This inspection took place on 27 September and 6 October 2016, the first day was unannounced. At our last inspection in May 2014 the provider met the regulations we inspected.

Hollybank Residential Home is a privately owned care home for up to 17 older people who require residential care and may be living with dementia. Accommodation is arranged over three floors and there is stair lift access to one floor. Communal areas include a lounge, conservatory, kitchen and dining room with bathroom and toilet facilities throughout. There is also an enclosed rear garden with sloping lawn and paved area for people to access. At the time of our inspection there were 17 people using the service.

Under the conditions of registration the home is not required to have a registered manager as it is owned by an individual provider. There was an established manager who had worked at the service for over twenty years. The registered provider was in the home each day and was actively involved in how the home ran.

People using the service and their relatives told us they felt safe and well cared for. Staff knew how to recognise and report any concerns they had about the care and welfare of people and how to protect them from abuse and harm. Where risks were identified, there was guidance on the ways to keep people safe in their home and in the local community.

The environment was safely maintained and people had the equipment they needed to meet their assessed needs. Individual bedrooms were personalised and furnished to comfortable standards.

The provider followed an appropriate recruitment process to check staff were suitable to work in a care setting. Staff received an induction and relevant training to support people with their care needs. This was followed by ongoing refresher training to update and develop their knowledge and skills. Staff also undertook training courses specific to people’s needs such as dementia awareness, diabetes and understanding depression.

The staff team had worked at Hollybank for a number of years and knew people well. There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Staff treated people who used the service and their guests with respect and courtesy. They were caring, patient and maintained people’s privacy and dignity.

People's needs were assessed and planned for and staff had accurate information about how best to meet people's needs. People's wishes, preferences and beliefs were reflected in their care plans. There was information about people’s social links and relationships with family and friends. Staff were responsive when people's support needs or circumstances changed and care records were updated appropriately.

People’s rights were protected because the provider acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This legislation is intended to ensure people receive the support they need to make their own decisions wherever possible. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Where people lacked capacity to make decisions, staff were aware of how to support them in line with the law. Families and professionals were consulted about people’s care so decisions could be made in the person’s best interests. Appropriate applications had been made to the supervisory body to restrict people's liberty where required.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were provided with homemade, freshly cooked meals. When people were at risk of poor nutrition or dehydration, staff involved other professionals such as the GP or dietician

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with six people using the service, two visitors, three members of staff, the registered provider and home manager. We also toured the premises and reviewed records relating to five people using the service and the management of the home.

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

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

Is the service safe?

There were sufficient numbers of suitable staff to meet people’s needs. Staffing levels were flexible to meet any changing needs.

A safeguarding policy and procedure was in place to advise staff what they should do if they suspect abuse and staff received regular training in safeguarding. We spoke with two members of staff who both demonstrated a good understanding of types of abuse and how to protect the welfare of vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The manager had been trained to understand when an application should be made, and how to submit one. We saw that there were plans for other care staff to attend refresher training. We saw where people no longer had capacity to make specific decisions, the staff acted appropriately and decisions were made in people's best interests.

People were cared for in an environment that was safe, clean and hygienic. We saw that equipment was available to enable people to mobilise safely around the home.

Is the service effective?

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met. The service had made timely referrals for health and social care support when they identified concerns in people’s wellbeing. Records showed that staff had followed the advice and guidance provided by health and social care professionals.

The staff we spoke with had a clear understanding of the care and support needs of the people living in the home.

People spoke positively about the quality of the food and choices available.

Is the service caring?

We saw that people were at ease in the presence of staff and staff knew people well, and were able to talk and share experiences. Those people who were able to talk with us said that they were supported by kind and attentive staff. Comments included, “It’s the best here”, “Everyone is so lovely” and “I’m very happy with the staff and care.” A visitor told us, “They are all very caring here.”

Staff assisted promptly and we observed that people were relaxed and comfortable in the company of staff. We saw they were kind, attentive and supported people at their own pace. People we spoke with told us they were well looked after. They described the staff as “very good”, “kind” and “they will have a chat with you if you need one.” One person told us “they are only too willing to help if you want something.”

Staff we spoke with knew the importance of treating people as individuals and maintaining their dignity when giving personal care.

People were able to provide feedback about the quality of the care and support provided through regular meetings and annual satisfaction surveys.

Is the service responsive?

Care records were person centred and clearly described people's needs and risks and how these were to be managed. People needs and risks were regularly reviewed and changes made to the support provided as and when required.

People were supported to access health and social care services such as GPs, dietetic services, chiropody, community nursing and mental health support. Staff members we spoke with told us how they monitored people's general well-being and health needs, which was reflected in their care plans.

Is the service well led?

There was a long standing manager who demonstrated a good knowledge of their role and responsibilities and how to effectively lead the team of staff. The registered provider was in the home each day and was actively involved in how the home ran.

The staff team had also worked at Hollybank for a number of years and knew people well. Staff told us that they had the training and information they needed to care for people and that the manager was always available to offer guidance and support.

Staff felt there was good teamwork and one told us, “It works well here as the home is organised.”

The service worked in partnership with key organisations, such as the local authority, to support care provision and service development.

The manager undertook a range of quality audits to ensure risks to people's health, safety and welfare were identified and managed.

There were systems in place to make sure the staff learnt from events such as accidents and incidents. These meant risks to people were reduced and there was evidence that the provider used this to improve and develop the service.

The provider notified us, the Care Quality Commission (CQC), of any incidents that occurred as they were required to by law.

We spoke with five people who used the service. They told us that they were happy with their care and support. Comments included “This is a well organised home”, “I receive good care”, “the staff are excellent” and “I always receive support with my care at times I prefer.”

We observed staff engaged with people in a supportive and sensitive manner. A person who spoke with us said “The staff are friendly and caring." Another person said “the staff respect my privacy."

We looked at the home's medicines administration practices. We found that people received their medicines in a safe way. Two people who spoke with us said they always received their medicines at the right time.

We found that the home had not always informed the Care Quality Commission of all incidents they were required to notify us about. We also found that prompt action had not been taken to report two potential safeguarding matters to the local authority.

We found that before staff commenced employment at the home checks had been completed to ensure they were safe and fit to do their job.

The service had systems in place to ensure that people’s comments and complaints were listened to and acted upon. A person who spoke with us said “The staff are very good at sorting out problems and requests.”

There were 16 people residing at Hollybank at the time of our visit. We spoke with seven people using the service three members of staff, the registered provider and manager.

People who used the service told us they were happy living at the home and they were well looked after. Comments included, “this is the best home I’ve been in”, “The staff are good to me, the food is nice”, “we are very lucky here and well fed!” and “I’m very happy, we have a laugh.”

People knew who to talk to if they had any worries or concerns, and felt assured that staff would respond to these in an appropriate manner.

There was a stable staff team who have worked at Hollybank for a number of years. Staff told us that they had the training and information they needed to care for people and that the manager and provider were very supportive.

All the people we spoke to complimented the staff and described them as “very caring”, “helpful”, “friendly” and “very patient.”

There were systems in place for ensuring that the service was operating effectively. We saw evidence that when improvements had been identified at Hollybank they were acted upon.

Prior to our visit, we asked the provider to complete a self assessment for eight of the outcomes. This information is used to help us reach a decision about whether the service is meeting the essential standards. The returned Provider Compliance Assessment (PCA) was informative and included good information about how the home complies with the standards.

The people who live at the home prefer to be known as residents, so that is the term that has been used in this report.

We were able to meet and talk to several residents throughout the day who were happy to tell us about their experience of living at Hollybank. They told us that the manager and staff are approachable, have a caring attitude and respect their views. Residents were very complimentary about the service and the good standards of care provided. Individuals commented that they enjoy the meals in the home and find the staff to be helpful and attentive. They said there are activities to join in with and musical entertainers who visit.

Two residents who had recently moved to the home commented favourably about their introduction to Hollybank and were made to feel very welcome.

Please refer to each outcome below and within the main report for more detailed comments about specific aspects of the service

All those who contributed to this inspection are thanked for their time and for sharing their views.