This inspection took place on 2 May 2018 and was unannounced.

Following the last inspection in March 2017 the overall rating for the service was ‘requires improvement.’ The provider was in breach of one Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to ‘safe care and treatment’ (Regulation 12) specifically about medicines management. On this inspection we found they had rectified the issues we identified last time. However, we found the providers systems and processes had not identified some further issues with medicines management.

Holly Park Care 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. The care home can accommodate up to 43 older people who may be living with dementia in one adapted building. Accommodation is provided over two floors.

There was no registered manager in place. A manager had been recruited and was in the process of applying to CQC to be registered. 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.

There were enough staff to keep people safe and to meet their care needs. Staff were receiving appropriate training and they told us the training was relevant to their role. Staff told us they felt supported by the manager and were receiving formal supervision.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. We saw appropriate referrals were being made to the safeguarding team when this had been necessary.

People’s healthcare needs were being met; however, improvements needed to be made to make sure medicines were managed safely.

People's nutritional needs were met and meals at the home were good, offering choice and variety.

People who used the service and their relatives told us staff were helpful, friendly, kind and caring. We saw people were treated with respect and compassion.

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.

The home was clean, comfortable and improvements to the environment were on-going.

The complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

Some activities were on offer to keep people occupied and the manager was keen to introduce more things for people to do.

Everyone spoke highly of the manager and said they were approachable and supportive. People using the service and relatives were consulted about the way the service was managed and their views were being acted upon. There were some good audits being completed that were picking up issues. 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 this report.

Holly Park Care Home is part of the Park Homes (UK) Ltd group. The home is registered to provide accommodation, personal and/or nursing care for up to 43 people who may be living with dementia or have mental health needs. Accommodation is provided over two floors, which can be accessed using a passenger lift.

The inspection took place on the 21 March 2017 and was unannounced. At the time of the inspection, 26 people were living in the home and nursing care was not being provided.

A new registered manager was in place, who registered with the Commission in January 2017. 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.

At the last inspection in November 2015, we rated the service ‘Requires Improvement’ overall and in the ‘Safe’ and ‘Well Led’ domains, due to issues identified with medicines and a lack of evidence of sustaining previous improvements over time. At this inspection, we again rated the provider “Requires Improvement” in the same areas. This was due to concerns over the way medicines were managed and because systems to monitor and improve the service were not sufficiently robust. However we also identified some good areas of practice with the ‘Effective’, ‘Caring’ and ‘Responsive’ domains rated as ‘Good.’

People and relatives provided positive feedback about the service. They said good, personalised care was provided and said they would recommend the home to others.

People said they felt safe living in the home. Following incidents and accidents, investigations were undertaken to help keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place to help keep people safe.

The premises was warm, homely and suitably spacious. However we identified some defects with the premises, including a lack of hot water in some areas of the building.

Medicines were not consistently managed in a safe way. Some people did not always receive their medicines as prescribed.

During observations of care and support we saw staff were available to provide prompt care and assistance. Some people told us that at times, they thought there were not enough staff on duty. In light of these comments and due to new people coming into the home, we have made a recommendation about the need to review staffing levels in the home.

New staff were recruited safely to help ensure they were of suitable character to work with vulnerable people.

Staff received a range of training and support relevant to their role. People provided good feedback about the quality of the staff that supported them.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Consent was gained and where people lacked capacity the correct processes were followed. 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

Nutritional risks were well managed by the service. People had access to a range of suitably nutritious food. There were several options available at mealtimes and snacks and drinks were provided throughout the day.

People’s healthcare needs were assessed and appropriate plans of care put in place. The service worked with external healthcare professionals to help meet people’s needs.

Staff were kind and caring and treated people with dignity and respect. We found a warm and inclusive atmosphere within the home with all levels of staff taking the time to interact and chat with people.

People choices were sought and respected by staff. We saw a personalised approach to care and support was practiced by staf

We inspected Holly Park Care Home on 5 November 2015 and the visit was unannounced.

Our last inspection took place on 25 June 2014. At that time, we found breaches of legal requirements in six areas, respecting and involving people who use services, care and welfare of people who use services, safety and suitability of premises, staffing, assessing and monitoring the quality of service provision and complaints.. We asked the provider to make improvements and they told us they would be fully compliant with the regulations by August 2015. On this visit we found improvements had been made.

On 12 August 2014 the home was struck by lightening and suffered significant water and storm damage. Everyone living there at the time was moved to other accommodation whilst major building and refurbishment work took place. The home did not re-open until December 2014. This is why the timescales for improvement took so long.

Holly Park Care Home is part of the Park Homes (UK) Ltd group. The home is registered to provide accommodation, personal and/or nursing care for up to 43 people who may be living with dementia or other mental health problems. Accommodation is provided over two floors, which can be accessed using a passenger lift. At the time of our visit there were 17 people using the service and nursing care was not being provided.

There is 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.

When the service re-opened in December 2014 the operations manager for the organisation became the registered manager and has, until recently, been in day to day control of the service. Although they are still the registered manager they have returned to their role as operations manager for the company, overseeing a number of services. The organisation are trying to recruit a permanent manager and in the interim the deputy manager is the ‘acting manager’ and is being supported by an external consultant.

We found a number of audits had been put in place which were picking up areas which needed to be improved. These improvements need to be sustained over time to show they are robust and support the change in management arrangements.

The communal areas of the home had been reconfigured and now offered a selection of seating areas for people in bright and airy surroundings. The home was clean, tidy and fresh smelling.

Recruitment processes were robust and thorough checks were completed before staff started work to make sure they were safe and suitable to work in the care sector.

There were enough staff on duty to make sure people’s care needs were met and activities were on offer to keep people occupied.

Staff had a good understanding of what constituted abuse and the reporting mechanisms to make sure people were kept safe.

On the day of our visit we saw people looked well cared for. We saw staff speaking calmly and respectfully to people who used the service. Staff demonstrated they knew people’s individual preferences and what they needed to do to meet people’s care needs.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

Generally people told us the meals were good. There was a choice available for each meal and the cook was aware of people’s preferences.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s health care needs were met. The medication system was generally well managed and people received their medicines at the right times. However, improvements to the way medicines were booked in needed to be made.

Visitors told us they were always made to feel welcome and if they had any concerns or complaints they would feel able to take these up with the registered manager or deputy manager.

A complaints procedure was in place and we saw the manager had taken action to resolve the complaints they had received.

The inspection visit was carried out by two inspectors and an expert by experience. During the inspection, they spoke with the registered manager, operational manager, quality assurance manager, three care workers, the cook, two domestic assistants (one cleaning and one in the laundry) and the maintenance person. They also spoke with seven people who lived at the home, six relatives and a regular visitor from the local church. Not all of the people they spoke with were able, due to complex care needs, to tell them about their experience of living at the home. They observed care given to people in the communal areas, including lunch, and in their bedrooms.

After the visit they spoke with another relative and visitor from the local church the by telephone. The inspectors also looked around the premises, observed staff interactions with people who lived at the home and looked at records. There were 34 people living at the home on the day of the visit.

At the last inspection in December 2013 the service was found to be meeting the regulations we looked at.

Before this visit we had received information of concern about how the home dealt with complaints and how the home kept people safe. We found evidence which supported this information.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key 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?

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

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

Is the service safe?

The service was not safe. People were not adequately protected from abuse and avoidable harm. We saw several people with unexplained bruising and skin tears. Following our visit we made a safeguarding referral to the local authority so that someone independent of the service could consider the issues we identified.

Care was not planned and delivered in a way that ensured people's safety and welfare. There were insufficient numbers of suitably qualified staff to meet people’s needs. We have asked the provider to make improvements.

The premises and grounds at the home were not adequately maintained and the home environment was not clean and hygienic. This meant people were not living in safe surroundings that promoted their wellbeing. The temperature at the home was not adequately controlled and peoples’ medicines were stored in a room which was above the required temperature; this meant vulnerable elderly people were being put at risk. We have asked the provider to make improvements.

Is the service effective?

The service was not effective. The home did not promote a good quality of life for the people that lived there.

Most people told us they were happy with the care provided at the home and that they thought their care, treatment and support needs were being met. From our observations and from speaking with staff and people who lived at the home and their relatives we found staff knew people well and were aware of their support needs.

However, staff had not received appropriate training to meet the needs of the people who lived at the home. Staff we spoke with were not aware of how best to support people living with dementia. We have asked the provider to make improvements.

Audits were not effective; they either failed to identify issues or failed to follow up on issues when they were identified. This meant peoples’ care needs were not being met. We have asked the provider to make improvements.

Is the service caring?

Staff who worked at the home were kind and caring. However, the provider had failed to take appropriate action where issues were identified which impacted on peoples’ care, safety and welfare. We have asked the provider to make improvements.

People we spoke with who lived at the home told us they were generally happy living there. One person said, “I’ve got no complaints about anything. I get looked after here.” Another person said, “It’s alright living here. It’s not like home, but they do their best.” A relative said, “I think the care here is as good as anywhere else.”

All of the people we spoke with who lived at the home and the relatives were complimentary about the care staff. One person said, “They are lovely people. Always rushing about and trying to help you.” One relative said, “The staff here are very friendly and they seem to know the residents well.” This was confirmed by our observations during the visit; we observed care staff were courteous and patient when speaking with people.

We observed various issues relating to people’s dignity during our visit. This included not offering to take people to the toilet on a regular basis and people wearing clothes without buttons, which meant their underwear was in view.

Is the service responsive?

The service was not responsive. Accidents and incidents at the home had not been followed up appropriately to ensure the risk of recurrence was minimised. People who needed additional support with their healthcare needs from external professionals did not always receive their support in a timely manner.

Care and support was not always provided in accordance with peoples’ wishes. People’s preferences, interests and diverse needs were not taken into consideration. For example we found people were not receiving baths and showers in accordance with their documented preferences. This meant peoples’ needs were not being met.

We heard call bells going off for long periods during our visit. We also saw several call bells which were out of reach and/or the cord was of poor quality in bedrooms and bathrooms we looked in. This meant people may not be able to access the call bell system which had been put in place to help them summon assistance.

All of the people we spoke with, including relatives and visitors, told us that there were not many activities for people to engage with. One person said, “There’s not much to do except watch TV, but I don’t like TV.” One regular visitor said, “I’ve never seen much going on in the way of stimulating activities. It’s a shame because some people really enjoy a chat and going out. I think people only get out if they have relatives to take them.” We have asked the provider to make improvements.

We also found the complaints system at the home was not effective. Comments and complaints people made were not responded to appropriately. We have asked the provider to make improvements.

Is the service well-led?

The service was not well-led. People were not protected against the risks of inappropriate or unsafe care because the provider did not have effective systems to assess and monitor the quality of the service people received. The leadership and management at the home did not assure the delivery of high quality, person centred care. We have asked the provider to make improvements.

The manager at the home had been in post since December 2013 and had registered with the Care Quality Commission as the home’s registered manager in May 2014. Nearly all of the people we spoke with said they did not know who the manager was.

People we spoke with who lived at the home were not aware of residents’ or relatives’ meetings and they could not recall completing any questionnaires.

We observed a lack of organisation and direction of staff. Staff told us they were not always clear about their responsibilities and they did not feel well supported by the manager. They said their views were not always taken into consideration. This suggested the home did not promote an open and fair culture and did not support learning and innovation.

We spoke with two members of staff who told us they felt there was enough staff to care for the people who used the service and one told us the levels of sickness among staff had fallen in the last 18 months since changes had been made. They also told us they received appropriate training. One member of staff told us they felt the recent deaths had been people either on end of life care pathways or who were very frail.

The other told us they felt people were safe and well cared for. They also told us there were some really good carers working at the home, many who would "go the extra mile." They also said they would not hesitate to report any concerns they had to the manager.

We observed care in the home and saw people being spoken to respectfully and care was being delivered in a sensitive way. We spoke with two people who used the service and one relative. They told us they were happy with the care they received. One person told us "I am like the Queen of England, I couldn't be looked after better."

The provider may wish to note the relative we spoke with felt the food was okay but they thought their relative had lost weight. They felt this was partly due to the low level of one to one attention. Also that one of the people we spoke with told us they felt the activities were not available as they had been, they also said "We used to do trips but we don't go out any more."

We spoke with three people using the service, they told us "It has definitely become cleaner and the bedrooms get cleaned every day now" and "I can go to bed when I want to."

They told us that the newly furnished conservatory was now their favourite place to sit as it was bright and quiet away from the television. They told us they enjoyed doing something useful and they were going to sell the necklaces they were making at a local fair and the funds raised would help them to do more activities.

There was a visitors book at the entrance to the home and the following comments had been made in the months before the inspection;

"Staff look after my mother very well."

"Staff were always helpful and pleasant and give care above and beyond what their pay would reflect, they have great patience."

"Staff have made Holly Park my mothers home, she always looks clean and comfortable."

"Pleasant surprise, very clean and not smelly home"

"I can rest easy knowing she is in good hands."

We spoke with five of the 30 people using the service when we visited. They all told us that they were happy at Holly Park and the staff were very nice. One person told us that they were not very happy at the home as they did not have anybody to talk to other than the staff.

They told us that they were happy with the care they received. One person told us “I like it here, the staff are alright” and another “I would rather be at home but its okay here”

Regarding the food at Holly Park, one person told us “The food is good” another that “The food is sometimes inedible”

People using the service told us that the staff were always busy. One person told us “The staff are nice but they don’t have time to talk.” whilst another told us that “The staff are so busy that they tell you to wait and sometimes you can’t wait and this can be very upsetting.”

We were also told that a number of planned social events had been cancelled and they really missed being able to get out and socialise.

We spoke to people living in the home they told us that generally they like the staff but didn’t think there were always enough of them. People said that some of the food was nice but there were things on the menu that they didn’t like. People told us that activities are organised to keep them occupied and one person said that they really enjoyed their trip out to the local pub on a Thursday.

We found that people who used the service were, where possible, involved in planning their care and people's friends and relatives were also involved where possible. We also found that people were asked to formerly consent to their plan of care and other aspects of their care, such as, consenting to share information.

We found that risk assessments and care plans were written in appropriate detail that ensured staff were fully aware of people's needs and how to meet their needs. We also found that staff knew the people living at the home well and care was person-centred. We found staffing levels to be adequate and staff and people who used the service felt staffing levels were sufficient.

We found that the environment of the home, in the main, was visibly clean throughout and people’s bedrooms were comfortable. Some areas of the home, especially communal toilets and bathrooms, were dated in appearance and some parts of the environment were worn which made effective cleaning more difficult.

We found there was a clear complaints process in place and saw examples where the complaints process had been followed appropriately. We spoke with three people who used the service; one person said the home was lovely and they liked living there. Another person said, "All the nurses are nice" and "The food had improved". A third person we spoke with described how staff were caring and they were happy and comfortable at the home.