We inspected Holyrood House on 7 and 13 March 2018. The inspection was unannounced on both days. There were 70 people using the service when we inspected. At the previous inspection in January 2017 we rated the service as requires improvement; we found the provider was in breach of one regulation which related to safe care and treatment. At this inspection we found some improvements had been made.

Holyrood House is a purpose built 85 bed nursing home in Knottingley. There are activity areas which include a sensory room, activity room, two cafes, library, beauty salon and enclosed gardens.

The home has 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. The registered manager was present on both days of this inspection.

Prior to the inspection we had received concerns about staffing levels and moving and handling procedures. We looked at these areas during our inspection.

At this inspection we found medicines were better organised than at the previous inspection. There was a system of monthly and more frequent ‘mini’ audits to check that staff were following the medicine policy. We did however point out some errors which we found on day one of our inspection. These had been addressed by day two of inspection.

Recruitment procedures were in place which helped ensure staff were suitable to work in the care service. However we spoke to the registered manager about exploring gaps in employment history. This was completed by the second day of inspection. Staff received the training and support they required to carry out their roles and meet people’s needs. Staff had just completed moving and handling refresher training to ensure they were up to date with any changes. The environment was clean and well maintained. We saw plentiful supplies of PPE throughout the home and we saw staff using these throughout both days of inspection.

People and relatives felt there was enough staff to support people’s needs. We saw staff were available and responded promptly to people. Staffing levels had increased on days and nights over the last few months and the use of agency staff had decreased which had resulted in a more stable staff team.

People told us they felt safe and this was echoed by relatives we met. Staff understood safeguarding procedures and how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to the commission where appropriate. Risks to people were assessed and managed to ensure people’s safety and well-being were been met. Mental capacity assessments had been completed for people who required these. However one person had bed rails in place and this had not been assessed. The registered manager arranged to put this in place straight away with speaking with the person and family.

Most people told us they enjoyed the food available and could ask for an alternative if they wanted to. We spoke to the chef about people’s needs and preferences. The registered manager showed us pictures of foods on the menu which they said were shown to people to help them choose their meals. We did not see these being used during our inspection. The registered manager told us they would speak to staff at the next staff meeting to make sure this happened at each meal.

We saw some examples of good care practice. Staff were observed to be caring and kind in their interactions with people. We saw activities in the home and people told us they enjoyed these.

We saw people received care tailored to meet their needs however the registered manager recognised the care plans needed more work to fully reflect person centred care being delivered. We saw life stories were not always

The inspection took place on 19 and 24 January 2017 and was unannounced. Holyrood House is a purpose built 85 bed nursing home in Knottingley. There were 58 people living in the home at the time of the inspection.

There was a registered manager in post. This manager had been newly appointed at the time of the previous inspection and had managed the home for 12 months.

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 inspection took place in February 2016 and there were multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was in special measures. The provider had sent us an action plan following the previous inspection to show when the regulations would be met. We found at this inspection there were significant improvements, although we identified a breach in the regulations regarding the safe management of medicines.

There was a friendly atmosphere in the home and each unit was welcoming. In particular, the unit for people living with dementia had been vastly improved since the last inspection. People told us they felt safe at Holyrood House and relatives said they had no safety concerns.

Staff had been given regular opportunities for support, learning and development and they had improved knowledge and understanding of mental capacity. 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.

Mealtimes were sociable and staff understood people’s dietary needs, with appropriate attention given to ensuring people had enough to eat and drink. Where there were concerns around people’s nutrition or ability to eat properly, these were referred to other professionals as necessary.

Staff delivered a kind, caring and compassionate service to people, with good quality interaction which enabled people to feel valued as individuals. Staffing levels had improved, although deployment of staff on the nursing unit meant staff were only able to engage in physical care due to people's dependency needs.

Care records had improved since the last inspection and staff updated these in a timely way and in partnership with other professionals to ensure continuity of care.

Activities were more meaningful and frequent, with staff paying attention to those people who remained in bed.

The culture in the home was open and transparent with effective communication throughout.

Systems and processes to ensure the quality of the service delivery were in place and in most areas were thorough and robust. There was close monitoring by the management team to check and reinforce good practice.

The inspection took place on 3 and 4 February and was unannounced. Holyrood House is a purpose built 85 bed care home in Knottingley. There are several communal areas.

At the time of the inspection there was no registered manager in place, although a manager had been newly appointed and in post for three weeks and was in the process of applying for registration with the Care Quality Commission.

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 inspection took place in April 2015 and there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had sent us an action plan following the previous inspection to show when the regulations would be met. However, we found continued breaches in two of these regulations at this inspection and a further five breaches in the regulations.

People and relatives considered the home was safe. Staffing levels were not always adequate to ensure people’s needs were met safely, particularly at busy times and in the dementia unit.

Staff files did not always contain evidence of thorough checks and vetting to ensure staff were suitable to work with vulnerable adults.

Medicines were managed safely and people told us they got their medicines when they needed them.

Staff did not all have adequate training to meet the needs of the people, particularly in relation to people’s mental capacity and dementia care.

Documentation for mental capacity assessments was not clear and was sometimes conflicting.

People enjoyed the food, although there was little choice about portion size and there was poor monitoring of people’s weight and food and fluid intake.

Staff were kind, patient and caring. People and their relatives spoke highly about the staff’s caring abilities.

Care records were up to date, although the information within was sometimes conflicting and some information in risk assessments was not clearly in place for staff to follow.

Activities were enjoyed by many people but care was not consistently person-centred. Some people said they could not have a bath or a shower when they wanted to and some people who remained in bed or in their rooms said they felt bored at times.

New management was in place and although there were some systems to assess and monitor the quality of the provision, these were not robust or fully implemented to drive improvement. Audits were incomplete as were records relating to the management of the home and people’s care.

The new manager showed us some examples of how the service would be more closely monitored moving forward, although these new systems were not in place at the time of the inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

You can see what action we told the provider to take at the back of the full version of the report.

This was an unannounced inspection carried out on the 15 April 2015.

The Holyrood House is a purposed built 85 bed care home in Knottingley. This very large home has several communal areas with various functions. The home benefits from its location amid housing and local amenities and is directly on a bus route to all major towns around the area. The homes’ activities areas include a sensory room, activity room, two cafes, library, beauty salon, enclosed gardens.

At the time of this inspection the home did have a registered manager. However, they were no longer in day to day control of the service. 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.

There were not always enough staff to keep people safe. Mental capacity assessments had not been completed and the service had made Deprivation of Liberty Safeguards applications inappropriately.

Staff training and support provided staff with the knowledge and skills to support people safely. People’s care plans contained sufficient and relevant information to provide consistent, person centred care and support. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work.

People were happy living at the home and felt well cared for. People enjoyed a range of social activities, however, the regional manager was to review the activities provided. People had good experiences at mealtimes. People received good support that ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

People told us they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely. People’s physical health was monitored and appropriate referrals to health professionals were made.

The service had good management and leadership. People got opportunity to comment on the quality of service and influence service delivery. Effective systems were in place that ensured people received safe quality care. Complaints were investigated and responded to appropriately.

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