Holbrook Hall provides a residential service for 36 older people. The service was last inspected in February 2014, when it was compliant in all areas inspected. We inspected the service on 6 and 7 September 2016, the first day of inspection was unannounced.

There was a registered manager in 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.

Improvements were required to how medicines were managed. Temperatures in medicine storage areas were not always within safe limits and controlled drugs were not always stored and administered safely.

Risks were not always managed effectively and we felt the recording of increased risk required improvement. Changes to the mobility needs of people were not always recorded accurately in care plans; and risk assessments were not always updated promptly. This meant that staff were not always aware of the changing needs and associated risks of people.

However, people told us they felt safe living at Holbrook Hall; they praised the service and the staff team. Pre-employment checks were completed for all staff to check their suitability, before they began caring for people. There was sufficient, suitably qualified staff available to care for people. Equipment was maintained and serviced regularly; and health and safety records were well organised and easy to navigate.

Staff had the skills and knowledge to care for people effectively. People were involved in planning their care and making decisions about their daily life. Care plans were informative and included the comments and preferences of people. People were supported to access local health and community services, where needed.

People were cared for by staff who were kind and compassionate. Staff were focused on providing a good quality, person-centred care experience for people. Staff supported people to maintain their dignity and independence and make their own decisions. There was a friendly, homely atmosphere in the home where people felt respected.

There was a varied activity programme based on the individual interests of people and people were free to join in or spend time on their own. There were plenty of communal rooms for people to spend time with friends, visitors or on their own. The management team proactively sought feedback from people and their families, and they responded positively to ideas and suggestions.

The quality assurance systems in place had not picked up the areas that we identified as requiring improvement. However, the management team were receptive to feedback and were keen to improve the care experience for people who used the service. People and staff felt supported by the management team and there was a positive culture within the home.

We spoke with ten people who used the service, three visitor, four staff and three visiting professionals.

We asked if people were consulted about their care. We were told that staff always asked them if they needed help. One person told us. “I am able to do most things for myself staff leave me to my own devices.” Staff spoken with understood about consent and we looked at three people's support plans that showed suitable arrangements were in place to ascertain people's ability to consent.

We asked people if they received the care and support they needed in a way that kept them safe. People told us they were aware of their plans and that they were involved in their reviews. Staff spoken with were aware of people's needs and how best to support them. We saw that support plans were reviewed regularly and changes made to meet people's changing needs.

People told us that they enjoyed the food and they received plenty of choice and where they needed supplements they received those. We observed the midday meal and saw people received choice and variety and where people were at risk of losing weight they received fortified drinks.

We toured the building and saw it was well maintained and a person told us. “It is like a five star hotel here.”

We asked people if they knew how to complain and we were told that when they arrived the manager explained the process. We saw records that showed that the manager took action when complaints were made.

We spoke with 11 people using this service, three family members and two visitors. We also spoke to four staff members and a visiting professional.

We found that people were fully involved in discussions about their needs and care. One person said that Holbrook Hall “can’t be faulted, I wouldn’t want to go anywhere else.” People told us that they were always treated with respect.

We observed and heard a good level of communication and contact between staff and people using the service. We saw that the care and daily routines were centred around people's individual needs and preferences.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping.

Everyone we spoke with was very happy with the standards of the care service. People told us that they liked using the service, that it was 'homely' and that staff were 'caring', 'very helpful' and 'kind'. One person said 'it's lovely here, they do everything for you'. Relatives told us that they were 'really, really pleased' with the service and that support was 'excellent'.

People enjoyed their food and the activities that the service provided. One person said the food was 'very good' and another that there was 'always something to do'.

Visitng professionals told us the service had 'high standards' and that they had 'no concerns' about the care. They told us that the service responded well to professional advice and guidance.

People told us the premises were clean and tidy and there was 'never any smell'.