We inspected this service on 26 February 2018. The inspection was unannounced.

The Hollies is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 provides accommodation and care for up to 21 people with learning disabilities and autistic spectrum disorder in six purpose built bungalows and three individual apartments within the same grounds. At the time of the inspection 21 people living at The Hollies.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The service had a registered manager who was in the process of de-registering as the registered manager for this service. A new manager had been appointed and had been in post for one week, they were in the process of submitting their registered manager application. We will monitor their progress.

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.

At the last inspection February 2016 the service was rated ‘Good’ in all key questions, at this inspection we found the service had deteriorated to ‘Requires Improvement’ in ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well-led’ and remained ‘Good’ for ‘Caring’.

People were not continuously supported with the required staffing levels to meet their assessed needs. Staff were not always deployed appropriately. Safe staff recruitment checks were followed. Risks to people’s needs and the environment had not always been appropriately assessed and reviewed.

The prevention and control measures for the spread of infections including cleanliness of the service were found to be poor. There was no effective analysis of behavioural incidents or accidents or learning to reduce further reoccurrence. Some inconsistencies were identified in the management of medicines.

Staff had received training in safeguarding and the provider had a policy and procedures to inform practice.

Staff received an induction and ongoing training and support. Staff had not received refresher training in Positive Behaviour Management as required. However, this had been identified and plans were in place for staff to receive this training. Staff were not knowledgeable about all people’s health conditions.

People had their needs assessed and planned for. People received a choice of meals, but some people had undue restrictions placed on them in relation to snacks.

People were not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. Where people lacked mental capacity to consent to their care and support, assessments to ensure decisions were made in their best interest had not been consistently completed. There had been a delay in acting on a condition that had been made on the authorisation of one person’s deprivation of liberty safeguard authorisation. People were supported to access primary and specialist health services.

Staff were aware of people’s needs, routines and what was important to them. Staff overall were kind and caring and supported people ensuring their dignity and with respect. Independence was encouraged and supported. People were supported by independent advocates. It was not clear if or how, people were

This inspection took place on 1 February 2016 and was unannounced.

The Hollies provides accommodation and care for up to 21 people with learning disabilities in six purpose built bungalows and three individual apartments. There were 20 people living there when we visited.

There was a registered manager who was available throughout this inspection visit. 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.

People were safe and protected from harm at The Hollies. Any risks to the safety of people were assessed and reduced as far as possible. There were enough staff available to meet people’s individual needs and action was taken to ensure people received their medicines safely.

A range of training was available to staff and they had information about the Mental Capacity Act and the manager ensured people’s rights were protected

People received appropriate support with their eating and drinking needs, their independence was promoted. People received their preferred choice of meal and were involved in food preparation where possible. People’s ongoing health was monitored and health needs were met.

All staff showed kindness and compassion in the way they spoke with people. People were supported to maintain relationships with family and friends and there were no restrictions on visitors. Staff showed respect for people’s privacy and dignity. They understood the importance of confidentiality, keeping all personal information about people safe and secure.

The service was responsive to individual interests and preferences, and plans of support and care were specific to people’s individual needs. People were satisfied with responses they had received when they raised any concerns.

There were systems in place for the registered manager to ensure all areas of the service were regularly checked and the overall quality of care was monitored by the care director on behalf of the provider.

When we visited on 22 April 2013, we were concerned that some information and documents were either not available or not up to date in respect of some people that used the service and in respect to the management of the service. This meant there was potentially a risk to people's health and welfare and we told the provider to take action to improve how information was recorded.

We reviewed a report about the action taken and we visited the service again to ensure records were fit for purpose.

We examined two people's personal records and some of the records relating to the management of the service. We spoke with two of the support staff and the registered manager about record keeping. Overall, we found improvements had been made.

We spoke with four people who used the service and observed the care of others. We spoke with support staff within each bungalow.

Support staff told us how they continually checked if people consented to their care. Where people did not have the capacity to consent, we found that support staff acted in people's best interests.

People told us they felt safe and comments included, "Happy here." And "They help me".

We performed a partial tour of each of the bungalows and saw a sample of individual bedrooms. We found the premises were mainly well maintained. Action was taken to replace a missing bedroom door during this inspection.

We found that all support staff received planned training and were supported to care for people safely.

The records kept at the service were useful, but we we had minor concerns that some records were not up to date or had not been maintained accurately.

The name of the registered manager was Russell Currie. In this report the names of two registered managers appear who were not in post and not managing regulatory activities at this location at the time of the inspection. Their names appear because they were still on our register at the time.

The Hollies provides accommodation and care for up to 18 people with learning disabilities in six purpose built bungalows. At the time we visited there were 17 people accommodated. There is a registered manager at this location.

People who lived in the home told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm.

Staff received a wide range of appropriate training and were knowledgeable about the needs of people living in the home. They provided effective care and support that met people’s individual needs.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are a code of practice to supplement the main MCA 2005 code of practice. We looked at whether the service was applying DoLS appropriately and found they were meeting the requirements of the code and following the conditions of the DoLS that had been approved.

During our visit we found a caring atmosphere and people told us that staff were nice to them. One person said, "Staff are kind to me and they listen to me." People were able to pursue a wide range of interests and hobbies with appropriate support from staff.

Management systems were well established to monitor and learn from incidents and concerns. There were also systems to ensure there were sufficient numbers of skilled and experienced staff to meet the needs of people at all times.