This inspection took place on 20 and 21 December 2018. The first visit was unannounced and we announced the second visit.

Holyrood House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 29 people. At the time of our inspection 23 people were using the service.

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.

The last comprehensive inspection took place in May 2017, when the service was rated Good.

At this inspection the home has been rated Requires Improvement. This is the first time the home has been rated Requires Improvement.

Risks to people were not always appropriately assessed, monitored and mitigated. This had the potential to put people at risk, and meant staff did not have the information to support and keep people safe. The quality assurance framework was not sufficiently robust and had not identified all the issues we found during the inspection. When actions had been identified, the quality assurance process had not always ensured that these were completed.

People were supported with food and nutrition but records relating to this had not always been consistently or effectively completed.

Care plans were in place but did not provide staff with guidance that was up to date to meet people's needs in a personalised way.

A complaints procedure was in place and displayed so that people would know who to talk to if they had a complaint. However, not all complaints were dealt with in line with the provider's policy.

Accidents and incidents had not been reported where required in line with company policy. This prevented the service implementing prevention methods to avoid reoccurrences.

The environment was clean and tidy, but two people's bedrooms had strong odours. The registered manager took action during the inspection to resolve this.

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's needs and choices were assessed and mental capacity assessments were undertaken. People were supported to access health care services.

We saw some warm, friendly, caring interactions between staff and the people they were supporting. Staff made efforts to communicate with people in a way they could understand. Visitors were made to feel welcome.

People and their relatives were involved in the running of the service, through meetings and surveys.

People were positive about the registered manager. The registered manager was working reduced hours at the service and this had impacted on service delivery. The registered manager was aware of their responsibility to uphold legal requirements, including notifying the CQC of various matters.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we told the provider to take at the back of this report.

Holyrood House is registered to provide accommodation and personal care for a maximum of 29 older people, some of whom may be living with dementia. The service is situated in Hedon, which is a small town in the East Riding of Yorkshire. It is within walking distance of local shops and other amenities. Accommodation is provided over two floors and there are a selection of bedrooms for single occupancy and communal areas which include a lounge, dining room and a large pleasant garden available for people who live at the service.

The service had a manager in post as required by a condition of registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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 last inspected the service in November 2014 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

People we spoke with told us they felt safe living at Holyrood House. We observed warm and positive interactions between people, the staff and the registered manager, and people were relaxed and at ease in their home environment.

We found that people's individual needs were assessed and the registered provider had put risk assessments in place to manage and reduce the risk of avoidable harm. The registered manager was aware of their obligations in relation to managing and reporting any safeguarding concerns.

The staff we spoke with understood the risks to people's wellbeing and knew what action they must take to help minimise risks. Service contracts were in place to ensure equipment remained safe to use. The environment had undergone some refurbishment in the year prior to our inspection. The registered provider employed domestic staff but we found some areas of the home had not been maintained and cleaned effectively. These issues were addressed during and immediately after the inspection.

We found that the management and administration of medicines was safely carried out. Staffing levels on the day of our inspection were adequate to meet people's needs. Recruitment policies, procedures and practices were followed to ensure staff were suitable to care for and support people living at Holyrood House.

People told us staff were caring. People were involved in decisions about their care and we observed people being offered choices, such as what they wanted to eat and drink. People's privacy was respected.

We saw that people were supported according to their person-centred care plans, which reflected their needs well and which were regularly reviewed. We found that people were supported to access healthcare services.

People received suitable nutrition and hydration to maintain their levels of health and wellbeing. People told us they had enough to eat and drink, and enjoyed the food. We saw people had access to refreshments and snacks during the day. The mealtime we observed was relaxed and organised. Food was presented well and people were able to choose what they wanted to eat.

People were supported to eat in a supportive and calm setting that provided an opportunity to socialise as well as eat.

People had the opportunity to engage in various pastimes and activities if they wished to do so.

There was a complaints procedure in place and people were able to raise concerns.

Holyrood House is in the town of Hedon and is close to local amenities. The service provides accommodation for a maximum of 29 people and offers support and care for older people, some of whom may be living with dementia.

Most bedrooms are for single occupancy and some have en-suite facilities. There is a lounge, a library, a dining room and a large garden available to people who use the service.

The upper floor of the service is accessed by a passenger lift and there is a small stair lift up to one bedroom. There is no car parking at the home, but on-street parking is available.

This inspection was unannounced and took place on 27 and 28 November 2014. At the time of this inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

This service underwent a change of ownership in 2014 and Yellow Rose Lodge registered with CQC in June 2014 as the new owners. This is the first inspection for the new owners since registration.

People told us that they felt safe living in the service. We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people’s needs. Staff we spoke with told us, and we saw that there were procedures in place to instruct staff in the action to take if they were concerned that someone was at risk of harm and abuse.

Care records contained assessments, which identified risks and described the measures in place to ensure the risk of harm to people was minimised. The care records we viewed also showed us that people’s health and wellbeing was monitored and referrals were made to other health professionals as appropriate.

Staff told us that they were happy with the training provided for them and the training records evidenced that staff took part in training that would equip them to carry out their roles effectively. People who used the service, relatives and health care professionals told us that staff were effective and skilled.

The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives. All of the people we spoke with said they were well cared for. They told us staff went out of their way to care for them and all said that it was a lovely place to live.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the service. People had been included in planning menus and their feedback about the meals in the service had been listened to and acted on.

People and relatives were satisfied with the activities taking place within the service, although we found these did not fully meet the needs of people living with dementia. Work was in progress to develop these further to include a wider range of interests and topics.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the service was meeting their internal quality standards.