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

The service is registered to provide accommodation and personal care for up to 21 people. People who use the service may have a learning disability or mental health needs. At the time of the inspection, 21 people were living in the home but not everyone using The Hollies received a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

Whilst the Hollies was not originally designed with the principles of Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion, so that people with learning disabilities and autism using the service can live as ordinary a life as any citizen. The registered manager ensured that staffing levels were flexible and responsive to people’s needs and people could be assured that they had choice and control over their care.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

People’s needs and risks were assessed and planned for. People's nutritional needs were met, people liked the food and had a choice. People were supported to have access to health services and receive ongoing healthcare support.

People were treated with kindness and respect. Their privacy was respected and their independence promoted.

People received personalised care that was responsive to their needs. People had not complained, but were regularly reminded of how they could do this if they wanted to. No one was receiving end of life care; however, this had been considered where necessary.

Quality assurance systems were in place and the registered manager knew people well and was approachable.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The building itself needed improving, there are plans in place for this.

The previous CQC rating was displayed as required.

We inspected this service on 23 December 2015. This was an unannounced inspection. Our last inspection took place in June 2014 and at that time we found the home was meeting the regulations that we checked them against.

The Hollies is registered to provide accommodation and personal care for up to 21 people. People who use the service have a learning disability and/or a mental health condition. At the time of our inspection 19 people were using the service.

The service had 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 and associated Regulations about how the service is run.

People’s safety was maintained because risks were assessed and planned for and the staff understood how to keep people safe. People’s medicines were managed safely, which meant people received the medicines they needed when they needed them.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

People’s health and wellbeing needs were met and people were supported to attend health appointments as required. People could access suitable amounts of food and drink that met their individual preferences.

Staff showed they understood and applied the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This ensured that when people had the ability to make decisions for themselves, their decisions were respected. It also ensured decisions were made in people’s best interests if they were unable to do this for themselves.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy.

People were involved in the assessment and review of their care and staff supported and encouraged people to access the community and participate in activities that were important to them.

People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

There was a positive atmosphere at the home and people and staff were supported by the registered manager.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with us.

An adult social care inspector carried out this inspection on 17 June 2014. As part of this inspection we spoke with the five people who use the service, one visiting friend, the registered manager, deputy manager, locality manager and two care staff. We also reviewed records relating to the management of the home which included, four care plans, daily care records, training records and audit reports.

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

Is the service safe?

From our observations and the information we saw set out in care plans, policies, procedures and audits the provider's safety monitoring systems were robust. The staff showed that they had a clear understanding of their role in providing care and in safeguarding the people they supported. The staff demonstrated that they knew the people well and had read and understood the instructions set out in individual care plans.

We saw evidence that people were supported to make decisions and develop their independence. The care plans detailed each person’s capacity to consent. When people lacked the capacity to make decisions on important areas of their lives, best interests, safeguarding and deprivation of liberty discussions were held. The service had the support of an advocacy service when required.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager told us there was one current deprivation of liberty safeguards order in place. We looked at all the documentation and found it was correct and dates had been set for the review.

The staff rotas showed that the management had taken people's care needs into account when making decisions about the number of staff required, the skills mix and experience staff would need. The night time staffing levels and on call system showed that the provider had taken steps to ensure the staffing provision was safe out of main hours.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

People's care needs had been assessed and detailed care plans were in place. There was evidence that people were involved in the assessments of their needs and care plan reviews.

The staff we spoke with told us how people were encouraged and enabled to develop their skills and abilities. People we spoke with told us that the staff helped them to do what they wanted and said that they really enjoyed living at The Hollies.

All care, activity and risk assessment plans were reviewed regularly. We saw that people who lived at the home were supported to develop their independence. We saw evidence in care plans and found from talking with people who used the service that the care provided was being constantly adapted to meet people’s needs.

Is the service caring?

The people we spoke to who lived at the home told us they were very happy there. One person said: "The staff are all really nice, I like it here." Another person said: "They look after me ever so well.”

The staff we spoke with told us they were committed to support the people to develop their skills and abilities so that they could achieve what they wanted. They demonstrated that they were aware of potential risks, people's rights and their responsibilities. Staff showed people respect and maintained people's dignity at all times.

Is the service responsive?

We found that care plans were person centred and contained detailed information about people's choices and preferences. We saw that people’s health and support plans were regularly updated to reflect people’s changing needs.

There was regular support from external social care and health professionals when needed. This meant that people’s health and welfare was regularly reviewed and monitored.

The staff and people who lived at The Hollies said that if they had any concerns, they could talk with the managers as they would always listen and address anything they raised.

The staff said they had regular training which equipped them with the knowledge to meet the support needs of the people who used the service.

Is the service well-led?

The Hollies had a clear management structure in place. The registered manager, deputy manager and the staff we spoke with were knowledgeable about the people who used the service, changes to legislation and developments in care provision.

The people we spoke with who lived at the home and the staff told us that the senior staff were always around to give advice and support. There were systems in place to provide feedback to staff about changes and developments.

All the staff we spoke with said they understood their responsibilities around safeguarding people’s welfare. They said that if they witnessed poor practice they would report their concerns.

Staff told us that they had worked with the people who lived at the home for some time and really enjoyed their work. They told us that there was a good team spirit and everyone listened to any concerns raised and acted to resolve these. They said that they felt they were supported and involved in the development of the service.

The provider had systems in place to ensure the quality of the services provided to the people who lived at the home was regularly monitored and reviewed. The systems we looked at showed that any issues raised by the people or the staff were taken seriously and addressed where possible.

When we inspected The Hollies on 30 June 2013, we identified that improvements needed to be made to the way that medicines and care records were managed and maintained. We completed this inspection to see if the required improvements had been made.

During this inspection we spoke with two members of staff and the deputy manager. We did not speak with people who used the service, as our inspection focussed on looking to see if staff were following the systems which had been put in place since our last inspection.

We saw that people were protected against the risks associated with medicines, because effective systems were in place to enable the registered manager to assess, monitor and manage any risks.

We saw that the information contained in people’s care records was accurate and stored safely. Staff training records were up to date, which meant the registered manager and provider could identify which members of staff required training.

We carried out this inspection as part of our schedule of inspections to check on the care and welfare of people who used the service. The inspection was unannounced, which meant the registered provider and the staff did not know we were inspecting. We spoke with six people who used the service and two staff about how the service was delivered and the quality of the service provided. We spoke with the registered manager following our inspection.

People told us they liked living at The Hollies. One person said, "I've been alright here" another said, "I'm going away on holiday soon". We spoke with people who told us that they were able to do the things that they liked to do and said they were supported by staff. We observed that staff engaged with people positively. We saw that staff demonstrated compassion and were respectful and caring in their approach when we observed people become anxious.

Medication systems were in place but staff did not have access to clear instructions about the administration of some medication. This meant that the provider could not evidence that staff would be consistent in its administration or if people who used the service had been consulted and agreed decisions.

Staffing levels on the day of the inspection did not meet the provider’s stated minimum levels. We found that this was not typical of staff numbers.

Records were stored safely but were not always fully complete or could be located promptly.

We inspected this service to follow up and to test compliance following concerns raised at the previous inspection on 13 September 2012. At the last inspection we found that two people did not have care plans or risk assessments in place, potentially placing them at risk of harm or inappropriate care. We set a compliance action at that time. Since the last inspection the provider has informed us and provided documentary evidence of compliance.

We found that care plans and risk assessments had been developed for the two people we pathway tracked. We found that there was evidence that one person had been involved in their implementation and review.

We found that staff were 'sleeping in' in the lounge of the Hollies. This meant that people using the service did not have access to their own lounge after 10:30pm. Staff we spoke with said it had been agreed because of changes to the sleeping in arrangements in the home that were deemed to be unsuitable. There was no documentary evidence that people using the service had been consulted.

We saw that records for people who used the service were not secure during our inspection. This meant that people's personal details were not protected.

We completed this inspection to follow up and to assess if the provider had made improvements to how it provides care and support to people since our last inspection of 25 November 2012. At our last inspection we found that the provider was non compliant with a number of the regulations we inspect against. We also noted that improvements to other areas were needed to ensure good outcomes for people who used the service.

We completed this inspection on 13 September 2012. We focussed on the outcomes that were assessed as non compliant at the last inspection.

During our inspection we spoke to five people who used the service and to staff. We observed interactions and looked at records including three care records. We noted improvements in all areas we looked at but some records and risk assessments for people were not sufficiently robust to protect people.

People we spoke with said that they were happy at the Hollies, they felt that they were consulted about the things that happened and felt supported when they made day to day decisions. One person said, "I have a key worker who I can go to if I need anything, but I can go to any of the staff."

Following the inspection we spoke to a relative, to a social care professional and an Environmental Health Officer (EHO). They were positive about the service. We speak to other people who have an interest in services to establish their views of the quality of service provided.

Information we hold about the home showed that we hadn't visited for some time. We needed to undertake a monitoring visit in order to update our records and to establish that people's needs were being safely met.

At the time of our visit the service was providing care and accommodation for 17 people. We observed how staff and people using the service interacted, and we talked to people about the things they did, what they liked and didn't like about the service. One person said, "The staff are good, they listen to what I have to say," another said "The staff don’t always listen and don’t always have the time to."

An expert by experience took part in this inspection and talked to people who used the service. An expert by experience is someone who uses services, or has had experience of services. They are people of all ages, with different experiences and from diverse cultural backgrounds. They help us improve the way we inspect and write our reports. Our expert by experience talked to people using the service individually, looked at what happened around the home and saw how everyone was getting on together and what the home felt like. They took some notes and wrote a report about what they found and details are included in this report.

One person said, "I know what my care plans say, the staff write in them." Another said, "My care plans are in the office, but my key worker talks to me about them" and "I haven’t seen my care plan for five years."

Others said, "I can choose what I want to eat, and what to do." "I don’t want to do anything. I used to go to college but don’t now." Another said, "I’m going to Wales for a holiday, with staff."

People told us they were asked about the things they wanted to do.

We observed that the environment was in a poor state of repair and in some areas wasn't very clean. We also identified infection control and hygiene issues in the home.