This inspection was unannounced and took place on 17 and 24 November 2016.

Our last comprehensive inspection took place on 15 and 16 September 2015. At this inspection, we found the service had not complied with all the regulations we reviewed. We found breaches in the regulations relating to risk management, the management of medicines, and not receiving all the notifications we required. The home had not had a registered manager for some time. We returned to the service on 25 February 2016 and found that action had been taken to ensure compliance with the regulations.

Hollybank Nursing Home is registered to provide nursing and residential care for up to 49 older people. Twenty one people were using the service at the time of our inspection. At the time of our visit there were no nurses employed at the home and no-one who used the service was receiving nursing care.

There was a registered manager in place at the home. 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.

It was clear from the paperwork we reviewed and discussions with other managers that the registered manager, who was also the registered manager for the providers’ sister home, Oak Lodge, had not been involved in the day-to-day running of the home. We were aware that the registered manager had handed their notice in and the group manager had started the interview process to appoint a new manager, who would be registered with us.

It was noted that the service also had a home manager. Although not registered with us the home manager took responsibility for the day-to-day running of the home with the support of the group manager.

People who we spoke with told us they felt safe at the service. Care staff we spoke with knew what action to take if they were concerned about a person who used the service being at risk of harm or the practices of a colleague.

Recruitment and selection procedures were in place to help protect vulnerable people from people who may be unsuitable to work with them. People and staff thought there were enough staff on duty to meet their needs.

There were procedures in place to ensure people received the appropriate support to manage their medicines. People were cared for in a safe and clean environment.

The premises had been through a major refurbishment. The providers had put in a great deal of thought into the refurbishment, which had been finished to a high standard incorporating up to date equipment.

Staff had an understanding of how to keep people safe and protect their rights should they be unable to consent to the care and support they required.

People were provided with a choice of suitable and nutritious food.

People had access to health and social care professionals to support them if required.

The atmosphere at the service was calm, relaxed and friendly. People who used the service spoke positively about the staff team who supported them.

People were able to participate in activities if they wanted to. This helped to ensure their emotional health and wellbeing.

There was a system in place for handling and responding to complaints. People told us that they were confident that the home manager would deal with any concerns that they raised.

People, relatives and staff spoke highly about the home manager. They said that they were approachable and supportive.

This was an announced focused inspection, which took place on 25 February 2016. This inspection took place to follow up the five breaches in the regulations we found at our last inspection visit on 15 and 16 September 2015.

The breaches in regulations related to there being no manager registered with Care Quality Commission (CQC) since April 2014 and we had not received all the statutory notifications we should have from the home. The providers of Hollybank Nursing Home are legally obliged to report any incidents, which may affect the well-being of people to us as a statutory notification.

We also found breaches in safe working practices in relation to the administration of medicines, the use of equipment and risk assessments.

Hollybank Nursing Home is registered to provide nursing and residential care for up to 49 older people. The home was still being refurbished and at the time of our visit. No one who lived at the home was receiving nursing care and no nurses were employed at the home.

Before our inspection, we saw from our records that there was a manager now registered with CQC. 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 was also the registered manager for the services ‘sister’ home Oak Lodge. The registered manager was not in attendance at this inspection visit.

Our records showed and clarification at this inspection confirmed that we had received all the statutory notifications we should have from the service.

We checked the shower areas in use at the Orchard Mews unit at the location. We saw that there were no shower chairs in place that could cause entrapment. In people’s bedrooms where bedrails were being used we saw that bedrail covers were in place to help prevent entrapment. Although detailed bed rail risk assessments were in place they had not yet been updated to reflect current practice and legislation. It was also noted that all the beds in the home were profile beds and had bedrails fitted as standard. We recommended the service considers current guidance and legislation in relation to the risk assessments of the use of bedrails to include profile beds.

We saw that a new medicines trolley had been purchased so that medicines could be stored securely during administration in communal areas of the home. There was no one taking ‘as required’ (PRN) medicines to help manage their behaviours at the time of this visit. The group manager and the home manager were aware of their responsibilities to ensure that clear guidance was in place for staff to follow when this type of medicine was to be administered in the future.

During the inspection, we spoke with two people who use the service. They told us the staff always asked them before they provided care and the staff were clear at explaining things to them. They told us they were happy at the home. They also told us they took part in activities and were given a choice of food and drink.

We found that people were asked for consent and the provider acted in accordance with peoples’ wishes. People who use the service received care in a way that met their needs and preferences.

The people we spoke with told us they felt the home was clean and well maintained. They told us their rooms were regularly cleaned. We found that the provider did not have suitable arrangements in place to ensure the appropriate standards were being followed in relation to the provision of hand wash sinks and the storage of reusable items and linen.

The people we spoke with told us they were happy with the staff. They told us the staff were friendly and did what was asked of them. They also told us they had no concerns about the services they received and they would speak to the staff if they had any concerns.

We found that people were cared for by staff that had been through the appropriate recruitment checks. There was an effective complaints system available, in case anyone wished to raise a complaint.

We did not speak with any people who use the service as part of this review.

We spoke with two people who use the service and the relative of one person who uses the service. They told us that staff were friendly, helpful and always listen to them.

The people we spoke with told us they were generally happy at the home. They also told us that the staff were very good with them. Two people told us that they were kept involved in the review of care plans.

People told us that they had no concerns about the care they receive. They told us that if they had any concerns or complaints, they would speak to senior staff or the Manager. Two people told us that staff were always around when they needed them.

This was an unannounced inspection which took place on 15 and 16 September 2015. We had previously carried out a scheduled inspection on 2 July 2014 when we found the service had not complied with all the regulations we reviewed. We found breaches in the regulations relating to the management of medicines and assessing and monitoring the quality of service provision. We returned to the service on 28 August 2014 and found that action had been taken to ensure compliance with the regulations in both areas.

Hollybank Nursing Home is registered to provide nursing and residential care for up to 49 older people.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and three breaches of the Care Quality Commission (Registration) Regulations 2009.

When we arrived at the home we saw that Hollybank Nursing Home was not fully in operation and in the process of major work being carried out to the main building which was being extended to join Orchard Mews, a unit within Hollybank Nursing Home’s grounds. At the time of our visit there were no nurses employed at the home and no-one who used the service was receiving nursing care.

There was no a registered manager in place at the home. 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 had been no registered manager at the home since April 2014. It is a condition of the registration of Hollybank Nursing Home that they have a registered manager to carry out the day to day running of the service.

Although we had recently received eight deprivation of liberty safeguarding notifications from the provider we found that we had not been notified about the death of a person who lived at the home or a safeguarding alert that had been raised with the local authority. The providers of Hollybank Nursing Home are legally obliged to report such incidents to us as a statutory notification.

We also found breaches in relation to safe working practices in relation to the administration of medicines, environmental risks and risk assessments.

We found an old shower chair being used in a shower room that had a seat design that could cause injury to people. This was removed from the premise immediately. We also had concerns that bed rails were being used and rail covers were not always in place. The risk assessment format for the use of bed rails was dated April 2004 and needed to be replaced by a more up to date assessment that reflected current practice and legislation.

The monitored dosage system (MDS) system for the administration of medicines could not be stored securely in the medicines trolley during administration. ‘When required’ prescribed medication to help support people manager their behaviours was being given without a clear reason why recorded on the back of the medicines administration record (MAR) and in their care records. This must be done to show that appropriate action is being taken to support people with their behaviour.

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

People who used the service, their relatives and staff told us that they did not think there was always enough staff on duty to meet people’s needs. We were told by managers that the arrangements for staffing were under review to include the role of a senior care staff.

We asked the provider to produce a timescale for when the work would be completed and what action was being taken to reduce the ongoing disruption to people who used the service, for example noise.

People who we spoke with told us, ”I feel safe here and am looked after.” “I feel safe here because I know if I fall then there's always somebody around to pick me up. “I would approach the receptionist lady if I had any problems.” “I've been here a while. I'm not afraid of anything in here. Nobody bothers me. I talk to the staff and they listen to me.”

Care staff we spoke with knew what action to take if they were concerned about a person who used the service being at risk of harm or the practices of a colleague.

Recruitment and selection procedures were in place to help protect vulnerable people from people who may be unsuitable to work with them.

People who used the service told us “It is a clean home and I haven't found any nasty smells. I find it warm enough here and the staff have rugs and blankets if I feel the cold.” “It's very clean in here” and “It's clean in here and I'm warm enough.”

Training records showed that staff had received basic training in fire safety moving and handling, infection control, food hygiene, first aid and health and safety. All care staff had undertaken an appropriate NVQ to Level 3 and level 2 standard. Staff received supervision from the manager which was a mixture of formal discussion and competence checks.

People were provided with a choice of suitable and nutritious food.

People who used the service said “The staff are kind to me. I like the girls.” “The staff are very kind. They will sit and chat with me when they have the time which isn't very often.” “My son and daughter in law come to visit me. Staff make them very welcome.”

We were informed that earlier this year the provider had carried out a two week independent review of the quality of service provided by Hollybank Nursing Home and its sister home Oak Lodge. From this review a new management structure was created with a group development manager being appointed to support both locations in July 2015. Weekly managers meetings had started to take place to improve communication and action plans to make improvements in the quality of service provided to the people who lived at the home.

We were told by members of the new management team that there was still “lots to do” to make improvements to the service and plans were in place to achieve this. The managers that we spoke with were open, honest and enthusiastic about the task that lay ahead.

A quality assurance exercise was carried out in May 2015. Comments from relatives included, “Lovely home with lovely ambience” “All staff are doing a great job to look after my mum” and “This is a lovely home with very caring staff.”