This inspection took place on 16 and 23 November 2016 and was announced.

Hollins Park is registered to provide accommodation for 49 people who require nursing or personal care and who are living with dementia. It is located in a residential area of Macclesfield, close to the local hospital and is approximately one mile from the town centre. Accommodation within the home is laid out in four separate wings, each wing has its own communal and living area. At this inspection they were providing care and support for 49 people.

A registered manager was in post but owing to a pre-arranged career break was not present at this 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 2008 and associated Regulations about how the service is run. A relief manager was present during day two of this inspection.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. People had individual assessments of risk associated with their care. Staff knew what to do in order to minimise the potential for harm.

People were supported by enough staff to safely meet their needs. People received help with their medicines from staff who were trained to safely support them. The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work.

The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if needed.

People received care from staff that had the skills and knowledge to meet their needs. New staff members received an induction to their role and were equipped with the skills they needed to work with people. Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s requirements was provided.

People’s rights were maintained by staff members who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a management team who they found approachable. People and staff felt able to express their views and felt their opinions mattered. People had positive relationships with the staff members who supported them. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly and consistently. People were supported to eat and drink sufficient amounts to maintain good health.

The provider undertook regular quality checks in order to drive improvements. The provider engaged people and their families and encouraged feedback. People felt confident they were listened to and their views were valued.

We undertook an inspection of Hollins Park on 19 May 2014.

During the inspection we spoke with the registered manager, the quality manager, the dementia trainer and five staff members. We also spoke with six of the people who lived in the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At our previous inspection we had serious concerns about safeguarding systems within the home and we took enforcement action and issued a warning notice. We found that our previous concerns had been dealt with and resolved. Incidents had been investigated again and appropriate action had been taken. This ensured that people in the home had been protected from the risk of those issues reoccurring.

Policies and procedures had been developed by the provider to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Staff had been trained in safeguarding vulnerable adults and were able to demonstrate a good understanding of what they would do if they had concerns.

Is the service effective?

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We looked in some detail at the care and support provided to four people who lived in the home. These records included the person's care plans, risk assessments, and records about the support they had received from professional people outside of the home. We found the information in each person's care plan was detailed and reflected the person's needs.

Is the service caring?

During our inspection we spoke with six people who lived in the home. They all spoke highly of the staff who supported them and the care that they received. One person said "Yesterday was lovely. We all sat in the garden chatting. It was sunny and we had ice lollies." Another person said "The staff are kind and helpful. We are lucky here."

We carried out a SOFI observation in a communal area of the home. All interactions we observed with people who lived in the home were positive. The staff we observed were very skilled in their approach and they appeared to know the people that they were supporting well. We saw that staff had warm relationships with people who lived in the home.

Is the service responsive?

We spoke to staff and they showed a clear understanding of consent issues. They showed us the future care plans where they had been supporting people who lived in the home to make sure that their wishes were carried out in specific circumstances.

The day of our inspection was very warm. We saw that the home was well ventilated and people were encouraged and supported to go outside and enjoy the nice weather. We saw people sitting outside chatting to each other and to staff. We also saw that staff were organising additional drinks for everyone and were making sure that people had them.

Is the service well led?

We saw that a number of audits were completed in the home to assess and monitor the quality of the service being provided. We saw that the manager and senior staff completed audits in various areas such as medication administration, infection control and building safety. We also saw that the provider completed governance audits which involved an inspection of all areas within the home. We spoke to the Quality Manager and they told us that they had recently completed this audit at Hollins Park and that the feedback was good and significant improvements to the service had been made.

We carried out this inspection to look at some previous areas of concern that we had found on our previous visit in October 2013 and in response to some information of concern that we had received from a whistle blower and from a member of the public.

We spoke to the registered manager, the head of nursing and three members of staff who all said that they enjoyed working at the service and that they felt well supported in their roles. We looked at the support arrangements in place for staff and saw that they had improved. We also looked at the staffing levels and saw that they had been consistent over the six weeks prior to our inspection.

We looked at records and had some concerns that information was not been recorded and reported in accordance with the Health and Social Care Act.

We had been made aware of the outcome of an investigation the day before our inspection and when we looked at the evidence for this outcome we saw that safeguarding requirements had not been followed and that people who lived in the home could be at risk from harm and abuse.

We undertook this visit to follow up on a warning notice that we had issued to the home for failing to safeguard people who lived in the home following our visit in October 2013.

During this visit we spoke to the Registered Manager, the Deputy Manager, the Regional Manager, the Head of Nursing for Care UK (the provider) and three members of the care team. We also looked at records. We found that people who use 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.

Prior to this inspection we had received some information of concern from the police and the local authority regarding the safeguarding practices in the home and the home's alleged failure to report and respond to safeguarding concerns. We found a number of issues that had not been dealt with and that people had not been protected from harm.

We looked at the care practices of staff in the home during our SOFI observations and found that not all staff treated people who lived in the home with dignity and respect. We looked at the care files and saw that they were regularly updated and reviewed.

We looked at the processes and procedures for recruiting new staff and saw that the home met all of the legal requirements.

We looked at the support for staff and found that it was not always available. Staff were not supervised on a regular basis and team meetings were not regularly held and were poorly attended.

The care needs of the majority of people who use the service were such that they were unable to comment on the care and treatment they received. We spoke to one person who lived at the home. They told us; "it's nice here."

We spoke to two relatives of people who live at the home. They told us; "Staff are well trained and are brilliant with the residents." and "The care is good but they need more activities."

The staff we spoke to during our visit told us that they enjoyed working at the home because the standard of care was very good and that they had access to lots of training. They said that they were supported by the manager and the deputy manager who were always available to offer advice and support.

Our observations, documentation we reviewed and the people we spoke to assured us that the people who lived in the home were experiencing care and support to meet their needs.

The care needs of the majority of people who use the service were such that they were unable to comment on the care and treatment they received. We spoke with two visitors who had relatives living in the home. One person told us their relative had improved since moving into the home. Another person told us their relative had recently transferred from another service and that it was too soon to comment on their care and treatment.

During our visit we saw a copy of the audit programme for the home which included a copy of a satisfaction survey report, dated March 2010. The information we saw told us that, overall, relatives and friend of people living in the home were satisfied with the level of care and support offered.

The staff we spoke with during our visit told us they had received training that had been provided internally and by professional trainers from outside the organisation. They also told us they receive supervision from senior staff in the home and that senior staff were available if they needed advice or guidance.