The inspection took place on 27 January 2017 and was unannounced, which meant the provider did not know we were coming. We last inspected the service in October 2015 and although we identified no breaches of regulation, we found some areas required improvements. The overall rating was requires improvement.

The Hollies provides personal care and accommodation for up to 29 older people. The service is a converted older property with accommodation on three levels accessed by a lift. It is situated in Wakefield. At the time of the inspection the home was providing care for 25 people, some of whom had a diagnosis of dementia.

The service had a registered manager in post at the time of our inspection. 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.

People told us they felt the home was a safe place to live. Systems were in place to protect people from the risk of harm. Staff were knowledgeable about safeguarding people from abuse, and were able to explain the procedures to follow should there be any concerns of this kind.

Recruitment processes were thorough so helped the employer make safer recruitment decisions when employing new staff. At the time of our inspection we found there was adequate staff on duty to meet people’s care needs in a timely manner. Although staff told us that on occasions at night it could be busy.

The registered manager told us they did not have or use a staffing dependency tool. This would determine people’s level of needs and care hours required to ensure there were adequate staff on duty at all times. We were told dependency was discussed with staff to determine staffing levels.

Systems were in place to protect people by the prevention and control of infection. However, we identified these had not always been followed.

Care plans reflected people’s needs and had been reviewed and updated to reflect people’s changing needs

Medicines were stored safely and procedures were in place to ensure they were administered correctly.

The manager was aware of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place and key staff had been trained. This helped to make sure people were safeguarded from excessive or unnecessary restrictions being place on them.

People were treated with respect, kindness and understanding. Staff demonstrated a good awareness of how they respected people’s preferences and ensured their privacy and dignity was maintained. We saw staff took account of people’s individual needs and preferences while supporting them. People had access to activities and stimulation.

People were supported appropriately to eat and drink sufficient to maintain a balanced diet and adequate hydration.

There was a system in place to tell people how to raise concerns and how these would be managed. People told us they would feel comfortable raising any concerns with the management team.

People we spoke with told us the management team were approachable, always ready to listen and acted promptly to address any concerns.

There were systems in place to assess if the home was operating correctly and people were satisfied with the service provided. This included meetings and regular audits. Action plans had been put in place to address any areas that needed improving. The areas we had identified that required improvement had been identified and were being addressed.

The inspection of The Hollies residential home took place on 6 October 2015 and was unannounced. We previously inspected the service on 11 March 2014 and the service was not found to have been in breach of the Health and Social Care Act 2008 regulations at that time.

The Hollies provides accommodation and personal care for up to 29 older people some of who may also have a physical disability or be living with a diagnosis of dementia. The home has three floors with a lift and there are assisted bathing facilities for those who require them. There are a number of rooms downstairs allowing for social interaction or quiet time. On the day of our inspection there were 29 people living in the home.

The home had a registered manager, although they were not working on the day of the inspection as they were on leave. However, the deputy manager and Director of Care were present. 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 told us they felt safe and staff were able to explain how they would identify and respond to any concerns about abuse. Risk assessments were focused on the individual and reflected their specific needs.

Staffing was appropriate for the needs of the people living at the home on the day of inspection. People received their medicines in line with the guidance from the National Institute of Clinical Excellence meaning that staff were trained and administered medicines safely.

People had access to a range of food and drink throughout the day and were supported where required with eating and drinking. There was also regular contact with other health professionals such as GPs or dieticians.

The home was following the principles of the Mental Capacity Act 2005 and its associated Deprivation of Liberty Safeguards by ensuring all people had been assessed for their levels of capacity, and where this was deemed to be lacking, decisions were made in their best interests.

Staff received a comprehensive induction and subsequent supervision. However, we found that training was not always up to date in core subjects. This meant staff did not always have the latest information for their role.

People’s consent was sought prior to undertaking any care task and their privacy was respected. Most staff we observed to be caring, however there was some incidents of poor practice and these were raised with the Director of Care.

There were activities available for people to join in with and it was evident that people actively participated in making decisions about what happened in the home. We found the home had received many compliments and dealt with complaints effectively.

Records focused on the individual and were updated on a regular basis reflecting any change in needs.

People spoke highly of the registered manager and rated the care as good or excellent. The home had a positive atmosphere and staff also told us how much they liked working there.

We made a responsive visit to The Hollies because we had received information of concern. The information suggested there were not enough staff on duty and this meant there were too many unwanted incidents. We were told people’s personal care needs were not being met and there was a strong smell of urine in the home. We were told staff did not use correct moving and handling techniques and there was a lack of professional care.

We spoke with the manager, the operations manager and three members of staff who were working on the day of our visit. We spoke with people who lived there and with three relatives. We reviewed four people’s care records and three staff files.

We found there was no strong smell of urine in the home, people’s needs were appropriately met and there were sufficient numbers of staff on duty to care for people. We saw staff were kind and caring with people and they promptly attended to their personal care needs.

We found staff had received regular training and support to carry out their role.

People told us they enjoyed living at The Hollies. People said they liked the people caring for them. One person told us they “love” their bedroom and had everything they needed.

Another person told us they liked the meals and had a choice of menu and if they wanted something else all they had to do was ask. Another person told us they liked helping in the garden and showed us the rose bushes they had planted and had watered that morning.

A visiting District Nurse told us that they enjoyed coming to the home. All the staff were very friendly and they were always made to feel welcome. They also said that there was always a homely atmosphere in The Hollies and all the people living there seemed happy and were well were cared for.

Another person living in the home told us that they liked the activities and in particular playing Bingo and having parties.

Staff we spoke with understood what to do if they observed poor practise and abuse and felt confident action would be taken by management in the home to protect people.

A sample of staff records showed that appropriate checks were undertaken before staff began work.The Registered Manager stated that staff would only be deployed to give care when they had been assessed as competant to do the job.

People told us they felt safe and well cared for. One person said the carers were “absolutely wonderful and couldn’t be better”.

You can see our judgements on the front page of this report.

One person said they are very happy living in the home. Another said the meals are very good and they have a choice of menu. Another person said they look after the garden and have put bedding plants in the front garden and plan to plant more once these have stopped flowering. Someone else says the home is very good and they are well cared for.

People we could not communicate with were relaxed, comfortable and happy.

People living in the home said they feel safe and well cared for. One person said the staff are very good and listen to what they say. One returned relatives satisfaction survey says ‘Residents are made to feel safe and secure. All problems are dealt with immediately, and all families are shown affection and great care’.

One person using the service said they take part in interviewing new staff and like asking them questions to see if they are suitable to work in the home.

One person said the carers are very good and they feel well cared for. Another says the staff listen to what they say and there is always someone around if they need them. One relative comments on a returned satisfaction survey “I am completely satisfied with the service provided, well done and the staff are excellent”.

People said they like the carers. One person says the staff are very good and very caring.

A visiting District Nurse when asked what the service does well on a satisfaction survey, writes, “Partnership working and communication. I can always be confident that when I’ve plan a program of care the staff at the Hollies follow this. If there is anything we need to know they always contact us”

People say they like living in the home and that they are happy. One returned relatives’ satisfaction survey when asked what the home does well replies ‘Good care and everyone seems happy. My mum seems to have thrived and put weight on, the carers are very good’

People say they like living in the home and that they have no complaints. One person said they have never had to make a complaint. One returned satisfaction survey shows that one relative had a complaint about items of clothing going missing, however, this had been resolved.

We spoke to several people who live in the home. All of the people that we talked to told us that they were that they were happy with the care they got from staff, very happy with the food and that the home is comfortable and is kept nice. They told us that the staff are very good at listening to and acting on people’s views.

One person who lives in the home told us they enjoyed being involved in staff recruitment interviews.