We carried out an announced inspection of Holt Mill House on 13 December 2017.

Holt Mill House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Holt Mill House provides care and accommodation accommodates for three adults with a learning disability or autistic spectrum disorder. The home is a terraced property located on a quiet road in the town of Whitworth, Rochdale. Holt Mill House is part of a wider service provision which includes a day care facility and evening activities which are accessible to the local community. At the time of this inspection there were three people living at the home.

The service was managed by a registered manager. 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.

At our last inspection in March 2015, the service was rated Good. At this inspection we found the service remained Good.

During this inspection we observed people were treated with kindness, care and respect. Staff understood their responsibilities to safeguard people from abuse. There were appropriate arrangements in place in relation to the safe storage, receipt, administration and disposal of medicines and new staff were recruited safely. Risks to people’s health, welfare and safety were managed well.

The service was safe, clean and well maintained and suited to the needs of the people living there. People enjoyed a varied and healthy diet and changes in their health were monitored and acted on.

Each person had a support plan which provided clear guidance on how their needs and preferences would be met. Care and support was focused on people's wishes and preferences and people were supported to be as independent as possible in all aspects of their lives. People’s rights to privacy, dignity, independence and freedom of choice were firmly embedded into the culture of the home and staff embraced people's diversity.

Communication between people using the service, relatives and staff was good. People who had difficulty using words or expressing their needs were well supported by the use of other methods of communication which were known to staff.

People 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 supported to live full and active lives and use local services and facilities. Activities were provided both inside and outside the wider service and were meaningful, varied and personal to people’s requirements and in line with their wishes and aspirations. People were supported to keep in contact with friends and family.

There were sufficient numbers of staff to ensure people’s care and support was provided flexibly. The staff team at Holt Mill House was stable and happy and were committed to providing quality care; they felt valued, supported, well trained and respected by the management team.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. People’s views and opinions were sought and acted on.

Further information is in the detailed findings below.

The inspection of Holt Mill House took place on 3 March 2015. We gave the registered manager short notice of our inspection as the service was a small care home for younger adults who were often out during the day; we needed to be sure that someone would be in.

Holt Mill House is registered to provide accommodation and personal support for three adults with a learning disability. The service does not provide nursing care. At the time of the inspection there were three people accommodated in the home.

Holt Mill House is located on a quiet street of Whitworth. The house is close to local amenities and has easy access to the town of Rochdale.

At the previous inspection on 13 December 2013 we found the service was meeting all the regulations we looked at.

There was a registered manager in day to day charge of the home. 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.

Staff spoken with made positive comments about the way the service was managed and understood the values of the service.

We were unable to talk to people about what it was like to live in the home as they had difficulties expressing their views. However, we were able to observe the care and support being given by staff. We did not observe anything to give us cause for concern about people’s well-being and safety. We observed caring and friendly interactions between people living in the home and staff. We spoke with relatives who were confident people were treated well. One relative told us, “The staff are very good with him; they know what he needs.”

Staff told us they were confident to take action if they witnessed or suspected any abusive or neglectful practice and some staff had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered. People living in the home were involved in discussions about abuse and who to inform if they had any concerns. This would help raise their awareness of personal safety.

Staff knew whether people were able to make decisions and choices about their lives. Personal risks had been assessed and discussed with each person, or their relative, and recorded in their support plan. People were supported to take responsible risks as part of their daily lifestyle with the minimum necessary restrictions.

We found accurate records and appropriate processes were in place for the ordering, receipt, administration and disposal of medicines and people received their medicines on time.

A safe and fair recruitment process had been followed and proper checks had been completed before staff began working for the service. We were told there had been no new staff employed at this service for four years. Staff told us, “We have a good and stable team.”

We found there were enough staff to meet people's needs in a flexible way. One relative said, “Staff are very good; X gets on well with them all.” All staff were given the training and support they needed to help them look after people properly. During our visit we observed staff responding to people in a kind and friendly manner and we observed good relationships between people. Staff had a good knowledge of the people they supported and were able to respond appropriately to keep them safe from harm.

People were involved in the menu planning and would go shopping with staff to local shops and supermarkets. When needed, staff used pictures of people’s favourite foods to determine their choices. We observed people were supported and encouraged with their meals. The meals were presented well and people looked like they enjoyed them. Staff were aware of people’s dietary needs and preferences.

People living in the home had difficulties expressing their views. Staff used different methods, such as photographs and picture boards to enable good communication and to understand people’s views. We observed people were involved in decisions and choices about how they spent their day, the meals they ate, room décor, clothing choices and involvement in household chores.

Each person had a support plan that was personal to and included information about people’s likes and dislikes and routines as well as their care and support needs. People’s changing needs were identified, recorded and regularly reviewed.

There were opportunities for involvement in meaningful activities both inside and outside the home. People were involved in decisions about the activities they would prefer and were supported to maintain hobbies and interests. During our visit one person was attending the day centre, another person helped with the weekly shopping and the third person had been out in the car for a drive as he found this relaxing. People were also involved in household chores and would help with cleaning their rooms and taking washing to the laundry. People were supported to maintain relationships with their friends and family and were able to spend periods of time away from the home.

The complaints procedure was available in an easy read picture format that could be understood by everyone who lived at the home. People were encouraged to discuss any concerns during meetings and reviews, in day to day discussions with staff and management, and could also attend a ‘drop in’ session. Relatives spoken with said they knew how to make a complaint and were confident to do so.

There were systems in place to assess and monitor the quality of the service. They included checks of the medication systems, money, support plans, infection control and environment. There was evidence these systems had identified any shortfalls and that improvements had been made.

People were able to express their views and opinions of the service. People’s views about the service had been obtained during meetings, attending a drop in session, during reviews and during day to day discussions with staff and management.