The inspection took place on 4 July 2018 and was unannounced. The last inspection to this service was carried out on 19 December 2016 and was rated good throughout with no breaches of regulation. According to our inspection methodology this service did not require an inspection for thirty months. However due to concerns received about the service from a whistle blower and several concerning notifications we brought the inspection forward. During our inspection on 4 July 2018 we found this was no longer a good service and identified breaches of regulation around person centred care, consent, safe care and treatment, staffing, the premises and equipment and clinical governance. Since the last inspection the registered manager had left and a new manager came into post in November of last year. They told us they had made some significant changes to the service and had in place a detailed action plan they were working towards. We were confident in the manager’s ability to identify and bring about positive change to the service. We were less confident in the overall management and oversight of the service by the registered providers.

The service is registered for up to 27 people who primarily have a mental health need. However, people might also have a learning disability, a diagnosis or autism or issues relating to alcohol and substance misuse.

The Hollies and Holly Lodge is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is divided into two separate units joined by corridors. The main house accommodates most people and has shared communal areas and communal showers. It offers single occupancy bedrooms and generous gardens and grounds. The second part of the building has fewer number of people and separate communal facilities and separate staffing.

During our inspection on 4 July 2018 there was a manager in post but they were not yet registered with the Care Quality Commission although they advised us they had put their application in and had been waiting at least twelve weeks.

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.

At this inspection we found people were receiving care that was not always safe or met their identified needs. The manager had taken actions to try and ensure people got their medicines as intended after a series of medication errors. This had resulted in either people not getting their prescribed medicines or medicines administered incorrectly. There had also been issues with accounting for medicines to make sure they were available as people needed them. The manager had put more robust procedures in place and had supported staff to ensure they were competent and had accessed the right level of training.

The manager confirmed they had significantly increased the staffing levels since coming into post including the introduction of waking night staff. However, we were unable to see what people’s assessed needs were as some people had not been reviewed for some years. Some people had high risk behaviours which could put themselves or others at risk. Staffing levels meant that people were not always supervised for their safety and were not sufficient for people to have personalised care around their needs. The service did not have a dependency tool in place to show how they calculated the numbers of staff they needed.

The environment was not safe for its intended use. We found during our inspection broken window restrictors, ligature risks, uncovered radiators, water that exceeded recommended temperatures, and exposed

This was an unannounced inspection, which took place on 19 December 2016.

We previously carried out a comprehensive inspection at The Holies and Hollies Lodge on 21 and 23 January 2015. At this inspection, we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. This was because we identified concerns in respect to the safe management of medicines. The service received an overall rating of 'requires improvement' from that comprehensive inspection.

After our inspection in January 2015, the provider wrote to us to tell us what action they were taking to meet the legal requirements in relation to the breach.

We undertook this unannounced comprehensive inspection in December 2016 to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. At this inspection, we found improvements had been made in the required areas and the provider was no longer in breach of the regulations.

The Hollies and Hollies Lodge provides accommodation and personal care for up to 23 adults living with a long-term mental health condition. On the day of our visit, there were 22 people using the service.

The home had 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 registered manager had been in post since March 2016.

Staff were aware of their role in safeguarding people from the risk of abuse and had received appropriate training. Risk assessments had been devised to help minimise and monitor risk, while encouraging people to be as independent as possible. Staff were very aware of the particular risks associated with each person's individual needs and behaviour.

Staffing levels were sufficient to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff worked at the home.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Where people required the use of ‘as and when’ medicines (PRN), these were given safely.

There was positive interaction between people and the staff supporting them. Staff spoke to people with understanding, warmth and respect and gave people opportunities to make choices. Staff knew each person's needs and preferences in detail, and used this knowledge to provide tailored support to people.

The service was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff received specific training in this area and were able to explain to us how they used this in their work.

People were supported to eat and drink sufficiently to maintain a balanced diet and encouraged to be involved in supporting themselves at mealtimes. People were supported to maintain good health and received support from healthcare professionals when required.

People's individual care plans included information about what was important to them. People participated in a range of different social activities and were supported to access the local community.

The registered manager and staff knew what they should do if anyone made a complaint.

Staff liked workin

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

A new company, Eastern Healthcare Limited, now own and operate the home. People and their relatives and staff told us that improvements were being made to the environment, staffing levels and the care planning system. This was seen during our visit.

People living at the home and their relatives said that The Hollies and Hollies Lodge was a good place for people to live. They told us that the staff were kind, friendly and polite and provided the people living at the home with the care and support they needed.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant that the staff members employed were suitable and had the qualifications, skills and experience needed to support people living at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). Policies and procedures were held. Staff had been trained and knew when a DoLS application was needed. The manager knew how to submit a DoLS application. However, DoLS applications had not been submitted when required and improvements were needed.

Is the service effective?

People’s health and care needs were assessed with them or their family member. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person told us. “This is a nice home and the staff will do anything to help you.” Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. Relatives told us that staffing levels had increased to ensure people could be involved in activities and outings. Our observations confirmed this. A visitor told us. “I am happy with the care given to my family member. The members of staff are polite and respectful.”

Is the service responsive?

Care and risk assessments had been completed but not all were up to date and had been recently reviewed. The care and support provided was adjusted to meet the needs of each person. Improvements were being made to ensure that any change in care and support was recorded in the person’s plans of care. A record was held of people’s preferences, interests and diverse needs. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People had access to a range of planned activities that they said they enjoyed.

Is the service well led?

Staff spoken with had an understanding of the ethos of the home and quality assurance processes were in place but were not complete. Relatives told us that they had been asked for their feedback on the service their family member received. Visitors and staff said that they had felt listened to when they had made a suggestion or raised their concerns. People told us that the manager and new provider were approachable. We have asked for improvements to be made to ensure that we are told when events such as people experiencing an injury or being admitted to hospital occurred at the home.

We inspected this service on 21 and 23 January 2015. The inspection was unannounced.

The Hollies and Hollies Lodge provides accommodation and support to 23 people living with a long term mental health condition.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At our last inspection in July 2014, we found breaches of the regulations and asked the provider to make improvements to how people were protected; how the services was monitored; record keeping and how we were notifed of significant events. This action had been completed.

Most people felt settled and safe at the home, received good support from staff, had positive relations with other people living there, and the freedom to come and go as they pleased. The manager communicated well with relatives and improvements in the premises had taken place since the new providers had taken over.

Safeguarding procedures were followed and action was taken to keep people safe. Staff knew how to manage risks to promote people’s safety and independence. Robust recruitment and selection procedures were in place prior to staff starting work to ensure they were suitable for their job and there were enough staff on duty to meet people’s needs. However improvements were needed in the recording and administration of people’s medicines and you can see what action we have told the provider to take at the back of the full version of the report.

People’s needs were assessed and support was planned and delivered in line with their individual needs. Support plans contained a good level of information which explained how to meet people’s needs in a way that they liked. People’s health care needs were monitored closely by staff and they were supported to access health care professionals when needed

Staff were supported in their work and received essential training for their role. However we have made a recommendation that staff receive further training on the subject of enduring mental health conditions so that they can better understand how these illnesses affect people.

People felt able and comfortable to raise concerns, and the quality of the service that people received was regularly monitored to ensure it was of a good standard. Leadership in the home was strong and created an open, positive and inclusive environment both for people living there, and staff working there. It was clear there had been improvements in the home since our last inspection and the manager was bringing about change.