We inspected The Hollies Rest Home on 27 and 28 July 2017. The inspection was unannounced. The Hollies Rest Home provides support and accommodation for up to 31 people. At the time of our inspection there were 26 people living at the service.

There was a registered manager in post who was registered with the CQC. 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.

We previously inspected The Hollies Rest Home on 13 and 14 June 2016 and it was rated requires improvement. At this inspection improvements had been made.

The registered provider had systems in place to protect people against abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. When appropriate, risks were being updated when people’s needs changed.

Medicines were stored securely and safely administered by staff who had received appropriate training.

There were sufficient staff to provide care to people throughout the day and night. The provider used a dependency tool to identify the amount of care hours each person required. When additional staff were required due to staff sickness or leave the registered manager had an approved agency list. When staff were recruited, they were subject to checks to ensure they were safe to work in the care sector.

The registered provider had effective policies and procedures in place to ensure that the service remained clean and tidy. Staff received training on infection control.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. Staff spoke positively about the training supplied by the registered provider and the encouragement to progress their careers. Staff met together regularly and felt supported by the registered manager.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Mental capacity assessments were being carried out and these were decision specific. Staff and the registered manager demonstrated good knowledge of the Mental Capacity Act 2005. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

People were referred to health care professionals when needed. People's records showed that appropriate referrals were being made to GP's, speech and language therapists, dieticians, dentists and chiropodists.

People were being supported to have a nutritious diet that met their needs. People were supported to eat by suitably trained staff. Staff were completing fluid and eating charts for those that need it.

People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people's decisions.

People told us they were very satisfied with the care staff and the support they provided. Relatives told us they were happy with the service their loved ones received. Staff communicated with people in ways that they understood when giving support. Staff and the registered manager had to know people well.

People and their relatives told us they were involved in the planning of their care. Care plans were being reviewed on a monthly basis by s

This inspection was carried out on 13 and 14 June 2016 and was unannounced. The Hollies Rest Home is a large period building set over three floors. It provides accommodation and personal care for up to 31people. The service supports older people and those who are living with dementia.

There were 20 people using the service at the time of the inspection, 17 of whom lived with dementia. Some of the people were not able to converse with us.

At our last inspection on 27 July 2015 we issued two warning notices and seven requirement notices in relation to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan detailing the improvements they would make and confirmed they would be meeting the requirements of the regulations by 26 November 2015. This inspection was carried out to follow up on compliance with these notices. At this inspection we found that the registered provider had met the requirements detailed in the warning and requirement notices and had made improvements to the culture of the service and the care people received. However these improvements needed to be sustained over time and we will check this at our next inspection.

There was a new manager in post who was registered with the Care Quality Commission (CQC) since November 2015. A registered manager is a person who has registered with the 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

People, relatives and staff told us there was a sufficient number of staff deployed to consistently meet people’s needs. Staffing levels had been re-calculated taking into account people’s specific needs and dependency levels.

There were thorough recruitment procedures in place which included the checking of references and full employment history. A process to fill in gaps in staff employment history records was still in progress.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

Staff had received mandatory training and were scheduled for refresher courses. All members of staff received regular one to one supervision sessions. Staff reported feeling well supported in their roles.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered.

Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions; meetings with appropriate parties were held and recorded to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People’s individual assessments and care plans were reviewed monthly or w

The inspection was carried out by one inspector. There were 29 people using the service at the time of the inspection. The people living at the service were experiencing dementia which meant that they were not always able to tell us about their experiences. This report is based on our observations of the care and support people received, talking with people, relatives and staff and looking at records.

We used the information to answer the five questions we always ask; 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 saw that staff supported people safely, for example, when helping them to move around the building or to move from a wheelchair to a lounge chair.

The service was safe, clean and hygienic. There were systems in place to make sure that the risk of infection was minimised. Equipment to keep people safe was l maintained and serviced to make sure it was in good working order. Fire procedures and plans had been updated this year, and people had up to date personal fire evacuation plans for staff to follow in the event of fire at the service.

Maintenance work took place to make sure the building was safe for people to use and met their needs.

Is the service effective?

The service provided people with the care and support they needed and staff understood individual people’s needs. People and their representatives told us that they were happy with the service and that it met their needs. People told us “I am well looked after” and a visitor told us “they are never left on their own”.

Is the service caring?

Staff were kind, caring and attentive towards people and we saw that people were comfortable with staff. Staff did not rush people and demonstrated that they had a good understanding of people’s individual needs.

Is the service responsive?

Staff made sure that any health concerns were responded to promptly and reviewed when they needed to be. They asked the G.P to visit a person as there were concerns about the person’s health on the day of the inspection. Staff received dementia training so that they could understand the needs of the people they cared for.

Staff were kind and caring, we saw them reassuring people and making them more comfortable. A relative told us “They have time for all the people”.

Activities were provided to meet the needs of people of differing abilities and interests.

Is the service well led?

There were systems in place to make sure that the service was safe and there were sufficient staff on duty at all times. The views of people and their representatives were regularly sought.

Checks were made to the quality and safety of the service by the provider.

People told us they liked living at the service and people’s representatives said it delivered a good standard of care. A relative told us “It has lived up to expectations”.

The interactions we observed between staff and people using the service were friendly and helpful, and people were treated with respect.

Information was provided for people about activities in the home.

People had their capacity to make decisions for themselves assessed when they first started using the service. We saw that where people did not have the capacity to make decisions, decisions were made in their “best interest”. Where possible relatives were involved in this decision making process.

The people we spoke with or their relatives were mostly positive about the care they received. One person told us the service was “pretty good” and they had “no problems”. Another person said “they’ve been brilliant” and that they found staff “very approachable”. A relative told us “I haven’t got a single thing I could complain about” and that they were “very happy with them”.

There was an activity programme available, and people had their physical healthcare needs addressed.

Medication was safely managed, stored and administered.

There were enough skilled and experienced staff to meet people’s needs. One person said that the staff were “all very nice and helpful” and “ask and they help”.

Some of the people that used the service were able to tell us their views about the care they were receiving. Where people were not able to fully share their views we made observations of the care they received to understand their experiences of the service. We also spoke with a relative who was visiting the home.

We spoke with four people who used the service who all said they were happy with their care. Comments included “It’s all very good here” and “They help me when I need it, but not too much”. Everyone told us that they felt safe living in the home and one person said “I am very happy here, they look after me well”. People told us if they had any concerns or worries they would speak with staff. All four people we spoke with told us that the staff treated them well. One person said “The staff here are very good, they will do anything for you” whilst another said “I think the staff do a good job”. A relative visiting the home told us that “The staff are very pleasant and I am confident X is well looked after”.

The four people we spoke with told us that they liked the food. One person said “The food is very nice” and another said “I like the meals”. One person told us “We always get a choice of meals; they come and ask us what we want”. A relative told us that they often visited at mealtimes and that the meals were always very good.

We inspected The Hollies Rest Home on 27 and 28 July 2015 and the inspection was unannounced.

The Hollies is located in Southborough, Tunbridge Wells and provides accommodation and personal care for up to 31 older people. The home is set over three floors, with bedrooms across all three floors and communal areas situated on the lower ground floor. There is lift access between the lower ground floor and upper levels. At the time of our inspection there were 29 people living at the home. 28 people were living with dementia and many people had mobility difficulties and sensory impairments. Some people were living with mental health issues.

The service did not have 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. The previous registered manager had left at the beginning of July and interim management arrangements were in place to cover the service whilst recruitment to the post was in progress.

We found a number of 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 back of the full version of this report.

People said they felt safe living in the home, however we found that not all risks had been identified or effectively managed. People were not protected from risks associated with unsafe and or unsuitable premises.

There were insufficient numbers of staff to provide adequate care and supervision to meet people’s needs.

The provider did not always follow safe recruitment procedures to make sure staff were suitable to work with people because full employment histories were not always obtained or references checked effectively.

Staff received training and support to carry out their roles, but we have made a recommendation for improvement about this.

The provider had not ensured that, where people could not give their consent, the requirements of the Mental Capacity Act 2005 were consistently met.

People did not receive the support they needed to eat their meals. Staff did not take appropriate action to reduce the risk of dehydration and malnutrition for some people.

People received medical assistance from healthcare professionals including district nurses, GPs, and the local hospice. However, staff did not consistently follow guidance regarding people’s health needs.

The premises and equipment did not meet the needs of people living with dementia and mobility difficulties.

People were not always treated with compassion and their preferences and right to confidentiality respected.

People’s needs were not consistently met as assessment and review systems were not always effective. People’s changing needs were not consistently responded to. We observed that the people who required the most care and support were not always given the support they needed to ensure they had meaningful occupation during the day.

People felt the home was well run and were confident they could raise concerns if they had any. However, there was no registered manager and the registered provider had not adequately monitored the service to ensure it was safe and effective. They had not identified or acted upon areas where improvement was required.

People’s medicines were stored and administered safely in accordance with best practice guidance.

We did see and hear some individual examples of staff treating people with compassion and kindness.

People were supported to maintain their relationships with people that mattered to them. Visitors were welcomed and their involvement encouraged.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.