Hollie Hill is a care home which provides residential and nursing accommodation for up to 61 people. The home is arranged across two floors and divided into four areas. People with nursing needs are accommodated on the ground floor. Five bedrooms were contracted by the local Clinical Commissioning Group for people who need additional support following their discharge from hospital before they return home or decisions are made about their future care needs. At the time of our inspection there were 56 people using the service

At our last inspection in February 2017 we rated the service as good overall. We found a breach of Regulation 12; this was regarding the application of people’s topical medicine (creams applied to the skin). At this inspection we found the evidence continued to support the overall rating of good. Improvements had been made in respect of people’s topical medicines and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were cared for in a safe environment. Regular checks were undertaken to ensure fire safety systems in the home were working. Health and safety audits were also carried out.

Staff had training in safeguarding and told us they felt able to raise any safeguarding concerns about people in their care.

People and their relatives had different view about the staffing levels. The manager was using a dependency tool and had increased the staff levels in one area of the home. At the time of our inspection there were sufficient staff on duty to meet people’s needs.

Individual and personal risks to people using the service were identified and actions had been put in place to mitigate them.

The provider carried out appropriate checks on staff before they began working in the home. Staff were then supported to carry out their respective roles through induction, training and supervision.

Before people came to live at Hollie Hill staff carried out an assessment of their needs. Care plans to give guidance to staff on how to care for people were compiled which reflected their personal needs and preferences. These were regularly reviewed and updated if a person’s needs changed. The service worked in partnership with other professionals to meet people’s needs. Their advice was incorporated into people’s care plans.

Kitchen staff were aware of people’s dietary needs. They provided fortified food to prevent people from losing weight. Staff had involved dietitians to assess people’s needs and suitable diets were provided.

There was a regular activities programme displayed throughout the home interspersed with events and other individual activities. People were engaged with the programme and chose what they wanted to do.

Care was provided by staff who were kind and patient with people. Staff knew people’s backgrounds and engaged them in meaningful conversations. We found staff delivered people’s personal care behind closed doors to protect their dignity and privacy.

People knew there was a complaints policy in the home. The registered manager had responded to the complaints and provided an outcome for the complainant. During our inspection the registered manager took seriously concerns raised with her and sought to immediately resolve them.

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

Effective systems were in place to monitor the service. Actions were identified to improve the service using audits by the regional manager and the registered manager. The registered manager had an overall plan in place to make improvements which they monitored on a regular basis.

The registered manager held regular residents and relative’s meeting to e

Hollie Hill provides accommodation for people with nursing and personal care needs. The home can accommodate up to 61 people. At the time of our inspection there were 58 people using the service. The home is on two floors and is divided into four units including a nursing unit and residential care.

This inspection took place on 16 and 17 February 2017and was unannounced.

At the last inspection in November 2014, we rated the service as overall “Good” and found the home was meeting the regulatory requirements.

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.

People who used the service and their relatives told us they felt safe in the home. We saw there were regular checks to ensure the building was a safe place to live. Where a person’s individual risks had been identified then actions had been put in place to mitigate those risks.

We could not be reassured that people’s prescribed topical medicines (creams applied to the skin) had been applied in the manner they were prescribed. A new audit had been introduced by the registered provider had had been used by the registered manager. It showed action needed to be taken to improve the use of topical medicines in the home and reduce the risks to people where they were not receiving their topical medicines as prescribed.

The registered manager showed us the, “CHESS” tool; this is designed to enable the registered manager to calculate the number of staff hours required. They demonstrated to us they were providing more hours that required. However people in the home and their relatives experienced the need for more staff. We therefore recommended the home review the level of dependency needs.

We found appropriate checks were carried out on staff before they started working in the home. This meant people were being cared for by staff who were able to do the work and had been considered safe to work with people living in a home.

People told us they liked the food in the home and we observed staff offering to support people to eat. We found the catering staff understood about people’s dietary needs.

We found the service adhere to the principles of the Mental Capacity Act 2005 and where people were unable to make decisions for themselves best interests’ decisions had been put in place. These had involved family members and other professionals.

Staff were supported to carry out their duties through supervision, training and appraisal.

People living in the home and their relatives during the inspection told us staff were caring. We saw thank you cards and letters from people which thanked staff for their levels of care. Some of these were from relatives who had experienced the loss of a family member whilst being a resident at Hollie Hill.

We saw examples throughout our inspection of people being treated with respect and dignity. Staff closed people’s bedroom doors before attending to people’s personal care needs.

Staff were able to give us detailed information about people’s needs, backgrounds likes and dislikes. This meant staff knew and understood the people for whom they were providing care.

We found people had detailed care plans in place which guided staff on what actions to take to meet people’s care needs. These were reviewed on a regular basis to ensure they were up to date. Staff had also completed care documents required by the commissioners for people requiring intermediate care. These were for people who had been discharged from hospital who required a period of further care before they went home or alternative accommodation was found.

People were given a choice about being involved in activities. We observed people making Easter cards and two people were taken out to a luncheon c

We asked staff how they ensure they obtain consent from people. Staff were all able to give examples of how they obtained verbal consent. Comments included, “I ask permission first”, “I talk to people and ask if it’s ok before I provide any care” and “I ask people, I sometimes use picture cards to make sure people understand what I am asking.”

People appeared happy with the care provided. Comments included, “We are over the moon, the staff talk to (relative’s name) all of the time”, “They are all lovely people, I would not change a thing” and “The staff are very nice indeed.”

When we visited there were 52 people living in the home. We found there were sufficient numbers of staff on duty to meet people's needs.

People who used the service, their relatives and staff told us they were asked for their views on the care and treatment offered. One person told us, "They encourage me to speak to the manager if I have any problems."

We found people’s care plans were kept in offices which were locked when not in use. All documents we asked to view were provided immediately on request. This meant records were kept securely and could be located promptly when needed.

We spoke with several people who lived at the home and some of their relatives. They were all very positive about the care provided by the home. Comments included “They are really good”, “They are very kind, they will always help you”, “They’re very patient with (relative’s name)” and “I’ve had no problems here.” During this inspection we saw staff attended to people on a timely basis. For example, one person was supported to go back to her bedroom when she asked to. Another person wanted to go outside and we saw a member of staff responded quickly to this request.

We talked to people who lived at the home, visitors and staff, to find out what they thought about the home. Whilst some people said they thought there should be more staff, most people gave positive feedback. Comments included “Yes, I think there’s enough staff”, “Yes, there’s no problems” and “They come running if I need anything.”

People expressed their views and were involved in making decisions about their care and treatment.

We spoke with a number of people who used the service. One person said “we looked at a few places and decided on here”, another said “we came to have a look around before (relative’s name) moved in”.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke with relatives of people who used the services at Hollie Hill Care Home who told us they were confident their relatives were safe there. One relative said "I have peace of mind when I leave (relative’s name) here".

We talked to people who lived at the home, visitors and staff, to find out what they thought about the home. Several relatives said they thought that at times there didn’t appear to be many staff, one person said “sometimes, they’re rushed off their feet”, another said “sometimes there’s not enough staff, they can’t do everything”.

The provider had a clear policy on obtaining feedback from people using its services. This included information from sources such as comments, complaints and survey questionnaires. We saw numerous thank you cards throughout the home that had been sent from relatives expressing their gratitude for the care that had been delivered.

This inspection took place on 18 and 20 November 2014 and was unannounced. This meant the staff and provider did not know we would be visiting.

Hollie Hill Care Home provides care and accommodation for up to 61 people, including people living with dementia and people with nursing care needs. On the day of our inspection there were 58 people using the service.

The home had a registered manager 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.

Hollie Hill Care Home was last inspected by CQC on 01 July 2013 and was compliant.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

We saw evidence that thorough investigations had been carried out in response to safeguarding incidents or allegations and comprehensive medication audits were carried out regularly by the registered manager.

Training records were up to date and staff received regular supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

We saw staff supporting people in the dining room at lunch time and choices of food being offered.

All of the care records we looked at contained care plan agreement forms, which had been signed by the person who used the service or a family member. However, some of the photography consent forms had not been signed.

The home was clean, spacious and suitable for the people who used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the provider was following the requirements in the DoLS.

People who used the service, and family members, were complimentary about the standard of care at Hollie Hill Care Home. They told us, “The girls are lovely”, “they’re very nice” and “I think they do very well”.

We saw staff supporting and helping to maintain people’s independence. We saw staff treated people with dignity and respect and people were encouraged to care for themselves where possible.

We saw that the home had a full programme of activities in place for people who used the service.

All the care records we looked at showed people’s needs were assessed before they moved into Hollie Hill Care Home and we saw care plans were written in a person centred way.

We saw a copy of the provider’s complaints policy and procedure and saw that complaints were fully investigated.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources.