We inspected the Hollands on 18 and 22 September 2017. On the18 September 2017 the inspection was facilitated by the senior nurse and senior carer on duty, the manager was on annual leave. We returned on the 22 September 2017 to complete the inspection with the manager.

We last inspected the Hollands on 04 August 2015 and the overall rating for the service was good.

The Hollands is a detached two-storey purpose built home situated in the centre of Farnworth, Bolton, close to shops, local amenities and public transport. It has a car park to the front of the home.

The Hollands is registered to care for 39 people, predominately under 65 years of age. The Hollands provides services to people who require nursing and personal care, physical and learning disabilities and mental health problems. The service provides specialist care in alcohol and drug dependence, bipolar and manic depression, epilepsy head and brain injury and schizophrenia. There were 32 people using the service at the time of the inspection.

The home had a manager in post who was in the process of registering with the Care Quality Commission (CQC). The manager was an experienced manager who had previously been 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 found that privacy and dignity of people who used the service maintained. Staff treated people with respect and staff interaction with people was good.

We found there were enough staff on duty to meet people’s needs. Staffing levels were based on an accurate and current assessment of people’s needs. The manager was currently reviewing the dependency needs of people who used the service.

We found records necessary for the management of the home were in place and completed accurately.

People were provided with sufficient food and drink to ensure their health care needs were met.

We saw that new staff completed an induction programme to help ensure staff were prepared for their role by assisting them to develop their knowledge, skills and understanding.

We found that that home worked well with other healthcare professionals when required.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

Recruitment procedures were robust and appropriate checks had been completed.

The medication system was safe and we saw how the staff worked in cooperation with other healthcare professionals to ensure that people received appropriate care and treatment.

People's care records contained enough information to guide staff on the care and support required. The records showed that risks to people's health and well-being had been identified and plans were in place to help reduce or eliminate the risk.

Staff were able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

Records we looked at showed there was a system in place for recording complaints and any action taken to remedy the concerns raised. Records showed that any accidents and incidents that occurred were recorded.

The Hollands care home is a purpose built two storey nursing home. The Hollands is situated off the main high street in the Farnworth area of Bolton. The home is registered to provide personal and nursing care for 39 people.

This inspection took place on the 04 August 2015 and was unannounced. There were 36 people using the service at the time of the inspection. The majority of people living at the home were younger people who had a mental health related illness.

We last inspected this home on 17 April 2013. At that inspection we found the service was meeting all the regulations that we reviewed.

The home had a manager who was registered with the Care Quality Commission (CQC) and who was present on the day of the inspection. 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 and associated Regulations about how the service is run.

Staff spoken with were able to demonstrate an understanding of whistle-blowing procedures and they knew what to do and who to contact if any allegation of abuse was made to them or if they suspected that abuse had occurred.

We found that most of the people living at the home were self-caring and staff offered assistance as and when required. We saw that staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

People who used the service told us they felt safe living at the home and they spoke positively about the kindness of staff and their caring attitude. We observed that when assistance was required it was provided in a discreet and sensitive manner. We saw that staff were patient with people and that conversations were friendly and respectful.

Procedures were in place for the safe management of people’s medicines and we found that medicines were managed safely.

We noticed some areas of the home had been painted and refurbished. We found the downstairs lounge required attention and the carpet needed replacing. We discussed the ongoing improvement plan with the registered manager. The registered manager told us this was being actioned and that quotes were being tendered for new flooring. We saw a sample of the new floor that had been selected. We saw the conservatory, which was entered from the door in the garden was in need of refurbishment. The conservatory was used as a smoking area as most of the people living at the home smoked. Discussions with the manager and the provider were ongoing with the possibility of relocating the conservatory away from the main building.

People’s care records contained enough information to guide staff on the care and support needs required. People and their relatives were involved and consulted (where appropriate) about the development of care records. This helped to ensure the wishes of people who used the service were considered and planned for. The care records showed that risks to people’s health and well –being had been identified to help eliminate risk.

During the inspection we observed people were going out unaccompanied to the local shops. We saw risk assessments were in place for people going out to help ensure their safety.

We saw that arrangements were in place to assess whether people were able to consent to care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

Staff spoken with had a good understanding of the care and support people required.

People who used the service were living with a range of mental health needs. We saw for some people that personal care and grooming was not a high priority. We discussed this with the registered manager who told us that people living at the home managed their own budgets and made choices on how they spent their money. The registered manager and staff had to act with sensitivity when addressing people’s personal hygiene.

We saw there was enough equipment available to promote people’s safety, comfort and independence.

We spoke with people about the food. We received mixed responses with some people telling us the food was fine, however some comments were made that the food was boring and bland. We saw that stocks of fresh and dried food were in ample supply and a range of snacks and drinks were available.

To help ensure people received effective care, systems were in place to monitor the quality of the service provided. Regular checks were undertaken on the running of the home and there were opportunities for people to comment on the facilities and the quality of the care provided.

We visited The Hollands on 17 April 2013 and found the home to be warm, comfortable and clean. The home offered care to mostly younger adults with a physical disability.

We looked at four care records and saw they contained detailed information about the care, support and treatment each person required. This included personal preferences, medical and social background, wound care nutrition and hydration, monitoring charts and input from other professionals such as the Speech and Language team (SALT), dietician and GPs. We saw the care records had been regularly reviewed and were up to date.

We spoke with two visitors who told us they were happy with the care provided to their relative and they had no complaints. They told us if they were unhappy with anything they would speak to the manager.

We spoke with a visiting professional who said they were happy with the care their patient received. They told us,”The staff are very obliging and helpful”.

We spoke with three people who used the service, one person said, “I have no worries, the staff care for us really well”. Another person told us, “I like to stay in my room, I have everything I need”.

We saw staff training was ongoing and included infection control, food hygiene, safeguarding and mental capacity awareness.

Staff spoken with told they felt the running of the home had improved since the manager came in to post. We were told the manager was supportive and listened to what they had to say.

During our visit we spoke with people who used the service and with some visitors.

One person told us, “I am quite happy living here”.

Another said, “We could do with some more variety and choice at meal times”.

One relative told us, “We have no reason to complain, the staff are very good”.

A visiting professional told us, “My team have no worries or concerns about the home. We are very satisfied with the care our clients receive”.

We spoke with one person who told us that, “It may be beneficial if we had residents and family meetings so that we can discuss and plan things”