The inspection took place on 16 December 2016 and 13 January 2017 and was unannounced.

Little Holland Hall provides accommodation and personal care for up to 41 older people and people with nursing needs. As a nursing home, the service is also registered to provide the regulated activities ‘treatment of disease, disorder or injury’ and ‘diagnostic and screening services’. At the time of our inspection there were 36 people using the service.

At the time of our inspection there was a registered manager in post at 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. The day-to-day running of the service was carried out by registered manager supported by a clinical lead nurse and an administrator.

People were safe because the manager and staff understood their responsibilities to recognise abuse and keep people safe. People received safe care that met their assessed needs and staff knew how to manage risk effectively.

There were sufficient staff who had been recruited safely and who had the correct skills and knowledge to provide care and support in ways that people preferred.

The provider had clear systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People’s health needs were managed effectively by a team of staff including qualified registered nurses and trained care workers with input from relevant health professionals. People had sufficient food and drink that met their individual needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.

The management team supported staff to provide care that was centred on the person and staff understood their responsibility to treat people as individuals.

People were treated with kindness by staff who understood their needs and preferences. Staff respected people’s choices and provided support in ways that people preferred. People were encouraged to enjoy pastimes and interests of their choice and encouraged to maintain relationships with family and friends so that they were not socially isolated.

Staff had good relationships with people who used the service and understood their needs. People’s privacy and dignity was respected.

There was an open culture and the registered manager and clinical lead nurse supported staff to provide care that met people’s needs.

The provider had systems in place to check the quality of the service and take the views of people into account to make improvements to the service. There were systems in place for people to raise concerns and there were opportunities available for people to give their feedback about the service.

The registered manager and nursing staff maintained a visible presence and were actively involved in supporting people and staff. Staff were positive about their roles and their views were taken into account and valued.

Everyone we spoke with told us that they received good care at the service. One person told us, “I enjoy watching the television and the staff often come in for a chat.” Another person told us, “The staff here know me well, they know what I like.” One relative we spoke with told us, “They treat him with respect, I wouldn’t want him to be anywhere else.” We saw that care plans reflected people’s needs and how best to care for them as an individual. Where risk assessments indicated a person was at risk, for example from pressure ulcers, we saw that staff took the correct action.

There were procedures in place for the ordering, storage and administration of medication. We found gaps on the medication signing sheet so we could not be sure people were receiving their prescribed medication.

Staff told us that they felt well supported in their work. They had access to training and supervision and were supported to undertake further study.

The service carried out audits and had processes in place to monitor the quality of service provision.

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', a person who has experience of using services and who can provide that perspective.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Relatives told us they were made welcome when they came the home. One person said if their loved one was asleep when they visited they valued the fact that staff spent time with them to listen to any concerns.

People told us they enjoyed the lifestyle at Little Holland Hall and one person commented “You don’t get time to be bored.”

People told us that they are involved in planning their care. They also said that they are consulted and they felt their opinions mattered.

People living in the home and visiting relatives told us that they take an active part in the social life at Little Holland Hall. People with whom we spoke said the home was lovely.

A relative told us that they are, “Very happy with the home” and someone living there said, “The food is good you’d have to be very picky not to like it.”

People said they felt safe and staff treated them well. One person said, “The staff are very good.”