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Inspection carried out on 20 August 2019

During a routine inspection

About the service

The Holt is registered to provide accommodation for up to six adults with learning disabilities, autism and associated complex needs. Six people were using the service.

The Holt was a large home, bigger than most domestic style properties. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

The provider had systems in place to safeguard people from abuse. Staff demonstrated an awareness of each person's safety and how to minimise risks for them. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to reduce the risk of reoccurrence. Systems were in place to recruit staff safely. People were supported with good nutrition and could access appropriate healthcare services. Staff were equipped with relevant skills.

People were supported by staff who were kind, caring and treated them with dignity and respect. People were relaxed and happy in the company of staff and the registered manager. People received person-centred care from staff who developed positive, meaningful relationships with them. People had opportunities to socialise and participate in activities of their choosing. Care plans were detailed and up to date about people's individual needs and preferences. The environment was free from malodours. People had personalised rooms.

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

this practice.

Staff felt listened to and supported by the registered manager. There was a drive to improve the service for people. People using the service and staff had the opportunity to feedback about the service. There was a system in place to respond to any concerns.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 10 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 5 June 2018

During a routine inspection

The Holt 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. It provides accommodation for people living with a learning disability. The home can accommodate up to six people. At the time of our inspection there were six people living in the home.

There was a not a registered manager in post. 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. In this report when we speak about both the company we refer to them as being, ‘the registered persons’. A manager was in post and was in the process of being registered with CQC.

At the last inspection the service was rated, ‘Good’. At the present inspection the service deteriorated to ‘requires improvement’.

Medicines were managed safely. However, we found staff medicine training records on the day of inspection showed staff were due medicine updates. PRN protocols were not kept with medicine administration sheets to ensure safe administration.

Where people were unable to make decisions arrangements had been made to ensure decisions were made in people's best interests.

Suitable quality checks were being completed, on issues such as infection control, health and safety, however it was not always clear when actions had been taken. There was insufficient staff on duty to ensure people received all of the care they required.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Background checks had been completed before new staff had been appointed.

There were arrangements to prevent and control infections and lessons had been learned when things had gone wrong. However the environment had not been maintained in a manner which ensured it was appropriate.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives and to maintain their independence. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their choices and be actively involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was stored securely.

Information was provided to people in an accessible manner. People had been supported to access activities and community facilities. The manager recognised the importance of promoting equality and diversity. People’s and relatives concerns and complaints were not always listened and responded to in order to improve the quality of care.

Staff did not feel supported by the provider. They were not confident that any concerns they raised would be taken seriously so that action could quickly be taken to keep people safe. There were arrangements for working in partnership with other agencies to support the development of joined-up care. The provider had taken steps to enable the service to meet regulatory requirements. People and their relatives and members of staff had been involved in the running of the service.

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Inspection carried out on 25 September 2015

During a routine inspection

We inspected The Holt on 25 September 2015. The inspection was unannounced. The last inspection took place in January 2014 and we found the provider was compliant with all of the outcomes we inspected.

The Holt provides personal care and support to people who live with complex needs related to the autism spectrum, and learning disabilities. The service can accommodate up to six people and there were six people living there when we visited.

The Holt is part of a larger site called Heath Farm, which consists of five other homes, an activity resource centre and a main administrative office. It is located within the Scopwick area of Lincolnshire.

There was a registered manager in post at the time of 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.

CQC 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 in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection five people who lived within the home had their freedom restricted and the provider had acted in accordance with the Mental Capacity Act, 2005 DoLS legislation.

There was an open and inclusive culture within the home and people were kept safe by staff who supported them in a way that minimised risks to their health, safety and welfare. They were supported to engage in a range of personalised activities and social interests. They had access to a wide range of health services and their nutritional needs were met.

People were treated with warmth and dignity and their privacy was maintained. However, the provider did not take account of the security of people’s personal records when they were out of the building.

There were enough staff to ensure people’s needs, wishes and preferences were met. Staff were recruited appropriately to ensure they were suitable to work within the home. They were well trained and supported to carry out their job roles. They recognised the importance of supporting people to be as involved in their care as they could be and make their own decisions wherever they could do so. Where people could not do this staff used the principles of the MCA effectively to ensure decisions were taken in their best interests.

The provider recognised that not all of the systems in place to enable people to express their views and raise concerns or complaints were effective for people who had different ways of communicating. They told us they were taking action to improve this.

Systems were in place to assess and monitor the quality of the service provided for people and actions were taken to address any issues arising from audits. The provider ensured that the care and support provided for people was based on up to date care approaches and took account of lessons learned from analysis of events and incidents.

Inspection carried out on 29 August 2014

During a routine inspection

When we visited The Holt there were five people living at the home. We spoke with the provider�s operations manager, the provider�s quality assurance manager, three members of staff, a relative and two other professionals involved with supporting people.

We observed how the five people who lived in the home were cared for. This was because they had different ways of communicating and could not tell us directly about their experiences of the care they received.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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

If you want to see the evidence supporting the summary please read the full report.

Is the service safe?

There were enough qualified, skilled and experienced staff to meet people�s needs.

Where people could not make decisions for themselves we saw there was a system in place to make sure any decisions would be made in their best interests.

The provider had acted in accordance with the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) where people needed to have their freedom restricted. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others.

The provider had appropriate arrangements in place to manage medicines. This meant that people were protected against the risks associated with medicines.

There were up to date arrangements in place to deal with emergencies. For example, the failure of essential services such electricity, or fire or flooding. This meant that people could be confident that their accommodation and care needs would be reliably met.

Is the service effective?

Records showed care plans were reviewed and amended when people�s needs changed.

Staff demonstrated they knew about people�s needs, wishes and preferences in detail and we saw they provided the support and care that was set out in people�s plans.

Arrangements were in place to review information about accidents and incidents. This meant staff could make sure the situations were appropriately managed and they could look for ways to avoid similar situations occurring in the future.

Is the service caring?

Staff respected people�s wishes, choices and decisions. Throughout the visit we saw staff supporting people, in meaningful ways, to make decisions about what they wanted to do. Staff gave them time to make choices and decisions.

People responded positively when they were with staff. They appeared comfortable and relaxed in their company.

A relative said, �I can�t fault Autism Care, [my relative�s] life has improved greatly since he�s been there.�

Is the service responsive?

The provider had a policy about how to manage complaints and concerns. Records showed complaints and concerns had been managed in accordance with the policy and resolved satisfactorily.

There were arrangements in place to manage and respond to any staff shortages due to, for example, sickness.

The provider was reviewing the way in which they gathered the views of people living in the home. This was because people had different ways of communicating and the current system did not always reflect this.

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people receive. Action plans were in place to address any shortfalls.

Staff told us they felt well supported by the manager and felt comfortable to raise any issues or concerns. We saw they received regular supervision and support from senior staff.

Systems were in place to maintain clear communication between the provider, staff, relatives and people who lived in the home.

Inspection carried out on 13 January 2014

During a routine inspection

We used a number of different ways to help us understand the experiences of people who were available at the time of our inspection visit. This was because some people had complex needs which meant they were not able to tell us directly about their experiences of care and support.

Before we undertook our visit we reviewed all of the information we had about the service. During our visit we observed the support people received and spoke with staff and the manager. We also looked at a range of records kept in the home.

Throughout our visit we observed people were supported in a respectful and dignified way, and staff were responsive to each person's way of communicating their needs, wishes and choices.

Staff had been given training and support that helped them to understand peoples' complex needs. Staff told us this helped them feel confident in carrying out their roles.

We also looked at the statement of purpose and found this reflected the current service provision. Overall we found the service was well led and there were effective systems in place to audit and monitor the services provided.

Inspection carried out on 17 July 2012

During a routine inspection

We used a number of different ways to help us understand the experiences of people who used the service. This was because they had complex needs which meant that they were not able to tell us about their experiences. We looked at records, including personal care plans. We spoke to the manager and staff who were supporting people, and we observed how they provided that support.

We saw that staff supported people in a respectful and dignified way, and that they closely followed the care that was set out in people�s plans.

We saw that people were given support to make choices and decisions for themselves wherever they could do so, and staff clearly understood each person�s way of communicating their needs wishes and choices.

Inspection carried out on 4, 5 April 2011

During an inspection in response to concerns

People were not able to tell us about their experiences. However we saw that they were being supported to take part in daily routines and individual activities of their choice. We saw that they have a wide range of activities to choose from.

Reports under our old system of regulation (including those from before CQC was created)