We conducted an unannounced inspection at The Hollies on 22 June 2018. The Hollies is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Hollies accommodates up to 22 people in one building. On the day of our inspection, 14 people were living at the home, all of these were older people, some of whom were living with dementia.

A registered manager was present during the inspection. 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.

During the home’s previous inspection on 07 December 2015, we rated the home overall as ‘Good’ During this inspection, we found some areas of concern and the overall rating has now changed to ‘Requires Improvement’. The details of the reasons why are explained in the summary below and in the body of the main report.

People were supported by staff who understood the risks people could face and knew how to keep them safe. Some risks to people’s health and safety were not being clearly identified and managed.

People were provided with their care and support when this was needed because there were enough staff on duty. People medicines were not managed safely and they may not receive these safely at the time they needed these. People were being protected from infection because safe practices were being followed.

People were being cared for and supported by staff who had been trained to do so. The provider was not following the Mental Capacity Act 2005 legal framework to ensure they made the least restrictive decisions in people’s best interest. People’s human right to make decisions for themselves was respected and they provided consent to their care when needed.

People were provided with the support they needed to have sufficient nutritional and fluid intake. Staff understood people’s healthcare needs and their role in supporting them with these. People lived in a building that had character which required ongoing maintenance due to this.

People were cared for and supported by staff who respected them and their privacy and dignity was respected. Where possible people were involved in planning their own care.

People received care that met their needs and they were able to participate in meaningful interaction and activities. Measures were in place to provide information to people in the most suitable format for them. People knew how to raise any complaints or concerns they had and felt confident that these would be dealt with. People approaching the end of their life were supported in a caring and sensitive way at that time.

People used a service that was responsive to their needs and views. They had confidence in the registered manager who was respected and supported by staff. However the systems to monitor the quality of the service and make improvements were not being used to achieve this.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

The Hollies residential home is situated in the market town of Retford and is registered to provide accommodation for 22 persons who require nursing or personal care. At the time of inspection 16 people were using the service.

This inspection took place on 7 December 2015 and was unannounced.

The service has a registered manager. 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 risk to people experiencing abuse at the home was reduced because staff had received training on safeguarding of adults and knew who to report concerns to. Risks were assessed and any accidents and incidents were investigated. There were enough staff with the right skills and experience to meet people’s needs. Medicines were stored, administered and handled safely.

People were supported by staff who had received the appropriate training to support people effectively. They spoke positively about the food they received and were supported to eat and drink independently. People’s food and fluid intake was monitored when required. People had regular access to their GP and other health care professionals.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager had applied the principles of the MCA and DoLS appropriately.

People were supported by staff who were caring and treated them with kindness, respect and dignity. Where people showed signs of distress or discomfort, staff responded to them quickly. There were no restrictions on friends and relatives visiting their family members. People could have privacy when needed.

People and their relatives were involved with the planning of the care and support provided. People were able to access the activities and hobbies that interested them. A complaints procedure was in place and people felt comfortable in making a complaint if needed.

There was a positive atmosphere within the home. Staff understood the values and aims of the service and were aware of how they could contribute to reduce the risk to people’s health and safety. People spoke highly of the registered manager. The registered manager had clear processes in place to manage the risks to people and the service. Auditing and quality monitoring processes were in place. The service continually strived to improve the quality of the service that people received.

We used a number of different methods to help us reach a judgement on the quality of service provision. These included talking with four people who used the service and two visitors to the home and staff. We also looked at records mainatined at the service.

People were provided with a choice of suitable and nutritious food and drink. One person said, “The food is fantastic, in fact it’s top class. Nothing is too much trouble for them (care staff) I have no concerns at all.” Another person told us, “I cannot grumble about the food. It’s very nicely prepared and we cannot ask for anything better than that.”

We found that medication was managed effectively. One person said, “My tablets are always provided and they (care staff) watch me taking them before they go.”

People told us they felt the staff had the right qualifications and skills. One person told us, “We are all happy here, obviously we have our moments like anybody else but I feel that we are all happy”. Another person told us, “All the girls (care staff) are beautiful, they all look after me. They are always there if I need them, at any time of the day or night, they are top class. I definitely feel safe here.”

We found effective recruitment process in place which adhered to current legislative requirements. We also found that the support staff had received a training package to ensure they were competent and confident in performing their duties.

We spoke with four people who lived at the service. One said “It’s wonderful here. I couldn’t be happier. I was very lonely but not any more.”

Another person told us “I’ve lived her for years and it’s home from home.”

All the people we spoke with said they were happy at The Hollies and said the care was very good. They spoke highly of the staff and the manager and said they would not want to be anywhere else.