This inspection took place on 27 March 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

Holly House is a care home. People in care homes receive accommodation and personal care as single package under contractual agreements. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is provided from a large, older building and an adjoining flat which accommodate up to eight people with autism spectrum or associated conditions. Eight people were using the service at the time of inspection.

Although the building did not comply to the model of care proposed from 2015 and 2016 guidance that people with learning disabilities and/or autism spectrum disorder which proposed smaller community based housing. The provider was making some physical changes to the building to ensure it met the needs of the people who lived there. The care service had been developed and designed in line with best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism spectrum disorder using the service can live as ordinary a life as any citizen.

At our last inspection in January 2016 we rated the service good. However, we had found there was a breach of regulation 18 as staff were not receiving regular supervision.

At this inspection we found the service was meeting all of its legal requirements and the service was no longer in breach as improvements had been made with a system of supervision in place for all staff. We found the evidence continued to support the rating of good. 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.

Due to their health conditions and complex needs not all of the people who used the service were able to share their views about the support they received.

People appeared safe and comfortable with the staff who supported them. There was an open, relaxed and friendly atmosphere around the service. The staff team knew people well and provided support discreetly and with compassion. People’s privacy was respected and people were supported to maintain contact with relatives and friends.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Staff were well supported due to regular supervision, annual appraisals and a robust induction programme, which developed their understanding of people and their routines. Staff also received a wide range of specialised training to ensure they could support people safely and carry out their roles effectively.

Records were personalised. They provided staff with detailed information to enable them to provide effective care to people who may not be able to communicate their needs verbally. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks.

Staff were informed and enthusiastic. There were enough staff available to provide individual care and support to each person. Staff upheld people's human rights and treated everyone with dignity and respect.

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.

People were provided with opportunities to follow their interests and hobbies and they were introduced to new activities. They were encouraged and supported to go out and engage with the local community.

Staff spoke well of the regi

The inspection took place on 11 January 2016 and was unannounced. We last inspected the service on 14 May 2014 and found the registered provider met the regulations we inspected against.

Holly House provides care and support for up to eight people who have a learning disability and are on the Autistic Spectrum. At the time of our inspection seven people were using the service.

The home had a registered manager. 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 the registered provider had breached regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff had not received the registered provider’s expected number of supervisions or an appraisal.

You can see what action we told the provider to take at the back of the full version of the report.

Family members felt their relative received good care from skilled staff who knew their needs well. Family members commented: “Very well cared for. They are very supportive of [my relative] and the care she gets is very good to excellent”; “They really understand [my relative]”; and, “All of the staff we have seen are very well trained.” We observed warm and caring relationships had developed between people and staff.

People were supported to be as independent as possible. For instance, they were shown meal and drink options so they could choose what they wanted to eat and drink. One staff member said, “We encourage people to do as much as they can."

We received positive feedback about people's safety from family members. One family member told us, “[My relative] is definitely safe, they are very nice with [my relative]. I know [my relative] gets looked after and that makes me feel better. I have no worries at all about [my relative]. [My relative] seems content.”

People received their medicines safely from trained and competent staff. Medicines administration records (MARs) supported the safe administration of medicines.

Potential risks had been identified and assessed. Assessments identified the controls needed to reduce the risk and keep people safe.

Staff were appropriately recruited and sufficient to meet people’s needs in a timely manner. One family member said, “There seems plenty of staff on.” The home now had a settled staff team following the recruitment of new staff.

Staff had a good understanding of safeguarding adults and the whistle blowing procedure. They knew how to report concerns. One staff member said, “I haven’t used it [whistle blowing]. It is always in the back of my mind but never had to.”

Staff told us the environment was designed to be ‘autism friendly’ with neutral colours, heating and lighting controls and specific adaptations to meet individual people’s needs. Some family members felt the environment needed updating and was too noisy.

Incidents and accidents were recorded, including details of action taken to keep people safe. There were plans to deal with unexpected emergencies, including safe evacuation procedures for both staff and people using the service. Regular health and safety checks were undertaken to keep the building safe for people to live in.

The registered provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations were in place for all seven people. Staff had a good understanding of MCA, including how to support people with making their own decisions. Staff also understood people’s communication skills to help them make as many of their own choices and decisions as possible.

Staff were knowledgeable about how to manage behaviours that challenged. One family member told us, “Staff

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

Where staff had identified a potential risk, either during the initial assessment or after admission, a risk assessment had been completed to ensure people remained safe. The manager told us that risk assessments were reviewed regularly to ensure they were up to date. However, we did not see records that these reviews had taken place.

The provider had systems in place to ensure people received their medication in a timely manner by trained and competent staff.

Is the service effective?

Staff had a good understanding of people’s communication needs and supported them to make decisions about their care. For example, staff used visual prompts and technology to support people to make their own decisions.

Information gathered during the initial assessment was used to develop detailed support plans. We found support plans clearly identified people’s needs and how each need would be met. They also detailed the action needed to achieve each outcome, the person responsible for the outcome and timescales to work towards.

Staff had completed their mandatory training, including infection control, health and safety, first aid, fire safety and safer handling of medication. We also found staff had completed specialist training to enable them to meet people’s specific needs. For example, all staff had completed autism awareness training and training in relation to behaviours that challenge.

One family member commented, “The staff are very caring and well-trained”, and, “Key workers and co key-workers are very good.”

Is the service caring?

We observed that staff were very supportive towards people and their interaction was calm and re-assuring. As a result people responded positively to the interaction from staff creating a relaxing atmosphere over the period we observed. Staff sat and had their own lunch with people and offered encouragement throughout the meal-time.

Is the service responsive?

People had access to a range of specialists and health professionals to ensure they received appropriate care.

We spoke with three family members. They said they were satisfied with their relative’s care. Family members said they had seen their relative’s care plans and were involved in annual reviews of their relative’s care. Family members commented: “(My relative) seems very happy”; “They are interested in (my relative) as a person”; “They think about different ways of approaching a situation to get the best from the person”; “I know for a fact (my relative) is well taken care of”; and, “They take care of people marvellously.”

Family members we spoke with were aware of how to make a complaint. They did not raise any complaints or concerns with us about their relative’s care. Family members commented: “If I wanted to make a complaint I would just ring Holly House”; “I can’t say anything bad about them”; and, “If I have had concerns they have listened and dealt with them.” The provider had systems to log and investigate complaints received.

Is the service well-led?

Family members were consulted to gather their views about the service provided at Holly House. We viewed the completed questionnaires from the most recent consultation with family members. Comments included: “I have always found the staff friendly towards me”; “I am very happy with the support my (relative) is given”; “I am very happy about my (relative’s) treatment”; and, “The staff at Holly House are very friendly.”

The provider had a system of quality audits in place to identify gaps in care records, including medication records. Information from a range of sources including incidents and accidents was analysed and used to improve the care people received.

We haven’t been able to speak to the people using the service because they had complex needs, which meant they were not able to tell us their experiences.

However, we undertook a short observational framework for inspection (SOFI) exercise to observe the interactions between the people and the staff. SOFI is designed to be used when inspecting services for people who have some difficulty in communicating their opinions on the services they receive.

During the SOFI, we observed some of the people having their lunch. We saw people being offered choices; for example, people were offered a choice of drinks and lunch. There was a choice of two different meals. We observed staff taking both meals to each person and asking them to choose which one they would like. Staff were seen to be attentive and gave people the information about the drink and meal options in a way that was appropriate to their needs. One person was supported to make a choice with their I PAD. In addition, we observed staff trying to engage people in discussions about the activities they had been involved in that day.

During the inspection, the staff members on duty were observed speaking to people in a kind and respectful way. We also observed that the people were clean and well groomed.

We haven’t been able to speak to people using the service because the people using it had complex needs, which meant they were not able to tell us their experiences. However, we gathered some evidence of people’s experiences of the service by reviewing the residents review records and relatives surveys. One relative had commented “…is well cared for she has a lot of support from staff”.