This inspection took place on 19 and 21July 2017 and was unannounced. It was carried out by ¿one adult social care inspector.¿

The Hollies provides care and support for up to 16 older people. The home is located in the small ¿town of Castle Cary. It is not purpose built and has accommodation arranged over two floors; ¿there are two stair lifts, but no passenger lift. There were seven people living at the home during ¿our inspection; one person was on a short stay.¿

A registered manager was responsible for the service. This 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.¿

When we last inspected the service on 29 February 2016 and 2 March 2016 we found two ¿breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This

was because medicine administration records were not always accurate. Medicine audits were ¿not

completed thoroughly and checks were not always completed to ensure medicines were still safe ¿to use. People may have been deprived of their liberty without having their legal rights protected.¿

The provider sent us an action plan on 11 April 2016 which confirmed the action they were taking ¿in relation to these issues. At this inspection we found the necessary improvements had been ¿made. ¿

On both days of our inspection there was a homely, calm and relaxed atmosphere. Staff ¿interacted with people in a friendly and respectful way. People were encouraged and supported ¿to maintain their independence and to pursue their interests and hobbies. They made choices ¿about their day to day lives which were respected by staff. One person said, “I go out every ¿morning for a walk and have a coffee in the café. I go in the local shops. Nice to get out.”¿

People and their relatives said the home was a safe place to live. People spoke highly of the care ¿they received. One person said, ““The staff are caring. I would say they are excellent.” ¿

People were involved in planning and reviewing their own care. Staff respected people’s privacy ¿and were aware of issues of confidentiality.¿

People told us staff took the time to get to know them; staff asked them about their life history, ¿their interests, hobbies and preferred routines. There was a programme of activities in line with ¿people’s interests. People were involved in the local community. They had a choice of nutritious, ¿home cooked food. Each person we spoke with said they were happy with the food and drinks ¿served in the home. One person said, ““The food is good. You can ask for anything special. You ¿just say the word and they do it for you.” ¿

People had developed friendships with others who lived in the home; they kept in touch with their ¿other friends and relations. Friends and relatives could visit at any time. One relative told us, “I ¿usually come in every day. It’s lovely here; it’s like an extended family.” ¿

There was a stable staff team at the home. Staff were kind and caring. They had a very good ¿knowledge of people’s care needs. Staff received a thorough induction and ongoing training and ¿support. ¿

People were involved in decisions about the running of the home as well as their own care. ¿People knew how to make a formal complaint, but no one had needed to. One person said, “I’m ¿happy and I like it here. If I wasn’t I would talk to the staff about it. Nothing to worry about here ¿though.” ¿

The management structure in the home provided clear lines of responsibility and accountability. ¿People liked and trusted the registered manager. One person said, “[Name] the manager is very ¿nice and helpful. Very easy to talk to.” An improved system of audits and checks had been ¿introduced and now worked well to monitor people’s safety and the quality of ca

The Hollies Care Home provides care and accommodation for up to 16 older people. At the time of the inspection 10 people were living at the home. The home is not purpose built and has accommodation arranged over two floors; there are two stair lifts, but no passenger lift. On the ground floor there are bedrooms and communal facilities. The remaining bedrooms are on the first floor.

A registered manager was responsible for the home. 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.

This inspection took place on 29 February 2016 and 2 March 2016 and was unannounced. It was carried out by two inspectors.

At the last inspection on 11 November 2014 we found the provider to be in breach of Regulation 23 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because staff did not receive formal supervision or appraisals and there were limited opportunities to discuss issues or identify training needs in a confidential setting. We also found improvements were needed to make sure people received a healthy diet and had opportunities to make choices about the food served in the home and to make sure people who lived at the home and staff were fully involved in the running of the home. At this latest inspection we found the necessary improvements had been made.

Staff understood people's needs and provided the care and support they needed. People said the home was a safe place. One person said “Oh yes it’s safe. The staff make it safe.” There were organised activities and people were able to choose to socialise or spend time alone.

People interacted well with staff. There was a relaxed, homely atmosphere. There was laughter, chatter and friendly banter. People made choices about their day to day lives. They were part of their community and were encouraged to be as independent as they could be.

Staffing levels were good and people also received good support from health and social care professionals. Staff had built trusting relationships with people. People were happy with the care they received. One person said “The staff are wonderful, hardworking and dedicated. They are lovely.”

People, and those close to them, were involved in planning and reviewing their care and support. There was good communication with people's relatives. Relatives visited regularly and felt their views were listened to and acted on. One relative said “We have an annual survey; they listen and take it on board.”

Staff were well supported and well trained. Staff spoke highly of the care they were able to provide to people. One staff member said “I think the care is brilliant here.”

People liked and trusted the registered manager. All staff worked hard to provide the best level of care possible to people. The aims of the service were well defined and adopted by the staff team.

There were quality assurance processes in place to monitor care and safety and plan ongoing improvements but these were not yet fully effective. There were systems in place to share information and seek people's views about their care and the running of the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicine administration records were not always accurate. Medicine audits were not completed thoroughly and checks were not always completed to ensure medicines were still safe to use. People may have been deprived of their liberty without having their legal rights protected. You can see what action we told the provider to take at the back of the full version of the report.

The Hollies Care Home provides care and accommodation for up to 16 older people. At the time of the inspection 12 people were living at the home. The home is not purpose built and has accommodation arranged over two floors; there are two stair lifts, but no shaft lift. On the ground floor there are bedrooms and communal facilities. The remaining bedrooms are on the first floor.

There is 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 2008 and associated Regulations about how the service is run.

The last inspection of The Hollies Care Home took place in June 2014. At that inspection we found the home to be in breach of Regulations 9, 10 and 15 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At this inspection we found that action had been taken to improve the service and ensure these regulations had been met.

At this inspection we found that improvements were needed to make sure people received a healthy diet and had opportunities to make choices about the food served in the home.

Improvements were also needed to make sure people who lived at the home and staff were fully involved in the running of the home. There were no meetings for people, relatives or staff. Staff did not receive formal supervision or appraisals and there were limited opportunities to discuss issues or identify training needs in a confidential setting.

People spoke highly of the staff who supported them. Comments included: “All the staff are very nice, in fact they are lovely,” “Staff are very nice” and “There’s lots of kindness here.”

People told us they felt safe and there were adequate numbers of staff to make sure they received the support they needed. The risks of abuse to people was minimised because the provider checked staff were suitable before they commenced employment.

Medicines were safely stored and administered by trained staff. People received prescribed medicines correctly.

There was a calm and relaxed atmosphere in the home. Throughout our visit we saw kind and caring interactions between people and staff. We also heard lots of laughter and friendly banter. One visitor told us “One of the things I like best about here is there’s lots of chat and laughter.”

People were able to make decisions about their day to day lives and staff respected people’s wishes. Where people lacked the mental capacity to make a decision, the staff knew about guidance and legislation about making a decision in a person’s best interests.

There were some organised activities and people were able to choose to socialise or spend time alone. Visitors were always made welcome and people could see their visitors in communal areas or in private. Staff respected people’s privacy.

People felt their healthcare needs were met. One person said “They are very good if you’re poorly. They always get a doctor.” Another person told us they were seen regularly by a community nurse. Care records showed people were accessing a range of health and social care professionals in accordance with their needs.

People knew how to make a complaint and felt confident that any concerns would be listened to. One person said “I know who to talk with. If I had a complaint they would sort it out.” Another person told us they had made a complaint in the past and their concerns had been addressed.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

An adult social care inspector carried out this inspection. We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five 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 told us they felt safe living at the home and with the staff who supported them. One person told us: “I feel very safe here, there’s nothing to worry about and I get all the help I need.”

There were systems in place for the safe administration, storage and recording of medication. Medicines were only administered by staff who had completed training in this area.

The home carried out regular health and safety checks to make sure that the building was maintained to a safe standard. These checks included testing the fire detection system and hot water temperatures.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. While no applications have been submitted relevant staff have been trained to understand when an application should be made, and in how to submit one. People’s rights were therefore properly recognised, respected and promoted.

Is the service effective?

People’s care and treatment was not always effectively planned and monitored to ensure they received appropriate care and treatment.

Although care plans gave some information about people’s needs and preferences they did not always include details of how specific needs would be met. There were no nutritional assessments in place and therefore no plans of care to state how people’s nutritional needs would be met or the assistance they may require.

People we spoke with said they had access to healthcare professional including doctors, chiropodists and community nurses. One person told us: “They would certainly get the doctor if I wasn’t well.” Another person told us that a community nurse visited them regularly.

The standard of decor in some areas of the home was poor and did not provide a suitable environment for people.

Is the service caring?

People who lived at the home and visiting relatives were very complimentary about the staff who worked at the home. One person told us: “The staff are all lovely, if you want anything you only have to ask.” A visitor said: “The staff are all very kind and very caring.”

Staff respected people’s wishes about how and where they spent their time. Throughout the visit we saw that people were free to spend time in communal areas or in their personal rooms. One person told us they always liked to eat in their room. At lunchtime we saw that their meal was taken to them in their room.

Is the service responsive?

People were involved in decisions about their care and treatment which enabled them to express their views and wishes. Care plans gave evidence that they had been discussed with the person who lived at the home and/or their representative. One visiting relative we spoke with told us staff had gone through the care plan with them and their relative.

People told us they were able to make choices about their day to day lives. People were able to choose what time they got up, when they went to bed and how they spent their day.

People told us they would feel comfortable to speak with the registered manager or a member of staff if they had any concerns. One person said: “The manager always comes to see me if I’m not happy about anything.”

Is the service well led?

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 and shares the legal responsibility for meeting the requirements of the law with the provider.

There were some systems in place to monitor the quality of the service offered and ensure the safety of people who lived at the home. However these systems were not always effective in identifying shortfalls in the service and planning improvements.

There was sufficient staff on duty to meet the needs of the people who lived at the home. We observed that call bells were answered promptly and no one had to wait long for assistance.

People told us that they made decisions about the care and support they received. They told us they felt very well cared for and that staff were available when they needed them. Comments from people included “The staff are very good. They know what care I need”, “We are all very well cared for” and “All of the staff are wonderful and very caring.”

People spent their time as they wished. Some people chose to watch TV, listened to music, read or joined in with activities. Regular activities were arranged which people could choose to attend. People liked the food served in the home. They chose where they wished to eat their meals. Most people preferred to eat in the dining area, but some chose to eat in their own rooms.

People we spoke with said they thought the home was a safe place for them to live. One person “Yes, this is a safe place to live. I have never been upset here”. People said they would raise any concerns if they had any and would be happy to share these with staff.

People were cared for by friendly, competent staff. Staff members said they were well trained and well supported. They were never asked to carry out tasks they had not been trained to do safely and effectively.

The record keeping in the home was good. All of the records were kept securely and retained for appropriate periods of time.

We spoke with six people who used the service. We observed people were able to make lifestyle choices, for example, people had been able to bring their pets into the home. We asked people about the choices they made . The people we spoke with said they made decisions and the staff respected them. We asked people about the support they received from the staff team. We were told that the staff were "very friendly and helpful".

We looked at five care files of people who used the service. We saw the manager used a dependency profiling tool which meant that people who used the service has their needs reassessed on a monthly basis. This allowed the manager to monitor the support people needed.

The people who used the service we spoke with said that they felt safe using this service and knew what to do if they had any concerns. We were told “ I feel very safe here, staff kept popping in to make sure I'm alright”.

We spoke to the manager about the improvements to the premises, for example, the new wet room being installed on the ground floor. We were told there had been a programme for improvement identified to benefit people who used the service.

We were given a copy of the last survey for the service. We read that the majority of comments made by people who had returned the survey were positive. For example, a visiting professional wrote “ I have observed good practise by the carers during assessments and customers appear happy and well cared for”.

We spoke with a number of people who live at The Hollies. Given the needs of people using the service, not all were able to speak with us.

People said they felt safe and well cared for; staff who work in the home knew what care and support each person needed. Staff were available when people needed them.

People confirmed that they were able to make choices about how and where they spent their day. Some people told us that they preferred the privacy of their own room.

They told us they enjoy the meals served in the home and snacks and drinks were always available should they wish to have them.

Comments from people who live in the home included "it is fine here, I'm happy. I choose what I want to do", "things are alright here; I'm very happy", “it is my choice; I decide what I want or need”, "staff check regularly that I'm ok. If I need them they come straight away", "I usually have my meals in my room as I prefer that, the food though is very good", us "I am happy, I have everything I need in my room", "staff are nice" and "staff are very good".