HollyHouse 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.

HollyHouse can accommodate ten people. At the time of our inspection there were ten people living there who were diagnosed as having a mental health and/or learning disability diagnosis. They live in a detached house in a street in the middle of Cheltenham. They each have their own bedroom, nine of which have en-suite facilities. People have personalised their rooms and share bathrooms, a kitchen, lounge, dining room and conservatory. The garden is accessible and has patio furniture. There is a covered smoking facility.

HollyHouse has been developed and designed in line with the values that underpin the Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

This inspection took place on 17 July 2018. At the last comprehensive inspection in September 2015 the service was rated as Good overall.

At this inspection we found the service remained Good.

People received personalised care and support which reflected their aspirations, hopes and routines important to them. Staff understood them really well, anticipating their feelings and emotions, treating them respectfully, with patience and sensitivity. People’s needs had been assessed and they were involved in developing their care and support with staff. If they wanted to change any aspects of this, it was discussed with staff and their care records were updated. 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 encouraged to be as independent as possible. They were being supported to learn the skills they needed to live independently if they wished. People felt safe living in the home and accessing their community with staff support. They enjoyed a wide range of activities which reflected their hobbies and lifestyle choices. People’s diversity was acknowledged and respected. Staff advocated on their behalf and promoted their rights and wishes.

People were supported to stay healthy and well. They chose their weekly menus which reflected their likes and dislikes whilst promoting a healthy diet. People helped themselves to drinks and snacks and cooked meals for themselves if they wished. Each person had a health action plan which described their health care needs. They had annual check-ups with their GP and regular reviews with another specialist healthcare professional. People’s medicines were managed safely.

People had access to sufficient staff to meet their needs who had been through a satisfactory recruitment process. Staff felt supported in their roles and had access to refresher training to keep their knowledge and skills up to date. Staff were knowledgeable about people, their backgrounds and individual needs. Staff understood how to keep people safe and were confident any concerns they raised would be listened to and the appropriate action taken in response.

People’s views and the opinions of their relatives and staff were sought to make improvements to the service provided. People met formally each month to talk about their needs and any concerns they might have. They also talked with staff daily about any issues which were dealt with as they arose. The registered manager worked alongside staff enabling them to lead by example and to also ensure their values were embedded in people’s experience of their care. People told us, “The manager is kind and respects my wishes” and “Staff support us in any way they can.”

The registered manager kept up to date

An adult social care inspector carried out this inspection. The focus of the inspection was to follow up on action taken by the provider as a result of an inspection on 18 February 2014 and to answer four key questions; is the service safe, effective, caring and responsive?

As part of this inspection we spoke with three people who use the service, the registered manager and two care staff. We also reviewed records relating to the management of the home which included, three care plans, daily care records and training records.

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.

Is the service safe?

People were safe because staff had strategies to share information on risks associated with their care, treatment and support. Hazards were minimised and procedures were in place to keep people safe. The provider had put systems in place to make sure accurate records were kept in respect of people’s care and support.

The service was safe because there were clear procedures for giving medicines in accordance with the Mental Capacity Act 2005. Best interests meetings had been held to discuss how to make sure people took their medicines to maintain their health and wellbeing.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People received an effective service because their individual needs, choices and preferences were reflected in their care plans. People’s likes, dislikes and routines important to them had been recorded in their care plans. Staff spoken with had a good understanding of people’s needs.

The service was effective because people’s health was regularly monitored to identify any changes that might require additional support or intervention. Referrals were made to health care professionals when people’s needs changed.

Is the service caring?

A caring service was provided because staff knew the people they were caring for and supporting, including their preferences and personal histories. Individualised profiles described people’s wishes, aspirations and how they wished to be supported.

People received a caring service because staff showed concern for their wellbeing in a caring and meaningful way and responded to their needs at the time they needed it. People told us they were happy with the care provided.

Is the service responsive?

The service was responsive because people’s individual needs had been regularly assessed. Staff understood the care and support needs of people.

People received a responsive service because they were supported to be involved, as much as they were able to, in the assessment of their needs and have choice about who provided their personal care. Care records confirmed discussions with people about their care.

The service was responsive because people received consistent, coordinated care and support when they moved between services. Information was shared between organisations to make sure people’s needs were met.

We visited Holly House over two days. We spoke with four of the five people who use the service and three members of staff. The manager was on sick leave. We were able to meet with the new Operational Area Manager on the second day of our visit and discuss our findings. We found that staff were genuinely concerned about the welfare of the people living at the home, but were operating with practices which, without individual risk assessments, were discriminatory. Staff commented that "the manager isn't here very much" and it was evident that the staff had been left to run the home without the benefit of strong, proactive leadership.

There were mixed views from the people who lived at the home, comments ranged from "I like it here very much, I really like the staff", "the manager's nice, but we don't really see her" to "I don't want to live here, but the staff are alright". We were told that arrangements for the management of the home had been made and that a new manager would be starting work at the home on the 1st March 2014 and applying for registration.

We didn't speak with people as part of this follow up inspection to check on the maintenance of the premises. We gathered evidence of people's experiences of the service by walking around the environment, reviewing cleaning schedules and examining plans for a major refurbishment of the home. We found that issues identified at our last inspection such as the lock on the fire door, cleanliness of the home and damage to a bathroom and toilet had been resolved. Plans were shared with us for the renovation of the home which would involve creating en suite facilities for nine bedrooms and a tenth bedroom with its own bathroom. Worn carpets would be replaced during the renovations.

At the time of our visit there were five people using the service. We spoke with or observed the care being provided to all five people. One person told us "I like living here" and "I go swimming and like helping with the cooking". We observed people being supported to make choices and decisions about their daily lives. They were supported to access local community facilities such as the shops and library. When at home people helped around the house maintaining and developing independent living skills such as cooking, washing, shopping and cleaning.

We found that people's care records were kept up to date and reflected their care needs and likes and dislikes. People had access to a range of social and health care professionals to ensure their mental and physical well being. We observed people interacting positively with staff. Staff reported that staffing levels were appropriate to meet people's needs.

We had moderate concerns that the maintenance of the environment was not being dealt with in a timely fashion. We noted carpets which were worn, fraying or stained in communal areas and on stairs. Bathrooms and toilets needed some attention. Although there was a maintenance plan in place which identified these issues there were no dates to indicate when this work would be completed. The manager said that the provider was considering refurbishment of the home and that this had delayed dealing with current maintenance issues.

People said, "the staff are nice", "I have choice of what to do and what to eat" and "I like going for walks, into town and usually come back through the park which I enjoy."

One person said "surprisingly I like living here, there have been no problems." Another person told us "I get on with everyone."

We were told, "I have no concerns, if I did I would talk to staff."

One person talked to us about their expectations of staff conduct and that they would report any concerns they had to the manager.

Not everyone wished to talk to us, but we observed people going about their day to day living. People were supported to make choices about their day, going to buy a newspaper, going for a swim and out for a coffee. People chose whether to spend time in their rooms, in the lounge, conservatory or garden. Sometimes they chose to be in the company of staff and at other times on their own.

The inspection took place on the 24 September 2015 and was unannounced.

HollyHouse provides accommodation to 10 men or women over the age of 18. People may have mental health needs, an acquired brain injury or a learning disability.

HollyHouse 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.

People were protected from the risk of being cared for by unsuitable staff because robust recruitment practices were operated. Medicines were well managed. People were supported by sufficient numbers of staff who received appropriate training and had the right knowledge and skills to carry out their role. People were protected from the risk of abuse by staff who understood safeguarding procedures.

People were supported by staff with the knowledge and skills to carry out their roles, including knowledge of the Mental Capacity Act 2005. People were active in choosing menus and received support to eat a varied diet. People were supported to maintain their health through support in accessing healthcare.

People were treated with kindness, their privacy and dignity was respected and they were supported to develop their independence.

People received personalised care and support. There were arrangements to respond to any concerns and complaints by people using the service.

The vision and values of the service were clearly communicated to staff. Quality assurance systems were in place to monitor the quality of care and safety of the home.