About the service: Hollyacre Bungalow is a residential care home that was providing accommodation and personal care to nine adults with learning disabilities.

The service is a large home, bigger than most domestic style properties. It is registered for the support of up to 10 people. Nine people were using the service. This is larger than current best practice guidance. However. the size of the service did not have a negative impact on people. This was because the building design fitted into the local residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going out with people.

People’s experience of using this service: Improvements had been made since the last focussed inspection in 7 November 2018. People and their relatives told us the changes had improved the service for the better.

Some new policies and procedures had been introduced by the registered manager however, these were not fully completed. We have made a recommendation for a plan to be put in place to ensure this is completed in a timely manner.

Staff received support and an improved variety of appropriate training and support to meet people’s individual needs. However, there was still training outstanding. We have made a recommendation that a training plan be introduced for all staff.

Changes to the service had a positive impact on people. Improvements were made to ensure care plans were more person centred, using appropriate language and that care and support was individualised.

Regular outings had been arranged for people to be more active in their local community.

New risk assessments were in place. Staff knew how to keep people safe and were trained in safeguarding.

Audits and monitoring systems were effective at managing the service and making improvements.

Robust recruitment and selection procedures ensured suitable staff were employed.

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 supported to have enough to eat and drink.

Appropriate healthcare professionals were included in people’s care and support as and when this was needed.

People spoke positively about the improvements put in place by the registered manager and the provider. There was an effective quality assurance system in place to ensure the quality of the service and to drive improvement.

There were systems in place for communicating with staff, people and their relatives to ensure they were fully informed via team meetings and communications.

People had links to the local community through regular access to local services.

People were supported to be independent where they could and their rights were respected. Support was provided in a way that put the people and their preferences first. Information was provided for people in the correct format for them.

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

Rating at last inspection and update: At the last comprehensive inspection (published 26 July 2018) the service was rated inadequate. This was followed up by a focussed inspection and rated requires Improvement (18 December 2018).

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor information we receive about the service. If any concerning information is received, we may re inspect sooner.

We carried out an unannounced focused inspection of this service on 7 November 2018.

We last conducted a comprehensive inspection of this service on 13 June 2018 where breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hollyacre Bungalow on our website at www.cqc.org.uk.

When we completed our previous inspection, we found concerns relating to: fire safety, management of medicines, reporting of safeguarding concerns, person centred care planning, dignity and respect and staffing levels and deployment.

Hollyacre Bungalow 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. Hollyacre Bungalow accommodates up to 10 people. At the time of our inspection 9 people were living at the home.

At our last inspection we found the service was not meeting all of our fundamental standards and was rated as ‘Inadequate’ overall. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the time of our inspection the service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 that vast improvements had been made to fire safety and people who used the service were no longer exposed to risk of harm from fire hazards at the home.

A new fire safety risk assessment was carried out by a third-party professional to ensure fire risks were adequately managed.

Improvements had been made to the reporting and recording of potential safeguarding concerns and staff training to ensure safeguarding incidents were logged and reported appropriately.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation.

Accidents and incidents records had improved to ensure they were recorded, monitored and managed effectively.

Improvements had been made to the recording and management of medicines to ensure they were administered, stored and managed safely.

Office staff and an activity co-ordinator had been employed to improve staffing levels. This ensured there were adequate staff to meet people’s needs safely.

Personalised risk assessments had improved and were recorded in people’s care plans appropriately to enable people to take risks as part of everyday life safely.

Accidents and incidents were analysed by the registered manager to look for trends to ensure lessons were learned so that similar accidents and incidents could be avoided, or risks of a reoccurrence be reduced.

The home was clean, tidy, well presented and infection control practices were carried out to a good standard.

Staff were employed safely and pre-employment checks were carried out on

The inspection took place on 13 June 2018 and was announced. This meant the registered manager or registered provider didn’t know we would be visiting.

At our last inspection in December 2017 we found the service was not meeting all our fundamental standards and was rated as ‘requires improvement’ and following this comprehensive inspection due to further breaches of our regulations the service was rated inadequate overall.

At the last inspection there were issues regarding staffing levels, person centred care, and staff training and equipment. We asked the provider to send us a report on their actions and they completed the outstanding issues raised. At this inspection we found some improvements however, further issues were found and in some areas the service had deteriorated.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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. Feedback from staff and relatives regarding the registered manager was positive.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hollyacre Bungalow 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. Hollyacre Bungalow accommodates 10 people in one building.

The care service provided at Hollyacre Bungalow at the time of our inspection was not 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 to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People were not protected from the potential risk of harm due to a lack of preventative measures in place at the home. We found a lack of fire safety procedures including; poor maintenance of fire safety doors and exits and an inadequate fire safety risk assessment.

Maintenance checks were not always carried out at the home and we found that there was no gas safety check in place at the time of our inspecti

This inspection took place on 19 September 2017. The inspection was unannounced which meant the staff and provider did not know we would be visiting. The service was last inspected in 2015 and received an overall rating of 'Good.'

Hollyacre Bungalow provides care and support for up to ten people with a learning disability. It is located in a residential setting in Sacriston in County Durham. Nursing care is not provided.

The service 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. At the time of inspection the registered manager was on annual leave.

There were not enough staff to meet people’s needs. On the day of inspection there were two staff on duty, one male and one female, supporting ten people who used the service. There were five female people who used the service and they would not accept care from the male staff member. Therefore the female staff member had to support all five female people on their own. This included hoisting which should be carried out by two staff members. Therefore the services practices were unsafe. We contacted the provider at the beginning of the inspection to request more staff were put on duty immediately. The provider arranged for a further staff member to come in and added an extra staff member onto the rota going forward. The service employed 11 members of staff and they were working long hours to cover each shift. Following the inspection the provider increased the number of existing staff hours and they were interviewing for more staff in order to address this shortfall.

Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. However, staff records were not all completed.

Not all people who used the service were supported to access activities. We looked at three people’s daily notes going back to February 2017. One person went to a day centre once a week, the other two people had only left the service once in seven months. People watched the television all day or listened to music. Due to the lack of staff and the need for staff providing two to one care and support, staff told us they could not provide people access to meaningful activities.

A large proportion of risks to people arising from their health and support needs and the premises were assessed and plans were in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use. However, we could not establish that the hoists were safe for use; six people who used the service required hoisting. The service had two hoists which had had a service in May 2017; however, the service on these hoists could not be completed due to some parts being deemed faulty and needing replacement. The person who carried out the service said the parts may be difficult to get as the hoists were old and recommended new hoists were purchased. Nothing had been done about this. We followed this up after inspection and the manager had received quotes for two new hoists and was waiting for the provider to agree to the purchase. We followed this up with the provider due to the hoists being unsafe. Two new hoists were purchased on 27 September 2017.

A gas safety check, which took place in December 2016, was passed but it was recommended the provider purchased a carbon monoxide detector for the boiler room. These had not been purchased until we raised the concern at inspection. The fridge in the kitchen was also broken; it was freezing food and leaking. Therefore the safety of the food stored in the fridge could not be guaranteed. We also raised concerns about this during the inspection. A new fridge and ca

People who used the service were given appropriate information and were involved in making decisions about their care and treatment. They were treated with dignity and supported to make choices and remain independent.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

People had their health and welfare needs met by sufficient numbers of appropriate staff.

People’s personal records were accurate and fit for purpose.

The provider wrote to us stating the extractor fan had been repaired and a new shower chair had been purchased. We visited the home to check this had happened. We found the fan had been repaired and was in full working order and there was a new plastic coated shower chair which prevented it from rusting. This meant people were no longer at the risk of infection.

We spoke with several people using the service. Due to their communication needs, it was difficult for us to get detailed comments from some of the people living at the service. The comments we heard were all positive and included:

"I’m happy with everything, I wouldn’t change anything.”

“I have had a review at Empower with (Name) and the staff.”

“I go out to Shields, the chips aren’t nice there.”

“I like going out … we have a bus.”

“I get to see my boyfriend.”

Staff made positive comments about the management of the service. They told us they were well supported. They said “We’ve done loads of training. 1st aid was particularly useful.” and “We are all very well supported by (Name – the manager).”

This inspection took place on 20 July, 21 July and 5 August 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

Hollyacre Bungalow provides care and accommodation for up to 10 people with a learning disability. On the day of our inspection there were nine people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Hollyacre Bungalow was last inspected by CQC on 30 April 2013 and was compliant.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Accidents and incidents were recorded appropriately and there had not been any recent safeguarding incidents.

Comprehensive medicine audits were carried out regularly.

Staff training was up to date and staff received regular supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

The home was clean, spacious and suitable for the people who used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the provider was following the requirements in the DoLS.

People who used the service, and family members, were complimentary about the standard of care at Hollyacre Bungalow.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

We saw that the home had a full programme of activities in place for people who used the service.

Care records showed that people’s needs were assessed, care plans were written in a person centred way and regularly reviewed.

The provider had a complaints policy and procedure in place. There had not been any recent complaints however people knew how to make a complaint.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources.