We inspected Holly Tree Lodge Care Home on 12 December 2016. This was an unannounced inspection. The service provides care and support for up to 40 people. When we undertook our inspection there were 40 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses, mental health needs or because they were experiencing difficulties coping with everyday tasks, with some having memory loss.

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 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there was no one subject to such an authorisation.

We found that people’s health care needs were assessed and care was planned and delivered in a consistent way through the use of their care plans. People were involved in the planning of their care. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans were put in place to minimise risk in order to keep people safe. We found that the care plans and risk assessments fully reflected the needs of people and what action staff should take to prevent a person from being at risk of harm.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period. The home was divided into two units and a core staff team worked in each unit, with some staff working across units depending on people’s needs.

People were treated with kindness and respect. Staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. Meals could be taken in dining rooms, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. There were menus on display so people could remind themselves of the choices they had made.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. On-going training was available for all staff. Professionally trained nurses were supported to maintain their registration with the Nursing and Midwifery Council.

People had been consulted about the development of the home and quality checks had been completed to ensure the home could meet people’s requirements. There was an analysis of quality checks and any lessons to be learnt were passed on to staff through meetings and supervision sessions.

Prior to our visit we reviewed all the information we had received from the provider. Due to the complex needs of some of the people living at Holly Tree Lodge Care Home we used a combination of methods to assess the quality of service provision. We used observation to help us understand the experiences of some of the people who used the service as we were unable to ask them their views. We spoke with two people who used the service, the registered manager, seven members of staff, three visitors and one visiting health care professional.

We found people received care and support that met their needs. A relative told us, “Staff are absolutely wonderful. The care given is brilliant. I can’t fault it.” A member of staff told us, “Care is excellent, I would bring my relative here.”

We found that people were provided with suitable and nutritious food and drink in sufficient quantities to meet their individual needs and preferences. One person who lived at the home told us, “We get a choice but I would like more variety.”

The provider had in place systems to regularly monitor and assess the quality of the service provided.

We found that people were cared for in a safe and caring environment and the service was well led and managed

People we spoke with told us that they liked living at Holly Tree Lodge. They told us that the Manager and staff team provided the support and care they needed.

We also used a number of different methods to help us understand the experiences of some of the people who used the service. This was because they had complex needs which meant that they were not able to tell us about their experiences.

We looked at records, including personal care plans. We spoke to the manager and staff who were supporting people, and we observed how they provided that support. We also spoke with one relative who was visiting the home.

The relative told us that, “They (staff) are brilliant. When my relative was poorly they knew just what to do.”

We observed that staff provided sensitive support using special equipment when people needed help with moving safely, during meal times and when people were undertaking individual or group activities.

Other professionals who did not work at the home told us that the service offered personalised support for people, and were responsive to people’s needs.