This inspection took place on 14 December 2016 and was unannounced.

Hollywell Court Residential Home is registered to provide residential care and support for up to twelve older people. At the time of our inspection there were eleven people using the service. The service is located within a residential area and provides accommodation over two floors.

Hollywell Court Residential Home 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’s safety and well-being was promoted through the management of risk. This was achieved through the sharing of information and through the promoting of people’s choices and independence in their day to day lives. Where necessary equipment was used to enable people to move around the home safely. People’s safety was further supported through the robust procedures in the recruitment of staff and by their being sufficient staff to provide the support people required.

People’s medicine was managed safely and people were involved in decisions as to whether they wished to take their medicine. Audits were undertaken on a range of topics, which included medicines and maintenance of the environment to ensure people’s safety was promoted and maintained.

People told us that staff had had a positive impact on their lives due to the care and support they received. Staff told us that they undertook training which enabled them to provide good quality care. Staff received continued support by working alongside the registered manager and through supervision, which provided opportunities for staff to discuss their professional development.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were committed in their approach to supporting people to make informed decisions about their care. People’s capacity to make informed decisions was considered with regards to all aspects of their day to day lives.

People were encouraged to make decisions about their day to day lives. People’s care plans provided information for staff as to what the support people required, so that people’s independence was recognised and not undermined by staff.

People’s health and welfare was promoted through a range of assessments and the development of care plans which were regularly reviewed. People with the support of staff accessed the services of a range of health care professionals who monitored and promoted their health. People’s nutritional needs were assessed and met and were regularly reviewed. People spoke positively about the homemade meals and how they were regularly offered and encouraged to eat and drink well.

People spoke positively about the attitude and approach of staff towards them, stating staff were friendly and helpful and provided care and support when they needed it. We found people were consulted about their care and their views and needs were recorded within a care plan which was regularly reviewed.

People considered Hollywell Court to be their home and took pride in the environment in which they lived, its friendliness and homely atmosphere. People were relaxed within the home and spent their time as they chose, watching television, listening to music and reading.

The provider had quality assurance systems, which included a range of audits that were carried out by the registered manager, which meant the provider could assure themselves people received a high quality service. People’s views about the service were sought and used to provide information to people who used the service and their relatives.

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

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People told us they felt safe. A relative we spoke with also said they thought their relative was safe in the service.

An unlocked bathroom had been used as a storage area which could have caused trips and falls. This meant that people had not been fully protected from the risk of accidents. Fire systems had not been fully followed. There was therefore a greater chance of risks to peoples’ safety.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing a homely and safe environment.

Is the service effective?

People or their families had been involved in writing their care plans. People's needs had been included within care plans and care staff told us that they had read and followed care plans. Information the home had was able to support staff consistently to meet people’s needs.

People’s mobility and other needs were taken into account in relation to building adaptation, enabling people to move around freely.

A relative we spoke with confirmed that they were able to see their relative in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “staff are always there to help you. They do it in a nice way.” A relative told us; “staff are excellent. I could not fault them. You feel part of the family here.”

Is the service responsive?

Records showed that people's preferences, interests and needs had been included in care plans. This meant that the service was informed about people’s needs.

A relative told us that the manager was very proactive in making sure people's needs had been met.

Is the service well-led?

Staff said that if they witnessed poor practice they would report their concerns. They knew which agencies to contact to protect people from abuse.

There was evidence that the service worked in partnership with key organisations, including specialist medical personnel to support care provision and service development.

During the inspection we saw all the people at Hollywell Court enjoying a life music session with musicians and singers in the front lounge and were unable to seek their views and comments. We inspected the service to see the improvements since our last inspection in July 2013. We found there had been improvements with the handling of medicines for people who used services. The administration of medicines was now carried out by a staff member with one person at a time. This prevented any risk of errors because medicines were recorded for one person each time in accordance with the providers policy. We saw the manager had a locked cupboard for storing medicines and a new cupboard was due to arrive the following week which would meet legislative requirements. We saw medicines were disposed of properly and there was procedures for disposing of unused medicines. We found shortfalls around the key security for medicine areas and the lack of regular staff training. We found policy and procedures, and risk assements for administering people's own medicines needed review. This meant medicines were not handled safely, securely and appropriately.

We spoke with eight of the 11 people using the service and two visitors to people using the service. Three people described it as providing “a home from home.” Care workers knew people using the service well and this meant they were able to respond quickly to their needs. Comments from people using the service and their visitors included: “You couldn’t get a better place – good food, you’re looked after, nice bedroom.” and “Very happy indeed, in every respect; care, staff, food. Excellent cleanliness – no smells.”

People were asked for their consent before they received care. The service had excellent support from a local geriatrician, Dr Wong, to record people’s decisions about their end of life care.

People told us they were supported to take the right medicines when they needed them. We found the provider did not have appropriate arrangements to protect people from risks associated with medicines. This was because care workers did not follow the provider’s procedures for administering and recording medicines. Arrangements for disposing of medicines were not appropriate.

Staff were well trained and skilled. People told us: “I can’t fault them.” When we asked for their views about staff, they told us: “Wonderful.” and “We have a laugh.”

Although people were not formally asked for their views, people using the service and visitors were confident their views were taken into account. The manager was continuously making changes to improve the service.

We spoke with six people using the service about food and drink provided by the service. Five people said the food was very good. One person said they did not like food, but that they were offered a choice of food and drink and they ate what they were given. We found that people were offered a choice of food. All staff were knowledgeable about people’s nutritional needs, so people got the support they needed to maintain their nutrition and hydration.

We spoke with three people using the service about abuse. They all told us they felt safe using the service. They were all confident that staff and the manager would take appropriate action if they reported concerns to them. We found that staff had training in safeguarding people from abuse and had a basic understanding of the risk of abuse. Care workers did not know enough about how to report concerns about possible abuse.

We found the provider had put secure storage arrangements in place for care records. These were not being used effectively to ensure confidential personal information was secure. The manager agreed to take immediate action to address this.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an “expert by experience” (people who have experience of using services and who can provide that perspective) and a practising professional.

On the day of our inspection visit, there were seven people using the service. We spoke with six people and one visiting relative, to ask them for their views on the service they received. We found that people using the service were treated with dignity and had their nutritional needs met by sufficient numbers of staff. People using the service told us they were very satisfied with the service and with the food and drink provided by the service. We found that care workers were not familiar with the provider’s policies for protecting people from abuse. However, people using the service told us they felt safe at the home and care workers were confident that the manager would take appropriate action if they reported any concerns to her. We found that people might be at risk of malnutrition because staff had not received training to meet the nutritional and hydration needs of people using the service or in supporting people to eat and drink.

This inspection took place on 14 and 15 October 2014 and was unannounced.

Our last inspection took place 8 July 2014 when we identified breaches in the regulations. We required the provider to take action to ensure the safety and suitability of the premises. Since that inspection the provider had taken all the necessary action to meet the compliance actions.

Hollywell Court provides accommodation for up to 12 people who need support with their personal care.

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.

Staff knew what the standard of care was expected by the registered manager. People were supported to be as independent as possible whilst maintaining their safety. People felt safe living at the home and with the staff who supported them.

Staff told us how they recognised signs of abuse and what they would do to ensure people were kept safe. They knew what arrangements were in place to protect people from the risk of harm.

The manager monitored staffing levels to ensure they met the needs of people who used the service. They also ensured all staff received the training they needed to support people who used the service to maintain their safety and meet their needs.

Medication was managed safely to ensure people received their medication when they needed it.

Staff supported people’s assessed needs and what training they received to ensure they understood how best to meet those needs.

The registered manager and staff had recently received training on the Mental Capacity Act 2005 and were working with health care professionals to have a better understanding on how this may impact on people who used the service.

People had enough to eat and drink and they enjoyed the meals they had. People were provided with a choice of freshly prepared meals and were given choices. Staff monitored people to ensure they had enough to eat and drink and would refer people to the health care professionals where they identified people at risk of poor nutrition.

Staff received regular training but did not receive individual supervision or appraisals. This meant that staff did not always receive the support and guidance they needed. However the registered manager worked alongside people each day and was able to offer guidance during these times.

People saw doctors or nurses if they felt unwell or had specific needs such as pressure care needs. People were seen by appropriate health care professionals and staff followed up referrals. The registered manager contacted relevant professionals such as social workers and mental health care workers to make sure people received the support they required to meet their changing needs.

We observed staff during the inspection talking to people in a kind and patient manner. People who used the service told us staff were kind and caring. Where people showed signs of distress staff spent time comforting them.

People said staff treated them with dignity when they provided personal care. People’s privacy was respected. Bedrooms had been personalised and each room was decorated to the person’s choice before they moved into the home. Visitors told us they were encouraged by the manager to visit when they wanted to.

People could pursue their hobbies and interests. However people did tell us they would like to be able to go out more often.

People felt the registered manager was very good and they felt able to speak with them if they had concerns. The registered manager spent time talking to people who used the service to gather their views and develop the service. However the manager did not record these discussions, this meant there was no evidence to show what action may have been taken as a result of these discussions.

The registered manager regularly worked alongside staff they were able to offer guidance and keep an eye on staff attitude and behaviour. Most staff felt the manager was approachable and offered good advice about how to improve care practice.

The registered manager was aware of their duties and responsibilities to maintain a safe and effective service for people who lived there.

Staff were aware of the standard expected of them and were given guidance by the manager throughout the working day.

The manager had not recorded any audits that were carried out on the service and so was unable to show how improvements in the service were made.