions they would take if they had any concerns about the safety of people who used the service.

The service had a whistleblowing policy in place which gave staff clear steps to follow should they have any concerns.

Risk assessments were in place for people who used the service in regards to their health and well-being, such as moving and handling, falls and nutrition.

We saw that equipment was available throughout the service to support people who had limited or no mobility. We also found care staff were trained in the moving and handling of people.

Robust recruitment processes were in place when employing new staff members. Checks were also undertaken to ensure their suitability to work in the service.

People who used the service, relatives and care staff we spoke with told us they felt there were always enough staff on duty to meet their needs.

The service had a contingency plan in place that instructed staff in how to deal with an emergency situation such as flood or fire. We saw that all the people who used the service had personal emergency evacuation plans in place and a fire risk assessment was available.

We looked at medicines management. We found the service had a policy and procedure in place to guide and inform care staff, only care staff that had been trained to do so could administer medicines and regular competency assessments were undertaken to ensure care staff were competent in the role. We noted temperature checks of medicines being stored in people’s bedrooms were not being completed and some signatures were missing from cream charts.

The service had a policy and procedure in place for infection control. Staff told us and records showed that staff had received training on infection control and knew their responsibilities in relation to this. We observed that the service was clean, tidy and free from offensive odours.

People who used the service told us they felt care staff had the knowledge and skills to meet their needs. Staff told us and records confirmed that staff completed an induction when commencing employment and undertook mandatory courses such as first aid, fire safety and moving and handling. Staff also shadowed experienced staff before undertaking duties independently.

A variety of training courses were available to staff such as end of life and dementia which they could access through workbooks, online or DVD’s.

Regular supervisions and appraisals were undertaken where staff could discuss their progress and any learning and development needs they had.

Verbal and written handovers were undertaken on each shift, detailing each person who used the service and how they had presented, including any concerns about their well-being. This ensured continuity throughout the staff team.

The registered manager informed us they had not made any applications for depravation of liberty safeguards (DoLS). They informed us the local authority had sent out instructions to providers and they had followed these. Staff told us they had not received training in Mental Capacity Act (2005) or DoLS, however records we looked at confirmed that this was available to them and most staff members had completed this. The service did not have a DoLS policy in place, however the registered manager actioned this promptly and sent us a copy of this the day after our inspection.

The service had consent forms in place for people who used the service in relation to care planning, photographs, access to personal information and medicine administration. We saw that these had been signed by people who used the service.

People who used the service had access to a range of healthcare professionals such as GP’s, district nurses, podiatrists and opticians in order to meet their health needs.

People told us they enjoyed the food on offer. We saw plenty of choices available for each meal and the food looked appetising and nutritious. Meal times were a sociable event and visitors were invited to take lunch with their relatives.

Refurbishment work was being undertaken within the service specifically with those people in mind who were living with dementia. We saw people were able to choose the colour of their bedroom doors which resembled a front door, memory boxes had been purchased and the registered manager was sourcing suitable signage to use throughout the service.

People who used the service and relatives told us that care staff were caring. We observed interactions from staff that were kind and sensitive. People also told us they felt their privacy and dignity was respected by care staff.

Visitors told us they were always made to feel welcome in the service and were offered refreshments.

We saw that staff had completed training on end of life care and team leaders had undertaken enhanced training on this. The registered manager informed us that located within the service was a one bedroomed flat. The main use for this was during times when a person who used the service was at the end of their life and their relatives wished to be near them.

The service employed an activities co-ordinator. On the day of our inspection we saw a prayer meeting was held in the morning that people could attend if they wished to follow their religion, followed by exercises and bingo and a memory quiz in the afternoon. We saw that people living with dementia were given one to one time with staff to undertake activities such as reading through the newspaper and discussing the news.

The service had plans in place to convert a store room into a sweet shop. The registered manager showed us the plans and told us this would be run by two of the people who used the service and would incorporate adaptations for people living with dementia.

We saw that all the people who used the service had spirituality care plans in place. These informed care staff if they were religious and how they would like their needs to be met.

None of the people we spoke with had ever needed to make a complaint. However we were told if they did they would speak with the care staff or registered manager. The service had a complaints policy in place.

The service completed pre-admission assessments prior to people moving into Holt House to ensure that the service could meet their needs. Care plans we looked at were person centred and looked at what the person wanted to achieve, when and the help and the level of support required.

The registered manager was responsive to feedback and proud of the care she and her staff delivered at Holt House. Staff we spoke with told us that the management team were approachable and always thanked them at the end of their shift.

Quality assurance systems in place were sufficiently robust to identify areas for improvement.

Policies and procedures were in place that were accessible for staff and provided guidance to support them in their roles. These had been reviewed on a regular basis.

We saw that regular meetings were held with people who used the service and surveys were given out to people, relatives, advocates and staff members to gain feedback on the service provided. Regular staff meetings were also held to gain the views of staff.

Holt House is a large detached property set in its own grounds. There is a large user friendly garden to the rear with car parking to the front and the side. The entrance to the home looked welcoming with lots of hanging baskets with colourful flowers.

The atmosphere was calm and relaxed. People were complimentary about the staff team. They said staff were, “very good,” “the staff are great,” “they are kind” and the “staff are brilliant”.

People told us that they generally enjoyed the food provided by the home. One person told us that if they did not want what was on offer then an alternative would be provided. One person said they could “always have a salad instead.” We saw that people enjoyed their meal and nearly everything was eaten.

People and relatives we spoke with said that the home was always clean and tidy and most importantly to them there were no malodours.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Appropriate checks were undertaken before staff began work.

Before our visit we contacted the local commissioning and safeguarding teams. They informed us that they had no concerns about Holt House.

When asked about the service, the two people we spoke with told us, “Absolutely lovely" and “Happy to be here”. We also spoke with two relatives who spoke highly of the staff and of the care provided. We were told, “Very good indeed” and “It’s like a home from home”.

People's care records contained enough information to show how they were to be supported and cared for. They also showed that people gave consent to their care and treatment.

Adequate equipment and adaptations were available to promote people’s independence and comfort and assist in their safe moving and handling.

People were cared for by a sufficient number of experienced staff who were suitably trained. This helps ensure the safety and welfare of the people using the service.

Regular monitoring of the services and facilities provided was in place to help protect people against the risks of inappropriate or unsafe care.

We spoke with five people who lived at the home and two relatives. People spoke positively about living at Holt House. They said that the members of the care staff team were, “very nice” and “very helpful.” One relative said that they had “peace of mind” that their relative was being well cared for.

We spoke to 2 people who had recently moved into the home. One person and their relative had looked at other homes before deciding to move into Holt House. Another person had previously had a short stay at the home. They liked Holt House and decided it was the right place for them to move into permanently.

One relative told us that the person they were visiting was well cared for. One person told us that they had been to hospital a number of times and that a member of the care staff team had always accompanied them.

Everyone we spoke with said that the food was good and there was plenty of choice.