This inspection took place on 30 November 2018 and was unannounced. Holly Lodge Nursing Home 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. At the time of our inspection there were 57 people living at the home.

Holly Lodge Nursing Home provides specialist care and support for people living with dementia and physical health care needs. It’s a large purpose-built nursing home spread over two floors accessed by internal lifts and is set in extensive landscaped grounds surrounded by woodlands. At the time of our inspection there was an experienced registered manager in post. 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. They were aware of the legal requirement to display their CQC rating.

At our last inspection of the service on 7 November 2016 we rated the service overall as ‘Good’ and 'Requires Improvement' in Effective. This was because people's dietary needs and preferences were not always respected and met by staff. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found improvements had been made and the breach of Regulation 9 had been met.

Risks to people were assessed and safely managed by staff. Medicines were managed, administered and stored safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take to ensure peoples safety and well-being. There were systems in place to ensure people were protected from the risk of infection and the home environment was clean and well maintained. Accidents and incidents were recorded, monitored and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs in a timely manner.

There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. 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’s nutritional needs and preferences were met. People had access to health and social care professionals when required and staff worked well with health and social care professionals to meet their needs.

People told us staff treated them with kindness and respected their privacy and dignity. People’s diverse needs were met and staff were committed to supporting people to meet their needs with regard to their disability, race, religion, sexual orientation and gender. People were involved in making decisions about their care. There was a range of activities available to meet people’s interests and needs. The service provided care and support to people at the end of their lives. People’s needs were reviewed and monitored on a regular basis.

There were well-led systems in place to monitor the quality of the service provided. People’s views about the service were sought and considered. The provider worked in partnership with other professionals to ensure people received appropriate levels of care and support to meet their needs.

Holly Lodge Nursing Home provides nursing and residential care for up to 60 people who are elderly, frail, with medical needs or are living with dementia. At the time of our inspection there were 56 people living in the home.

This was an unannounced inspection which took place on 7 November 2016.

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. The registered manager helped us with our inspection on the day.

People’s dietary needs were not always respected by staff as some people were being given food which was not in line with their dietary requirements.

Staff understood the requirements of the Mental Capacity Act 2005. People were cared for by a sufficient number of staff. People would be protected from the risk of harm as systems were in place to keep them safe.

People were supported by individual staff who showed kindness and compassion. Staff respected people’s choices and decisions in their care needs. Each person had a care plan in place which detailed their needs and preferences. Staff were knowledgeable about people’s needs, likes and dislikes. People were supported to maintain relationships with people who were important to them. Activities were varied for people and people had the opportunity to participate in external activities.

Accidents and incidents were monitored and action taken to keep people safe where trends were identified. Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse. Records held for people were reviewed regularly and held detailed information about people.

There was a contingency plan in the event of an emergency and evacuation plans had been written for each person to help support them safely in the event of an emergency. Regular audits of the service were carried out to review the quality of the service provided.

Medicines were managed well and records showed that people received their medicines in accordance with prescription guidance. People were supported to maintain good health and had regular access to a range of healthcare professionals.

Prior to starting work at the home recruitment checks were completed to help ensure only suitable staff were employed. All new staff completed an induction to enable them to learn about the home and people’s needs. Training was provided and staff received supervision and staff appraisals. Staff told us they felt supported by the management and worked well together as a team.

A complaints policy was in place and people knew how to make a complaint and were confident their concerns would be addressed. Relatives told us they were involved in the running of the home through residents and relatives meetings and suggestions and ideas they raised were listened to.

Relatives and staff told us they felt the home was well-led and that the registered manager was approachable.

During the inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt very safe in the home. We observed people being spoken to by staff in a respectful and caring manner. We found the staff and registered manager were knowledgeable about safeguarding people who used the service. We saw evidence which demonstrated staff had received training in safeguarding vulnerable adults.

We were not able to speak to people who used the service as they had complex needs and difficulty communicating. We gathered evidence of people's experiences of the service by reviewing records, observing care practices and talking with the manager, staff on duty, family members and a visiting professional.

During our visit we observed there was a relaxed atmosphere with people choosing where they wished to spend time. We observed staff treating people with affection, kindness and patience. Staff demonstrated how well they knew people's needs and ensured people were treated with privacy and dignity. We looked at people's records and noted that they incorporated their care plans, risk assessments and health care needs. We found that they encompassed the safety and well-being of people who use the service. Staff and family members we spoke with said they knew how to raise a concern or complaint and felt confident in doing so.

We looked at the management of medicines. The quality management system and reviewed staff records and found the provider had adequate systems in place which ensured the care and welfare of people who use the service.

During our visit to Holly Lodge Nursing Home on 27 March 2013, we observed a friendly environment, with positive interactions between staff and residents. People looked relaxed and well cared for, and we saw staff took time to talk with people.

At the time of our visit, 55 people were living in the home. We spoke with 11 of the 55 people, although due to some people’s dementia needs, not everyone was able to tell us about their experiences. We therefore used a number of methods to help us understand the experiences of people using the service, including observation and talking with people’s relatives and care staff.

Two people’s relatives said they were very happy with the care provided and the homely environment. People who were able to speak with us told us they felt cared for and supported by staff. Two people said the care was “wonderful”, and one person said, “I can’t fault it, the staff are so lovely.”

We observed staff providing respectful care and support to people, and saw this was delivered in line with the care records we reviewed to meet people’s needs.

We saw that information related to the service was clearly displayed in the reception area, including dates for the next relatives meeting due the day after our inspection.

We saw that the home had received a number of compliments and thank you letters which were displayed for people and visitors to read. Clear processes were in place to manage any concerns or complaint made.

People that we spoke to said they felt comfortable and settled at Holly Lodge.

The registered manager was not available on the day of our visit therefore the service was represented by the registered provider and the head of care.