About the service: Holly Cottage is a residential care home that was providing accommodation and personal care to five people at the time of the inspection.

People’s experience of using this service: Holly Cottage has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Improvements had been made to the service following our previous inspection in May 2018 to address concerns and a breach of Regulation 11 of the Health and Social Care Act 2008.

There were enough staff on duty to enable people to remain safe and receive care in a timely way. Staff were safely recruited, they knew how to keep people safe from avoidable harm.

The environment was safe, and people had access to appropriate equipment where needed. The premises were clean and followed infection control guidelines. Accidents and incidents were analysed to prevent re-occurrence.

People were supported to take their medicines in a safe way.

Staff were kind, caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensured they did this. People were observed to have good relationships with the staff team. Staff actively ensured people maintained links with their friends and family.

People were supported to have 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. People were supported to pursue their hobbies and interests.

The registered manager provided staff with leadership and was visible and approachable. Staff were motivated and enjoyed strong team work.

Information from audits, incidents and quality checks was used to drive continuous improvements to the service people received.

More information is in the full report.

Rating at last inspection: Requires improvement (Published May 2018)

Why we inspected: This was a scheduled inspection based on our previous rating. The service has improved its rating to good in all key questions.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 6 March 2018 and was unannounced. Holly Cottage is a residential care home providing support to up to 12 people. At the time of our inspection there were seven people living at the service. People living at the service had learning disabilities and physical disabilities.

Dons Care Limited, became the registered Provider with the Care Quality Commission for the registered location of Holly Cottage in December 2017.

Holly Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Holly Cottage accommodates people in one building, which had been extended and adapted in some areas.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

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 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.

At this inspection we identified a breach of Regulation 11 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. This relates to obtaining peoples consent within the framework of the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people and the management of these had not been regularly reviewed to ensure that they remained appropriate. When people’s needs had changed, changes had not been made to reflect this. The Provider and registered manager had not identified this as a priority when taking over the running of the service in December 2017.

Staff understood their roles in safeguarding people from abuse and were clear who they would report any concerns too.

There were sufficient numbers of staff to meet people’s needs and the Provider had carried out checks to ensure that staff were suitable for their roles. People received their medicines safely. Trained staff administered medicines and the Provider managed medicines in line with best practice and regularly audited them. The Provider had systems in place to ensure the risk of the spread of infection was reduced and people lived in a clean home environment.

People were supported to access healthcare professionals when required with support from staff.

Staff received one to one supervisions and there was an appraisal process in place. Regular meetings took place that involved staff, people and relatives in decisions about the service.

The management of best interest’s decisions and assessments of people’s mental capacity was not always undertaken in line within the framework of the Mental Capacity Act 2005 (MCA). The registered manager did not fully understand their responsibilities in relation to this.

Staff knew people well and interacted with them with kindness and compassion. Staff were respectful of people’s privacy and dignity when providing care to them. People were supported to maintain relationships that were important to them.

Care plans had not been regularly reviewed and changes in people’s needs had not been identified in them. People and relatives were not routinely involved in care planning.

People had access to a range of activities that suited their needs and interests. The Provider had a clear complaints policy in place and had a proactive approach to feedback to identify improvements.

There was a variety of audits in place to monitor quality but this had not identified shortfalls in the provision of some aspects of care. The Providers’ serv