The inspection took place on 17 August 2016 and was an announced inspection. This meant that we gave the home notice of our arrival so that we could meet with people who lived there.

The home is registered to provide accommodation with personal care and there were six people living at the home at the time of this inspection. The home provided care and support to people with a sensory impairment and physical and learning disabilities.

There was a registered manager for this service, who was available every day. 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 home is run.

People’s relatives told us that people were safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff who were competent to do so. Risk assessments recorded what action staff should take if someone was at risk and referrals were made to appropriate health care professionals to minimise risk going forward.

There were sufficient staff to keep people safe and meet their needs, and the registered manager had followed safe recruitment procedures. Staff were competent with medicines management and could explain the processes that were followed. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. The registered manager understood that there should be processes in place for ensuring decisions were made in people’s best interests. Staff sought consent and recorded this.

Staff were caring, knew people well, and supported people in a dignified and respectful way. Staff acknowledged people’s privacy. Relative’s felt that staff were understanding of people’s needs and had positive working relationships with people.

Care provided was individualised according to each person’s needs and preferences. People and their relatives were involved in assessment and reviews of their needs. Staff had knowledge of changing needs and supported people to make positive changes to their care plans.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people, relatives, health and social care professionals were sought as part of the quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.

We were unable communicate verbally with people who used the service due to their complex communication needs. However we carried out direct observations of staff supporting and interacting with them.

We spoke with two staff. We looked at three people’s care and support records, risk assessments, communication plans, daily records of care and support provided, maintenance records, quality assurance audits and health and safety records.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There was sufficient moving and handling equipment at the home which had been well maintained and serviced regularly. Staff had received appropriate training and guidance to use the equipment safely.

Records contained detailed assessments of people's needs that had been carried out prior to them moving to the home. Any training needed for staff to support people safely was identified and provided prior to the person moving to the service. This was to ensure that they had the relevant skills and knowledge required to meet the individuals identified needs.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Is the service effective?

People who used the service were unable to tell us verbally whether they felt their needs were being met. For this reason we observed staff providing care and support. We saw that they had a good understanding of individual’s needs, preferences and dislikes.

The premises had been adapted so that someone with physical impairments could move around the home.

Is the service caring?

Staff engaged with people in a polite caring and sensitive manner, treating people with dignity and respect. Staff had received training to meet the needs of the people who used the service

People were supported by kind and caring staff that were attentive to the needs of the people who used the service. Our observations identified that care and support was provided at a pace that was unrushed.

Is the service responsive?

People’s needs were assessed before they moved into the service. People were encouraged to visit the service before moving in. Where this was not practicable for one person the provider had ensured that staff visited the person in their existing home on eight occasions over a three week period. The provider provided a video of the home for the person on an IPad which staff in their home could support the person to have contact with the manager and staff through SKYPE when they had any questions.

Is the service well led?

The management team held regular team meetings and staff received 1-1 supervision sessions and annual appraisals. This meant they would be clear about their roles and responsibilities. The manager monitored staff training to ensure that staff received the required training to meet the individual needs of the people who use the service. The manager consulted with staff regarding any changes to the home.

The provider had an on-call system in place to ensure that appropriate management support was available for staff in an emergency. A senior manager visited the service regularly to audit the quality of the service provided.

People living in the home were unable to tell us verbally what they thought of the service. We observed and listened to how staff supported them, discussed their needs with staff and reviewed their records. We were not able to use a formal observational tool to assess people's experiences, as it would have been intrusive given the small number of people using the service.

There was guidance in place for supporting one person to understand information about their care and how staff were to communicate with them. For another person, we found that there was an assessment of their ability to understand and retain information about their care, and records to show how a particular decision had been taken that reflected their best interests. This showed that the service was responsive to individual needs and offered safe care.

The information staff gave us about people's care, including recent changes, was consistent with what we saw in care plans. Staff understood how to support people safely. They also understood how people expressed themselves, including when they were distressed or happy. Staff also supported people to receive a healthy diet, taking advice from other professionals where appropriate. This was confirmed by discussion and from records. This showed that people were treated as individuals and the service responded to their needs. A visiting professional told us they had no concerns about the way service met people's care needs and sought appropriate advice when it was needed.

Medicines were managed safely and checked regularly so that any anomalies could be addressed promptly. The records of medicines given were complete. This helped to show that the care people received was safe.

We found that, although there were acknowledged problems with holidays and sick leave, staff were covering shifts to ensure there were enough of them to support people effectively. We were informed this was a short term problem and was likely to improve during the following week. The staff spoken with were knowledgeable about the support people required.

People living in the home were not able to tell us verbally what they thought. Because of this we used a formal tool to help us observe and assess the support that people received. Our observations and discussions with staff showed that staff understood people's needs and supported them well. They made efforts to explain things to people, despite clear difficulties with communication. The interactions we saw and listened to were respectful and polite and we saw that staff took time to assist people at their own pace. However, although interactions were positive and encouraging we did note that praise for one person was not always appropriate to their age. We told the manager about this so that it could be addressed.

Staff were able to give us information about people's needs, their mobility, personal care, communication, diet and health. We concluded that this meant they understood how to support people safely and how independence was encouraged as far as practicable.

We found that there were systems in place to ensure staff had access to training and support so that they worked with people effectively and safely. They spoke highly of the support that they received from the management team. There were also systems to assess the quality and safety of care.

While we were unable to discuss matters directly with people at Holmlea due to difficulties with communication, we did see that people were relaxed and fully included in discussions during our assessment visit.

We have also had comments from family members that include ‘I am most satisfied’, ‘I would give medals to all staff and managers’ and ‘Holmlea does extremely well to meet individual needs’. There is also a book with thank you letters and cards that have been sent to the staff from various people.

There is also further information contained in this report that shows what people at Holmlea actually experience.