Hollybank is a care home that provides support for up to 4 people living with learning disabilities. The service is set out as a domestic type setting, with each person having their own room and shared communal areas. People have access to a well maintained garden to the rear of the premises. The care service has been developed and designed 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Audit systems were in place to monitor the quality of the service being provided. We spoke with one person's relative who gave very positive feedback about the service, and one health professional who also gave good feedback. However, we have made a recommendation regarding the consistent completion of audits as these had not always been done in a timely manner. This had not impacted on the running of the service or people's wellbeing.

People were protected from the risk of abuse. Staff had received training in safeguarding vulnerable people and low level concerns had been reported to the local authority.

Recruitment practices were safe and people which helped protect people from the risk of abuse.

Staffing levels were sufficient to meet the needs of people using the service.

Training was in place for staff to ensure they had the correct skills in place to meet people's needs.

People were supported to have a nutritious diet, and where appropriate special diets were prepared in line with people's needs.

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.

Staff were kind and caring towards people and positive relationships had been developed.

Care records clearly outlined people's needs and provided instruction around how staff needed to support people.

Activities were available for people which helped protected them from the risk of social isolation.

The inspection took place on 21 March 2016 and was announced.

The service provides accommodation and support to four young adults with autism. This is a mental condition, present from early childhood, characterized by great difficulty in communicating and forming relationships with other people and in using language and abstract concepts. Whilst all autistic people share certain difficulties, being autistic will affect them in different ways.

The service is located within a detached property in a residential area of Weaverham, close to local amenities. At the time of the visit, there were four people living at the service.

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.’

We previously inspected the service on 9 May 2014 and returned on the 2 March 2015 to ensure that improvements had made to the environment. At that time, we found that the registered provider met the regulations assessed.

People lived in a detached house that had been adapted in part to meet their needs and people had access to communal areas as well as the privacy of their own rooms. The building was kept clean in order to minimise the risk of infection. Remedial repairs and refurbishment took place when required. The registered provider ensured that all required checks were carried out on a regular basis.

Observations indicated that people were happy at the service and there were positive interactions with staff. People were mainly supported by staff that knew them well and could anticipate their needs. New staff shadowed existing staff until they knew the person well. People had busy social lives and encouraged to be as independent as possible.

The requirements of the Mental Capacity Act 2005 were partly met. Staff used a range of strategies to communicate with people to help them express themselves and to indicate consent. However, they did not document a person’s ability to make decisions or those situations where they had to act in their “best interests”. Applications had been made under the Deprivation of Liberty Safeguards where it was felt a person’s liberty was being restricted or deprived.

Staff were aware what was required in order to keep people safe and there was evidence that they were confident to report matters of concern. People received care and support from staff that had been through robust recruitment procedures to ensure that they were of suitable character to work in this setting. Staff also underwent an induction programme to equip them with the knowledge and skills to support people with complex needs.

Care records were personalised and gave a clear picture of a person’s needs, wishes, preferences and personality traits. Risk assessments and management plans were written to direct staff in managing certain aspects of a person’s care. This meant that staff not familiar with people at the service would be able to something know about them and how their support needed to be delivered. Medications were administered correctly which meant that people received the medication they needed to keep them well.

The registered provider ensured that audits were carried out on a regular basis in order to monitor the quality and effectiveness of the service. There was a complaints policy in place but there had been no formal complaints since out last inspection. Matters were usually responded to and dealt with informally.

We carried out an unannounced focused inspection to check that the provider had followed the action plan they had prepared after our visit in May 2014.

We found that the provider had followed their plan and the home was clean and fresh and in good decorative order. This means the home is now fully compliant with essential standards.

The inspection team included two inspectors and a specialist advisor. The team gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? An inspector gathered information from representatives of people using the service by telephoning them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with representatives of people who used the service and staff and from looking at records.

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

Is the service safe?

Representatives told us they felt people who used the service were safe and their rights and dignity were respected.

People's care records were accurate to ensure that they received appropriate care. Staff knew about risk management plans and gave us examples of how they had followed them. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents.

Recruitment practice was safe and thorough and there were enough staff to meet people's needs.

The environment was safe, but some maintenance work was needed. We have asked the provider to tell us what they are going to do to improve the environment.

Is the service effective?

There were systems in place for seeking and obtaining valid consent to care and people's human rights were respected.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service caring?

Feedback from people was positive, for example; "I'm more than pleased; my relative is safe and happy" and "They're brilliant, I couldn't be happier".

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

There was investment in staff training and staff were clear about their roles and responsibilities.

There was a complaints procedure in place.

Is the service well-led?

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Staff had a good understanding of the ethos of the service and said they felt well supported.

We gathered information about people's views of the service provided by speaking with their relatives and by making observations and looking at records. We were not able to speak with the people who used the service because we were unfamiliar with their communication needs.

Our observations indicated that the people who used the service were content with the staff that supported them. The staff observed had a very caring and patient approach and knew the needs of the people they supported.

We spoke to two relatives who said that a good standard of care was provided. They said they were kept well informed about their relatives well being. Some comments made were:-

“I am very pleased with the care and support provided.”

“I feel very involved. My relative is happy there.”

We spoke to two staff who said they enjoyed working at the home and considered that the people who lived there got a good service.

We spoke to a social care professional who said that the person they supported had their needs well met.

We found that people were assessed before they began to use the service and they had care plans that identified their needs. People were appropriately supported with their nutritional needs. The home was clean with adequate systems in place to promote infection control. Medication was managed safely and the quality assurance systems that were in place ensured people received safe, appropriate care, treatment and support.

We were not able to speak with the people who used the service. This was because the Compliance Inspector was unfamiliar with the verbal and non-verbal way the people who used the service communicated.

We gathered information about people's views of the service by speaking with relatives and a service commissioner and by looking at records of people’s care reviews.

Our observations indicated that the people who used the service were relaxed and happy with the staff who supported them. The staff interacted with the people who used the service in a manner that promoted their dignity.

Relatives spoken with said they were very happy with the service provided. They described the staff as friendly, caring and attentive. They said that they were kept informed about their relatives well-being and were invited to attend reviews of care plans were they could express their views. Some comments made were:-

“It’s a wonderful service. I’m very happy. The staff know my relatives needs very well and they provide a good standard of care. My relative is happy. “

"I'm completely delighted with the service. My relative is so happy and they are doing great."

"The service is fantastic. My relative is very settled and happy at Hollybank. The staff are second to none."

"We are very happy. We can tell our relative likes the new service. Their needs are well met there."

Records showed how the people who used the service had settled in well to their new home and feedback forms (some were completed with staff) indicated that they were satisfied with the activities provided, staff support, meals, decoration and bedrooms.

We asked the commissioners of the service and social workers for their views. Information was provided by a service commissioner. They said that the person they had placed at the home had their needs well met and was happy. They said a good service was provided, they were kept informed about the person's well-being and the home was run safely.

We requested information from Cheshire West and Chester Local Involvement Network (*LINks). At the time of writing this report no information was received from this agency.

* LINKs are networks of individuals and organisations that have an interest in improving health and social care services. They are independent of the council, NHS and other service providers. LINks aim to involve local people in the planning and delivery of services.