The Hollies is registered to provide accommodation and personal care for up 27 older people some of whom are living with dementia. At the time of our inspection 19 people were living at The Hollies.

The home had a registered manager in post who had been registered since October 2010. 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.

The inspection took place on 16 November 2016 and was unannounced. At our previous inspection on 28 April and 09 May 2016 we found breaches of regulations 09, 11, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were not always supported to maintain their independence as their needs and individual preferences were not consistently met. People were not supported by sufficient numbers of suitably trained and skilled staff. Staff had not acted in line with the requirements of the MCA 2005 when dealing with matters of consent and best interest decisions. People's medicines were not managed safely and people were unlawfully restrained. Governance systems were not sufficiently robust to allow management to review, monitor and respond to identified concerns.

At this inspection we found significant improvements had been made in areas relating to safe care and treatment, staffing levels, supporting and developing staff and people were no longer unlawfully restrained. However we also found improvements were still required in governance systems to ensure the service was well led and records relating to people's care were accurate.

People were supported by sufficient numbers of staff who responded promptly when they required assistance. Staff we spoke with were knowledgeable in relation to keeping people safe from harm and reporting incidents to management. People were supported by staff that had undergone a robust recruitment process to ensure they were of good character. People's medicines however were not consistently managed safely and we found an incident where one person had not received their medicines as intended by the prescriber.

Staff felt supported by the registered manager and management team who enabled them to carry out their role effectively. Staff had received training relevant to their role and were further training was required this had been organised. People’s consent was sought prior to care being carried out and staff took time to explain the tasks they wished to carry out. People's nutritional needs were met and their food and fluid intake and weight were monitored, although not always documented. People were able to choose what they ate from a varied menu. People`s health needs were met and they had access to a range of health professionals when needed.

Staff spoke with people in a kind, patient and friendly way and respected peoples dignity. People felt listened to and told us they felt they could shape their own care to reflect their own personalised choices. Staff were aware of people’s needs, choices and we saw that a friendly rapport had developed between people and staff who cared for them.

People received care that responded to their needs. People told us they felt able to shape and direct the care they received and that staff listened to their views. People were supported to remain independent and pursue individual hobbies and pursuits. People and relatives felt able to raise complaint or concerns with management, and regular forums were held for people to do so. The Registered Manager operated a robust complaints process that when required reviewed and reposnded to complaints appropriately.

Governance systems and updates in people`s care records continued to be an area that was under development, however the r

The Hollies is registered to provide accommodation and personal care for up 27 older people some of whom live with dementia. At the time of our inspection 26 people were living at The Hollies.

The inspection took place on 28 April and 09 Mat 2016 and was unannounced.

The home had 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. However the details for the Provider’s registration at the time of the inspection were incorrect.

At this inspection we found that there were not always sufficient numbers of staff deployed to meet people`s needs at all times. Risks to people’s health and well-being were identified and responded to positively. People’s medicines were not stored safely and information was not always available for staff on how to manage people`s medicines safely. However the registered manager was reviewing and developing this area.

People told us they felt safe living at The Hollies, and this was confirmed by their relatives and health professionals. People were supported by staff who had undergone robust recruitment processes which ensured they were of sufficiently good character to provide care to people.

Staff told us they felt supported by the manager. However training had not always been provided in a manner that supported staff’s understanding of how to provide care. People’s nutritional needs were met and monitored where required. People were able to choose what they ate and staff responded to people`s changing dietary needs. People we spoke with told us they had access to a range of health professionals, and records demonstrated they were referred quickly when their needs changed. This was also confirmed by visiting professionals.

Staff spoke to people in a kind, patient and friendly way, seeking their consent prior to delivering care. Staff did not always ensure people’s social needs were met and people did not always receive care at a time when they needed it.

People did not always receive high quality care that was well led. The local authority visited the service and required actions were taken in relation to areas such as MCA 2005, training and records. These had not been improved upon, and a service improvement plan had not been developed. The provider’s registration details were incorrect and people’s personal records were not always accurate or kept up to date. People's views about the quality of service they received had been sought and people felt the registered manager was open to discussion about the running of the home.

We carried out a follow up inspection at The Hollies because on our previous inspection the provider was not meeting all the standards that we inspected against. When we re-inspected the service on 8 July 2014 we found that they were now meeting all the standards we inspected.

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?

The provider had introduced more detailed checks for the administration and disposal of medication. Staff had received training on the safe administration of medication and safeguarding vulnerable adults. The home was clean and free from the risks of infection. People we spoke with told us that they felt safe within the home. People’s needs had been assessed and monitored; care documents reflected people’s needs and provided care staff with clear information on how to safely care for people. Risk assessments had been put in place for people and staff were aware of the risks and how to manage them.

Is the service effective?

We saw that people living in the home were free to move around and were happy in their surroundings. People told us that staff "couldn't do more" for them, and would "do anything to help" them. They told us that the care they received was "very good". We observed staff were caring towards people and offered them drinks and spoke to people in a kind manner. We saw that the care plans were regularly reviewed and contained detailed information about the person and their needs. This meant that staff were aware of people’s needs and were therefore able to provide the correct care and support. The provider had ensured that when staff were recruited, they followed a detailed recruitment process and any required checks were completed prior to the start of employment. Is the service caring?

People told us that staff were ‘marvellous’. One person we spoke with said that they had no complaints and that staff "give a lot of help". They said that the staff "keep us going" and encouraged them to remain independent. We observed that staff were attentive towards people. People said that there were no restrictions on what they did during the day and that staff were quick to respond to them when they called for assistance.

Is the service responsive?

Care plans and risk assessments were reviewed regularly and any changes required were made quickly and staff were made aware of the changes.

Is the service well-led?

The provider had a registered manager in post. People we spoke with told us that the home had 'very good managers'. They said that the managers were quick to act on any issues or concerns that they had.

People told us that they experienced care, treatment and support that met their needs. One person told us the care was, “…excellent” and another said, “The care is good.” We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

A choice of suitable and nutritious food and drink was provided. People were satisfied with the meals and drinks available. They told us they had plenty to eat and drink and were offered choices. One person said, “They always bring me something I like.”

People were not protected against the risks associated with medicines because procedures for storing, recording and disposing of medicines safely were not always followed.

Staff recruitment processes were not robust and people were not always supported by staff who were suitably trained and skilled. One person said of the staff, “The girls are lovely, I must say they look after you fine.”

The provider had a complaints system available. People we spoke with told us they could approach staff if there was anything that concerned them.

During our visit on 15 January 2013 we looked at the standards relating to quality assurance and record keeping. We found improvements had been made in both areas since our last inspection in September 2012. We saw there were effective systems in place to audit and monitor the records relating to people’s care. We found records were accurate, up to date, and stored securely.

During our visit on 11 September 2012 we spoke with four people who lived at the home, and another person’s relative. All were complimentary about the care and support provided. People told us that staff came quickly when they called and understood and met their needs. It was clear from speaking with staff that they knew the people living at the home well and were meeting their needs. A health care professional told us they thought the care provided at the home was, “Very good” and that the staff followed their instructions. However, we found that care plans and risk assessments had not been reviewed and kept up to date, so there was a risk that care may not be provided in a safe and consistent way.

We observed staff communicating with people in a respectful, kind and patient manner. People told us they were involved in making decisions about their care and day to day life at the home. For instance people told us they could chose where to spend time in the home. One person told us, “They let us do what we want.” Another person told us, “Anything you want you get. If you want a cup of tea they’ll get you one.” A third person said “It’s a nice place altogether, I like it.”

People told us they enjoyed the range of activities on offer. A relative of a person who lived at the home told us they were, “Quite impressed with all the activities” on offer in addition to finding, “Normal things [for their relative] to do, such as laying the tables.” They told us, “I don’t think we could have found a better place that suits my [relative’s] needs… I feel they’ve got my [relative’s] best interest at heart.”