Holbeach and East Elloe Hospital Trust is registered to provide accommodation for up to 38 people requiring nursing or personal care, including older people and people with physical disabilities. The registered provider had recently applied to add an additional bedroom to the home and, at the time of our inspection, this application was being assessed by the Care Quality Commission (CQC). The registered provider also operates a day care support service in the same building as the care home although this type of service is not regulated by CQC.

We inspected the home on 25 October 2016. The inspection was unannounced. There were 37 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLS applications for four people living in the home and was waiting for these to be assessed by the local authority. Staff at all levels had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Any decisions that staff had made as being in people’s best interests were correctly documented.

The registered manager and her team had worked hard to address the areas for improvement identified at our last inspection in June 2015. The registered manager had a positive and forward-looking approach and was committed to the continuous improvement of the home in the future. The provider had recently received a national award to reflect the quality of the end of life care received by people and we found strong evidence of a caring and sensitive approach in this area.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. A range of auditing and monitoring systems was in place to monitor the quality and safety of service provision.

There were sufficient staff to meet people’s care needs and staff worked together in a well-coordinated and mutually supportive way. The provider supported staff to undertake their core training requirements and encouraged them to study for advanced qualifications. Staff were provided with close supervision and shift handover meetings were used effectively to ensure staff were aware of any changes in people's needs. The registered manager maintained a high profile within the home and provided strong, compassionate leadership to her team.

There was a warm, relaxed atmosphere in the home and staff supported people in a kind and friendly way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink that met their individual needs and preferences. A range of activities and events was organised to provide people with stimulation and occupation.

This was an unannounced inspection carried out on 24 June 2015. Holbeach and East Elloe Hospital Trust is a charity owned service. It has a council of members who are elected to oversee the running of the service. The service provides accommodation for up to 38 people who require residential or nursing care and also supports people living with dementia. The service has a six bedded GP respite unit within this number. There were 38 people living in the service when we carried out our inspection.

There was not a registered manager 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. A new manager had been recruited to the service and had submitted their application to become registered with the commission.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. At the time of our inspection no one was currently subject to an active DoLS authorisation.

Staff knew how to recognise and report any concerns so that people were kept safe from harm and background checks had been completed before new staff were appointed. Staff helped people to avoid having accidents, however, not all care documentation was completed which meant staff did not have access to important information about a person.

There were arrangements in place for ordering and disposing of medicines. However, people did not reliably receive their medicines. Some of the checks which the registered provider said needed to be made when medicines were dispensed had not been completed.

People had been helped to eat and drink enough to stay well. We found that people were provided with a choice of meals. When necessary, people were given extra help to make sure that they had enough to eat and drink. People had access to a range of healthcare professionals when they required specialist help. However, when assessments were made of people’s capacity to make decisions for themselves these were not decision specific and were generic.

Staff understood people’s needs, wishes and preferences and they had been trained to provide effective and safe care which met people’s individual needs. People were treated with kindness, compassion and respect.

People were able to see their friends and families when they wanted. There were no restrictions on when people could visit the service. Visitors were made welcome by the staff in the service. People and their relatives had been consulted about the care they wanted to be provided. Staff knew the people they supported and the choices they made about their care and people were supported to be involved in activities.

The manager had submitted their application to be registered with the commission. There were systems in place for handling and resolving complaints. People and their relatives knew how to raise a concern. The service was run in an open and inclusive way that encouraged staff to speak out if they had any concerns. The service had established links with local community groups which benefited people who lived in the service. Some quality checks had been completed however, areas which included medicines management and people’s care plans had not been recently audited. This had not allowed the registered provider to address shortfalls in some of the care that people received.

As part of our inspection we spoke with four people that used the service and four people’s relatives. Not all of the people who used the service were able to communicate with us. One person told us, “It’s very good. If you want something you get it and you couldn’t be better looked after.” Another person told us, “The least little thing you mention and they will do it quickly.”

We found that people who used the service were given appropriate information and support regarding their care or treatment. People were supported in promoting their independence and community involvement.

During our inspection we observed care being given and reviewed nine sets of care records. We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care records. We also found that appropriate arrangements were in place in relation to the recording of medicines. Medicines were prescribed and given to people appropriately.

At the time of our inspection there were enough skilled, experienced and qualified to staff to meet people’s needs. We spoke with five members of staff one of whom told us, “There are safe levels of staffing. If people go off sick they phone and get cover straight away. People here get the care they need.”

We also found that people who used the service, their relatives and staff were asked for their views about their care and treatment. When necessary, changes were made to reflect people’s views.

Holbeach and East Elloe Hospital is an independent hospital run by a charitable trust. It has 38 beds, 32 of which were for nursing and residential care and six where the local GP’s can admit people for pain management, palliative care and respite care.

On the day of our visit there were 38 people living at the home. People we spoke with told us they were happy with the care they received. One person told us, “If I go to any other place I wouldn’t get the service I get here.” Another person told us, “I love it here.”

We could see people were happy and relaxed with the staff who were aware of their needs and knew how to meet them safely.

We saw the home was kept clean and tidy. Staff were able to tell us how they worked to reduce the risk of infection.

People told us their privacy and dignity were respected by staff, one person said "staff are always respectful, they always ask me how I like things done."

People said that they liked living in the home, they enjoy the activities offered and they felt well cared for. One person told us "I would definitely recommend living here" and two visitors told us "It's okay here, one of the better homes."

People told us they liked the food provided, their comments were "food is good here" and "I like the choices."

People said that they could request to see a doctor when they wished, they felt safe in the home and they felt the manager listens to them. They told us that there was enough staff on duty and staff are great.