The inspection visit at Holywell Home was undertaken on the 16 February 2017 and was announced. We informed the provider 24 hours before our visit we would be coming. This was because the home was small and we wanted to ensure people were available to talk with.

Holywell care home provides accommodation, nursing or personal care for up to six adults with a learning disability. There were five people living at Holywell Home at the time of our inspection.

The home is situated at the West End of Morecambe, close to the promenade and within easy access to local amenities. There is one communal lounge and a combined kitchen and dining room on the lower ground floor. There is no lift therefore the home is not suitable for people who cannot manage stairs.

The registered manager was not present during our inspection visit. We spoke with the registered manager the following day. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the last comprehensive inspection on 08 April 2016, we found the provider was not meeting the requirements of the regulations in respect of safeguarding people from abuse and improper treatment, need for consent, staffing, good governance and the notification of incidents. We carried out a focused inspection to check improvements had been made. At the focused inspection on 29 July 2016, we found the provider was meeting the requirements of the regulations that were inspected. We did not improve the ratings because to do so requires consistent good practice over time.

During this inspection in February 2017, we found staffing levels ensured people were safe. There was an appropriate skill mix of staff to ensure the needs of people who lived at the home were met.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received safeguarding from abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had ensured risks to individuals had been assessed and measures put in place to minimise such risks. A plan was in place in case of emergencies which included detail about how each person should be supported in the event of an evacuation.

The provider had recruitment and selection procedures to minimise the risk of unsuitable employees working with vulnerable people. Checks had been completed prior to any staff commencing work at Holywell Home. This was confirmed from discussions with staff.

Staff responsible for administering medicines were trained to ensure they were competent and had the required skills. There were appropriate arrangements for storing medicines safely.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able to speak with us told us they were happy with the meals available to them. We saw regular snacks and drinks were available between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had liaised with healthcare providers and responded promptly when people had experienced health problems.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the management t

We carried out an unannounced comprehensive inspection of this service on 08 and 27 April 2016, at which four breaches of legal requirements were found. This was because the provider did not take effective preventative action to manage risk and keep people safe. Suitable systems were not in place to monitor and mitigate the risks to people who lived at the home. We also found the provider did not maintain an accurate and complete record of the care provided to instruct staff and minimise risk.

Following the inspection, we took enforcement action as the provider did not ensure there were enough staff to respond to the changing needs and circumstances of people requiring support. They also failed in their duty to notify the Care Quality Commission (CQC) about events they were required to.

After the comprehensive inspection in April 2016, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches and enforcement action. We carried out this unannounced focused inspection on the 29 July 2016 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Holywell Home on our website at www.cqc.org.uk'.

Holywell Home provides personal care and accommodation for up to six adults with a learning disability. The home is situated at the West End of Morecambe, close to the promenade and within easy access to local amenities. There are two communal lounges, one on the lower ground floor and one on the first floor. There is also a combined kitchen and dining room on the lower ground floor. There is no lift therefore the home is not suitable for people who cannot manage stairs. At the time of our inspection, five people lived at Holywell Home.

A registered manager was not 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 2008 and associated Regulations about how the service is run. The provider was awaiting their Disclosure and Barring Service (DBS) clearance before submitting their application to become the registered manager. The Disclosure and Barring Service (DBS) helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups of people.

At our focused inspection on the 29 July 2016, we found improvements had been made. We saw documentation that indicated staffing levels were safe. The provider had systems to respond to unplanned staff absence. We saw safeguards were in place to manage risk.

Information we looked at in people’s care records reflected the current needs of people being supported and informed staff how to support them.

We read the diary sheets written by staff concerning people who lived at Holywell Home. We found no evidence incidents went unreported to the Commission.

We could not improve the rating for safe and well led from inadequate because to do so requires consistent good practice over time. We could not improve the rating for responsive from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

The inspection visit at Holywell Home was undertaken on the 08 April 2016 and was announced.

We informed the new manager 48 hours before our visit that we would be coming. This was because the home was small and we wanted to ensure people were available to talk with.

We had received several concerns about people’s safety and the management of the home. We checked people were not at risk of receiving unsafe care.

Holywell care home provides accommodation, nursing or personal care for up to six adults with a learning disability. There were five people living at Holywell Home at the time of our inspection.

The home is situated at the West End of Morecambe, close to the promenade and within easy access to local amenities. There are two communal lounges, one on the lower ground floor and one on the first floor. There is also a combined kitchen and dining room on the lower ground floor. There is no lift therefore the home is not suitable for people who cannot manage stairs.

The home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The provider had recently appointed a new manager who was applying to become the registered manager.

At the last inspection on 03 September 2014, we found the provider was meeting the requirements of the regulations that were inspected.

During this inspection, we found staffing levels were not sufficient to keep people safe from harm. Poor staffing levels had meant people who required care and support were at risk.

The provider had not managed risks to two people they supported. Risks had been identified but safeguards to keep them free from danger had failed.

People did not receive care that was responsive to their changing needs. The provider failed to ensure there were systems to manage people’s individual behaviours and keep them safe.

The provider did not have accurate and complete records to instruct staff on how to provide help to people safely. Records identified what help people required but did not instruct staff how to support them.

Not all staff had regular supervision meetings with a member of the management team to review their role and responsibilities.

The management team had not fulfilled their regulated responsibilities. They had not notified CQC and the local authority of all events and occurrences as required.

The provider had oversight of the home but failed to act to maintain the quality of the care provided.

Staff had received abuse training. They understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had recruitment and selection procedures to minimise the risk of unsuitable employees working with vulnerable people. Checks had been completed before any staff started work at the home. This was confirmed from discussions with staff.

Staff responsible for helping people with their medicines were trained so they were competent and had the skills required. Medicines were safely and appropriately stored.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Comments we received showed people we spoke with were satisfied with their care. The provider, new manager and staff were clear about their roles and

This was a responsive inspection because we had received information of concern regarding this service. This related to an increase in safeguarding incidents being reported within the home.

During our inspection we looked at the systems the home had in place to keep people safe and well. We looked at care plan records and risks assessments, the safety of the environment, staffing levels, staff support and the quality monitoring systems.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We spoke with several people who lived at the home, observed their care and support, spoke with members of the staff team and the registered manager.

We looked at several care plan records to show us how the staff team supported people to remain safe and well in their home. Information in the care plans identified a range of support required by people. There were detailed behavioural intervention plans in place, and joint working with a range of external professionals was in place to meet people`s needs. Care plan records and risk assessments were regularly reviewed.

Is the service effective?

People's health and care needs were assessed, monitored and reviewed. The staff team worked in partnership with other professionals in order to support people with their changing health conditions. We saw evidence of recent work with local psychiatric and neurology services, GP`s, District nurses and local learning disability services.

Is the service caring?

Staff we spoke with told us they felt well supported and enjoyed their work. They appeared to be caring and enthusiastic. Our discussions confirmed staff were knowledgeable regarding people`s needs and what actions to take if they had any concerns.

Is the service responsive?

We saw evidence to show us that the home was responsive when meeting people`s health care needs. The registered manager worked on a daily basis alongside people and the staff team. This meant that advice and guidance could be given and immediate action taken if there were any concerns. Staff told us the care plans informed them of people`s needs and preferences. They told us they felt well supported and received training and supervision.

Is the service well-led?

There was a range of systems in place to monitor the quality of the services being provided. However due to the increase in safeguarding incidents within the home we discussed that the provider may wish to consider implementing formal ways of gaining the views of relatives in relation to this. This feedback would help to ensure that people received a good quality service at all times.

During the visit we spoke with four people living at the home, the registered manager and a support worker. Although two of the people spoken with were vocal in telling us what they thought, other discussions were brief and more limited due to people's learning disability. People told us that they were happy living at the home, that they liked the staff who supported them and that they were able to enjoy social activities of their choice.

People also told us that they enjoyed the meals served and that they had helped to plan what they were going to eat. One person said, “I like the meals here, I can choose what I have”. People also told us that they could make their own drinks or toast at any time they liked. This meant that although staff assisted with main meals, people were encouraged to remain as independent as possible. People chose for themselves when to make a drink or snack.

People spoke positively of the care they received and described staff as, “All right”. We asked one person if staff helped them properly, we were told, “Yes they do”. Another person said that the staff that supported him always listened to what he had to say and helped him to achieve his aim.

We spoke with two people that live in the home about consent. One said, “I’m always asked if I want to do something”. We asked one person if they agreed with the way the staff supported them. They said they had just written a plan about what they liked and didn’t like.

We spoke with people living in the home about feeling safe. One said, “Staff always make sure I am ok.” People’s bedrooms had been personalised and they all had their own room keys. One person said, “I like my room, it’s my own space.”

On the day of the inspection the home had received the weekly supply of medication. We watched the process for receiving and recording the medication on to individual records. The process was comprehensive and included safeguards to reduce the risk of mistakes.

We spoke with people living in the home about the staff. One person said, “All the staff are really nice.” Another said, “Some old staff come back to see us. We are all friends.” One member of staff said, “I am confident we have the right staff to drive us forward.”

Care files were being reviewed and written information currently being used to inform support needs was basic. A comprehensive assessment of people’s current needs had not been completed. Risk assessments were in need of review.

During the course of the visit we spoke individually with three people living at the home and two members of staff. However some discussion took place with all staff and residents at some point during the visit often in a communal area of the home. Discussion with one person was more limited because of communication difficulties. One person told us, “Staff do the best they can for me especially ****. I can make choices for myself. **** tells me about risks and things, he talks to me a lot “. Another person said, “They help me in a way I like and ask if things are alright”. A member of staff explained that risks and options are always discussed with the individual concerned but the way this is done is very individual to the person, “Sometimes we need to break it down to the smallest component in order to explain”. A second member of staff said, “Rights and choices are always protected”.

Comments made about the care and support provided by the staff team was all very positive. One person told us, “I am looked after well here”. Another person living at the home told us, “Oh yes, I get on well with the staff they ask me if I am alright and happy”.

One person when asked said that they felt safe and comfortable living at the home. A member of staff spoken with confirmed that all staff have received safeguarding training and that the behavioural intervention team, as part of the challenging behavioural training, had covered the difference between restraint and abuse.

People using the service told us that they were satisfied with the accommodation provided and that they were happy living there.

Staff spoke positively about the training provided with one person telling us, **** (Homeowner) is a ‘course person’ and we are well supported”.

A member of staff told us, “Residents will clearly say if they have seen or heard something that they are unhappy with and are good at having their say”.