The inspection took place on 13 December 2018 and was unannounced.

Hollyfields is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hollyfields is a care home registered to provide personal and nursing care to 48 people, including older people and people living with dementia. At the time of our inspection, there were 41 people living at the home.

At our last inspection in February 2017 we rated the service good overall, but we found improvements were required as people's needs were not consistently met in a timely way due to the number of staff available. At this inspection we found those improvements had been made but we have rated the key question of ‘Responsive’ as ‘Requires Improvement’. However, the evidence continued to support the overall rating of good. 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.

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.

People’s care plans did not consistently provide sufficient details so staff had all the written guidance they required when supporting people with behaviour that challenges. Staff had not consistently ensured all monitoring documentation reflected the responsive care provided and or what people required to meet their individual needs. More could be done to provide people with sensory stimulation when they were in their rooms.

Staff had a good understanding of abuse and the procedures which should be followed to report abuse and incidents of concern. People were provided with assistance to promote their safety with aids and equipment to manage potential risks within people's lives, whilst also promoting their independence. The registered manager used the learning from incidents to prevent these from happening again.

There were enough staff on duty to meet people's needs and although staff were busy they spent time with people without being rushed. People were supported to receive their medicines at the right time. Staff were reminded to consistently label prescribed creams so there was evidence these were used in line with the manufacturer’s instructions.

The home environment was clean and tidy which reduced the risk of infection and staff knew how to report any concerns if required. There was an odour which the registered manager was already aware of and gave assurances they were working to reduce this. People were supported to receive their medicines at the right time.

People were supported by staff who had induction training and on-going training to ensure staff had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people's needs were met and they were supported effectively.

Staff were supported by the registered manager and had regular one to one and team meetings. The staff we spoke with were all positive about the senior staff and management in place, and were happy with the support they received.

People were provided with food and drink they enjoyed and it was presented in a way to meet people’s individual needs. Staff monitored people's health needs closely to ensure people were referred to healthcare professionals when needed.

People were supported in different ways by staff so their consent was gained before any care was provided on a daily basis. People were

Hollyfields is registered to provide accommodation and nursing care for people for 41 people. At the time of our inspection 34 people were living there. The inspection took place on 21 and 24 February 2017 and was unannounced.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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.

People’s needs were not always able to be met in a timely way due to the number of staff available. Staff believed there to be insufficient staff on duty. The registered manager reviewed the dependency tool used during our inspection and as a result assured us staffing levels would be increased.

Staff had the skills and knowledge to support people's needs. They were supported in their roles and attended training which was relevant to the people they looked after. People were protected from the risk of abuse as staff and management were aware of their responsibility to report any concerns about people’s safety.

Staff respected people's rights to make their own decisions and choices about their care and treatment. People's permission was usually sought by staff before they helped them with anything. Staff made sure people understood what was being said to them by using gestures, short phrases or words. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well.

Staff met people's care and support needs in the least restrictive way. Where it was felt people received care and support to keep them safe and well which may be restricting their liberty action was taken. This ensured people's liberty was not being unlawfully restricted.

People had a choice of food to eat and were prompted to maintain a healthy, balanced diet. People's routine health needs were looked after and people had access to healthcare when they needed it. People received their medicines as prescribed by their doctor.

Staff usually provided care and support to people which was personalised and responded to changes in their needs. People's preferences and wishes were known to staff and were respected. Occasions when care was not so good or when dignity was not upheld were highlighted to the registered manager. People who lived at the home and their relatives where appropriate were consulted about their care to ensure it responded to their needs in ways they wished. There was a system for handling and resolving complaints which was used to identify any aspects of people’s care which required improvements to be made.

The registered manager had systems in place to monitor the quality of the care provided and to monitor events which took place in the home to assist keeping people safe. The registered manager was aware of the provider’s visions for the future development of the care and support provided for people to further enhance the quality of life people experienced.

The inspection was unannounced and took place on 9 June 2015.

Hollyfields is registered provide accommodation and personal care for a maximum of 41. There were 37 people living at home on the day of the inspection. There was a registered manager in place. 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

People felt safe and had their needs met by staff that were available when they needed them. Staff felt they kept people safe and supported them by reducing their risks and promoting their independence. Staff spent time with people providing care and talking to people. People got their medicines when they needed them and as prescribed. Medicines were stored and staff knew how which medicines needed to be monitored or changed.

People and relatives knew the staff well and felt they had been trained had the skills required. People had been able to choose their care and treatment and were supported to make decisions if they had not been able to do this on their own. They were supported by relatives, staff and other health professionals. Where restrictions had been placed on people, the provider had followed the correct procedure.

People enjoyed the food and where needed staff supported them to eat and drink enough to keep them healthy. We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us and we saw that their privacy and dignity were respected and staff were kind to them. Staff had been understanding and supportive of people’s choice and decisions. People had been involved in the planning of their care.

People got to do the things they enjoyed and said that they also spent time in their home, the garden or out on planned trips. People had raised comments or concerns and they had been addressed.

The management team had kept their knowledge current. The registered manager was approachable and visible within the home. The provider and registered manager made regular checks to monitor the quality of the care that people received and look at where improvements may be needed.

During our inspection we spoke with the registered manager, the deputy manager, two nurses and some care staff. We spoke with people who used the service and three relatives.

We observed the care and support provided during the day. We also viewed some records about the service people had received and some management records.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People who used the service told us that they felt safe at Hollyfields. People told us the staff were kind and friendly towards them and provided the care and support they needed. One relative said: “They look after people well here”.

People told us that they were involved in their day to day decisions and could make choices about what support the needed.

People’s care records had been completed and these mostly matched their individual care needs. We found that risk assessments were in place to reduce the risk of inappropriate care and support.

We saw that people who used the service had their medicines administered at the right time as prescribed by a doctor.

Systems were in place to make sure that managers and staff learnt from accidents and incidents. We saw that suitable action had been taken to reduce accidents and the risks to people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We found that staff had knowledge of DoL’s. This meant that people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed and care and treatment was planned and delivered in line with their individual needs. People told us that they felt the staff met their needs and that they had been involved in their planned care. We found that relatives had been involved where appropriate. The majority of people were happy with the care provided to them or to their relative

We saw that staff did not always record that people had creams and ointments applied to them as prescribed by a doctor.

We found from our observations and from speaking with staff that they had a good understanding of people's care and support needs. We found that people’s mobility had been taken into account in relation to the environment.

Is the service caring?

People we spoke with told us that staff were caring and that they treated them kindly and that their needs were met. We saw staff interactions were supportive and respectful and that staff assisted people sensitively, whilst at the same time promoting their independence as much as possible. We saw that staff supported people and provided comfort and reassurance to people who used the service

People told us that staff respected their choices and we saw staff helped people to promote their own independence. We found that people were able to make choices about their food and drink and where they spent the day.

Is the service responsive?

People told us they felt able to raise concerns. We saw that people’s views had been sought through satisfaction surveys.

We found that people who used the service were confident that any issues they had would be responded to in a timely way. The majority of relatives we spoke with were confident in the care and support provided.

People received help and support from health care professionals when required such as doctors, dentist and chiropodists.

Is the service well led?

The provider had quality assurance systems in place. These systems had included obtaining the views of people who used the service and their relatives. The registered manager had carried out regular audits and checks to ensure the quality of the service provided.

We saw that records identified any shortfalls and the actions taken to address these and make improvements.

Staff told us they received supervision and that recent staff meetings had taken place. Staff felt supported by the manager and senior staff.

When we inspected 40 people lived at the home. All of the people at the home had complex health needs; this included dementia. We spoke with five people who lived at the home and four relatives. We also spoke with six staff members and the registered manager.

We found that people or when necessary their relatives had given consent for care. Staff understood what people had consented to and provided care that met their wishes.

We watched staff as they cared for people. We found that staff knew about the needs of the people they cared for. We looked at care records for five people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs had been reviewed regularly. However we found on occasions support and care did not meet people’s needs.

People had been protected from the risk of harm and abuse because staff had received training and had an understanding of their roles and responsibilities. The registered manager had taken reasonable steps to ensure that enough staff had been on duty. Relatives we spoke with were aware of the complaints system. Complaints had been recorded and investigated.

There were 40 people using the service on the morning we inspected with eight care staff, one nurse and the registered manager on duty to provide care. The registered manager told us that all but one of the people who used the service had been diagnosed with a dementia related illness. The service is set up as a home for life as it provides end of life care as appropriate.

Staff were visible throughout our inspection and with people using various rooms throughout the day. There were always care staff on hand to provide care and support. People were supported to move about the home as they wanted and we found that staff respected people as individuals and knew a lot about their life histories and their likes and dislikes.

People's changing care needs were regularly assessed and reviewed with the delivery of care amended in line with any assessments made. Care staff knew people's current care needs and provided the appropriate support to meet those needs.

People were safeguarded as the provider had taken steps to ensure any potential instances of abuse could be identified and reported. Care staff we spoke with expressed that they felt they worked in an environment where they were supported and listened to.

The provider made sure it identified where improvements could be made to care quality through audits, meetings and inviting feedback and demonstrated where changes had been made where improvements had been identified.

People who use this service are supported by staff who understand their needs.

Meal times were a positive experience for people. We saw people were given support as they needed it. They were offered choices about the meals they wanted to eat. Drinks were freely available for people to access.

The service has effective systems in place for assessing the quality of the service provision. Hollyfields is working with partner agencies to bring about further improvements in the care they provide for the people who use the service.