The inspection took place on 26, 27 and 31 July 2017. This was an unannounced inspection. The service was last inspected in March 2015.

The Hollies Nursing home is situated in Dursley and provides care for up to 56 older people who have nursing needs. The Hollies Nursing Home also supports people who have dementia. At the time of our inspection, there were 51 people living at the Hollies Nursing Home.

There was a registered manager in post at The Hollies Nursing 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

The service was safe. People received safe care and treatment and had clear risk assessments which reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment to support people. People were kept safe by staff who had a good awareness of safeguarding policies and procedures and felt confident to raise any issues or concerns with the management team. The registered manager had carried out the relevant checks to ensure they employed suitable people at The Hollies Nursing Home. There were regular health and safety checks of the property to ensure it was safe for the people living at The Hollies Nursing Home

People were receiving effective care and support. Staff were well skilled and had the appropriate knowledge to meet the needs of the people living at the Hollies Nursing Home. Staff received regular individual meetings called supervisions and appraisals. Where required, the service was adhering to the principles of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were met. Care staff and kitchen staff were aware of people’s dietary requirements and worked hard to meet individual needs. The environment had been adapted to meet the needs of people living at the home. People were supported to personalise their living spaces.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained peoples dignity. People had end of life care plans which reflected their needs and preferences.

The service was responsive to people’s needs. Care plans were person centred and contained sufficient detail to provide consistent, high quality care and support. People were supported to engage in a range of activities based on their preferences and interests. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The systems in place to manage staff training had not always supported the registered and deputy managers to ensure staff training was up to date. The registered manger carried out other quality assurance checks and audits regularly and where issues had been identified, action had been taken to address them. Staff, people and their relatives spoke positively about the registered manager. The registered manager and staff were aware of the vision and values of the service and worked hard to provide a service which was person centred for each individual.

We did not involve the people who lived in The Hollies Care Centre during this inspection. The purpose of our visit was to check that improvements had been made following our last inspection in August 2013.

The improvements we had asked the provider to make were in respect of specific items of equipment. The two refrigerators in the satellite kitchens on the middle and top floors had been replaced. Additional moving and handling body slings had been purchased which meant that they were now used by individual people and not shared by several people. The provider had made the improvements we had identified in August 2013.

People receiving care said that they were happy with the service they received. When asked whether they thought their needs were met the all agreed they thought they were.

At the time of this inspection we found that there were sufficient staff on duty. The staff we spoke with said that these were the usual staff numbers and that although they were busy at times, there were enough staff to meet peoples needs. Observations during the day showed that staff were not rushed and were able to spend time talking with people.

On the whole the home was decorated to a good standard throughout, it was homely and warm. Communal areas were well equipped with a range of furniture and televisions, stereos and DVD players. The kitchens on the first and second floors were not being maintained to an acceptable standard. We found that fridges were not cleaned, temperatures not monitored and kitchens not cleaned regularly.

People looked well and were relaxed and happy when we visited. People were spending time in the lounges reading papers, talking with friends or taking part in activities. Some people were enjoying the day in the privacy of their own rooms and receiving visitors. Everyone we spoke with shared their positive experiences about living in the home and the care they received.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people were receiving.

Staff gave us a warm welcome and they were enthusiastic to be part of the inspection. The majority of staff had worked in the home for a long time and were knowledgeable about people and their needs which meant that people could expect consistency of care. Good relationships of trust and understanding had been formed. It was evident that staff were equipped to support people effectively and that this was meaningful to those receiving it.

We spent time with the general manager and the newly appointed clinical manager who was in the process of applying to the Care Quality Commission to become the registered manager. Both managers were available throughout the day and were knowledgeable about people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home.

People told us that their needs were met and that the staff treated them with respect.

They also told us that usually there were enough staff but occasionally they had to wait for assistance.

People told us that their needs were met and they were able to make decisions about their daily activities. People told us, “the staff are lovely and they are respectful” and “all care is good here and staff treat me with respect”.

A new person told us that so far the care was fine and the staff were kind and respectful to them. Two other people told us their care needs were well met and that staff came quickly when they rang the call bell.

People told us they enjoyed the activities provided, one person told us that they had just been to the garden centre and in the November ‘What’s On’ there were excursions planned to Gloucester Quays and the shopping centre in Yate.

Generally people were satisfied with the food provided and they were supported to choose their food and eat their meals where they wished. People told us they had completed surveys about the food. They also told us they were able to make decisions about their daily living.

The inspection was unannounced. When we last inspected The Hollies Nursing Home in August 2013 we found one breach of a legal requirement; regulation 16, safety, availability and suitability of equipment. When we returned in December 2013 improvements had been made to meet the relevant requirement.

The Hollies Nursing Home is registered to accommodate up to 56 people older people who have personal and/or nursing care needs. The Hollies is a privately owned care service and offers accommodation in purpose built premises. Facilities are situated over three floors and are fully accessible. There is level access to the home from the car parking area. At the time of our inspection there were 55 people in residence.

There was a registered manager in post at the service who had been at The Hollies for a year. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

All staff including the registered manager had received safeguarding adults training and understood their role and responsibilities to protect people from harm. Staff knew what to do if they needed to raise safeguarding concerns and knew which other agencies they could contact. Any risks in respect of people’s daily lives or their specific health needs were assessed and appropriately managed. Management plans were in place to reduce or eliminate risks where these were identified. Staffing numbers on each shift were kept under constant review to ensure there were sufficient staff to meet people’s care needs and keep them safe. Staffing numbers were increased when people were ill, were at the end of their live or there were social activities taking place.

Regular staff training and opportunities to develop skills were available for all staff. This ensured that staff had the necessary knowledge and skills to meet people’s individual care needs. People were provided with sufficient food and drink and were provided with both that met their dietary requirements. People were complimentary about the food they were served. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

People who lived in the home had positive and caring relationships with the staff team. People where possible, were involved in making decisions about how they wanted to be looked after and how they spent their time. People’s privacy and dignity was maintained at all times.

People’s individual needs were met because everyone was looked after in a personalised way. They were actively encouraged to have a say about all things that affected their daily lives and this included the way they were looked after, the way the service was run and the social activities that were arranged. Staff listened to what people had to say and acted upon any concerns to improve the service they provided.

The registered manager provided good management and leadership and had instilled a shared commitment from the whole staff team to provide the best possible care and support. The quality of service provision and care was continually monitored and where shortfalls were identified actions were taken to address the issues.