Hillside Care Home

There was 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. 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 last comprehensive inspection at Hillside Care Home during February 2017 we had serious concerns about the lack of adequate numbers of staff on duty and the safe management of medicines. We issued the provider with a warning notice to the provider and registered manager who was in post at that time to inform them that the service was required to become compliant with Regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 27 May 2017.

We received an action plan following which we carried out a focussed inspection on 17 July 2017 to assess compliance. At this inspection we found that improvements had been met with regards to how the service effectively calculated the numbers of staff required to ensure that people's needs were met safely. We also found improvements had been made in the systems in place to ensure that people were provided with their medicines safely. At the inspection on 17 July 2017 we changed the rating for the key question of safe to ‘Good’. In line with our methodology the overall rating remained ‘Requires Improvement’.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hillside Care Home on our website at www.cqc.org.uk

During this inspection in February 2018 we found improvements were needed with regard to the provision of meaningful activities for people to take part in. Care plans were not all up to date; the information within them was not always current.

Staff had an understanding of abuse and safeguarding procedures. They were aware of how to report abuse as well as an awareness of how to report safeguarding concerns outside of the service. Risks were mostly managed well, risk assessments were in place and reviewed. The storage of mobility equipment meant that fire extinguishers were not easily visible. Action was taken to address this during our inspection.

Effective recruitment processes were followed and there were enough staff to meet people's needs. People received their medicines safely and as prescribed. Medicines were administered by staff who were trained to do so.

People's ability to make decisions was considered in line with the requirements of the Mental Capacity Act 2005. 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. Staff interacted with people in a professional manner and their consent was sought before any care was carried out.

Staff knew the needs and preferences of the people they cared for and people were given reassurance and encouragement when they needed it. People's rights to privacy, dignity and independence were taken into account by staff in the way they cared for them.

Improvements were needed to the environment on the first floor however this had already been identified and redecoration works were underway.

The registered manager encouraged an open, inclusive culture within the home. Relatives were free to visit their family members and were warmly welcomed. Relatives said they felt comfortable raising any issues or concerns directly with the registered manager. There were arrangements in place to deal with people's complaints and issues appropriately if they were raised. The provider had systems in place to monitor the quality of the service. These included audits of key aspects of the service.

We carried out an unannounced comprehensive inspection of this service on 15 February 2017 and rated the service as Requires Improvement. We had serious concerns relating to the lack of adequate numbers of staff on duty and the management of medicines.

We issued a warning notice to the provider and registered manager dated 3 May 2017 to inform them that the service was required to become compliant with Regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 27 May 2017. We received an action plan from the registered manager which informed us that the service would be compliant with the Regulation by 27 May 2017.

We carried out this focussed inspection on 17 July 2017 to assess the safety of the service. This report only covers our findings in relation to people’s safety and welfare regarding there being sufficient staff on duty to meet people’s needs and medicines management.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hillside on our website at www.cqc.org.uk

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 registered manager had recently left the service. A new manager had been appointed and commenced in post on 1 June 2017. They informed us that they were seeking registration with the Care Quality Commission.

Improvements had been made in how the service effectively calculated the numbers of staff required to ensure that people’s needs were met safely. Where shortfalls in staffing numbers had been identified the service had taken action to actively recruit more staff and in the short term use agency staff until this was addressed.

Improvements had been made in the systems in place to ensure that people were provided with their medicines safely. There were now effective organised systems in place for the safe handling of medicines. We have changed the rating for this key question to ‘good’ but the overall rating for the service remains as ‘requires improvement’.

Hillside provides a service for older people, some of whom are living with dementia. The service is based over two floors. At the time of the inspection there were 36 people living at the service and one person in hospital.

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 2014 and associated Regulations about how the service is run.

This was a comprehensive inspection to look at how the provider was meeting regulations relating to the fundamental standards of care and to check upon the implementation of the action plan supplied to the Care Quality Commission in response to our inspection of February 2016. At that inspection we rated the service as requires improvement.

At this inspection people and staff felt there were not always enough staff deployed in the service to meet people’s needs and medicines were not managed safely.

Safe recruitment procedures were followed to make sure staff were suitable to work with the people at the home and there were processes in place designed to safeguard people from abuse.

The staff records showed that supervision, appraisals and training were planned but not always well attended or carried out. Although there was a clear policy for the induction of new staff this was not being implemented effectively regarding ensuring they had effective support and training.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some people were assessed as lacking capacity to make decisions for themselves at this service. Staff were not always following best interests decision making processes when people were not able to make their own decisions.

People were complimentary about the food and were provided with enough to eat and drink. Choices of menu were offered each day. However, records of what people had eaten at lunchtime were not correct.

People had access to health care professionals but information about their visit was not always shared between staff in a timely way.

The planning of care for people included people’s physical, emotional, spiritual, mental, social and recreational needs. There was information about people’s likes and dislikes. However this was not always implemented effectively because the staff were busy with meeting physical needs rather than having time for other needs to be met.

Staff were kind and caring in their approach and had a good rapport with people. The atmosphere in the service on the day of our inspection was hectic when we arrived but became calmer during the day and particularly from the support and experience of the area manager talking with people using the service and staff.

There was a system for managing complaints about the service. People and their families were listened to and knew who to talk to if they were unhappy about any aspect of the service. The complaints policy had been followed to resolve complaints made.

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

Hillside provides a service for older people and some of whom have a diagnosis of Dementia. The service is over two floors. At the time of the inspection there were 37 people living at 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 2014 and associated Regulations about how the service is run.

This was a comprehensive inspection to look at how the provider was meeting regulations relating to the fundamental standards of care.

People and staff felt there were not always enough staff deployed in the service.

Although the service used a dependency tool, we did not consider that the needs of the people using the service were being accurately recorded, in particular more people were requiring high needs care that medium as recorded. The registered manager and area manager did re-assesses everyone using the service as a result of our inspection and did change four people from medium to high care, but this did not require according to the tool an increase in staff on duty. This meant that the service was understaffed.

Some people made complimentary comments about the service they received. People told us they felt safe and well looked after. Our own observations showed that the staff were very caring, however the records we looked at did not always match our observation and the positive descriptions people had given us.

The planning of care for people included people’s physical, emotional, spiritual, mental, social and recreational needs. There was information about people’s likes and dislikes.

Staff did not always feel well supported by the provider and the management team. The staff training records showed that not all staff had received necessary training to make sure they have the skills and knowledge required to care for all people’s specific needs. Refresher training had also not been provided in a timely way or staff felt that the e-learning training was not sufficient.

Staff supervision had not been arranged on a regular basis. However the manager did provide on the spot informal supervision and support to staff. A new supervision process was being set up so that the manager would not supervisor all staff and this would be appropriately delegated to other senior staff. The manager told us that each member of staff was to have an annual appraisal to assess their performance and any further training needs.

People were complimentary about the food and were provided with enough to eat and drink. Choices of menu were offered each day.

There was a system for managing complaints about the service. People and their families were listened to and knew who to talk to if they were unhappy about any aspect of the service. The complaints policy was on the notice board. We also found that complaints had been listened to and actioned.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some people were assessed as lacking capacity to make decisions for themselves at this service. Staff were supporting people following decisions they had made which were in their best interest. Not all staff felt confident in the training they had received training in the Mental Capacity Act 2015 or DoLS. The manager was knowledgeable in this area and had applied DoLS and Best Interest meetings appropriately.

Staff were kind and caring in their approach and had a good rapport with people. The atmosphere in the service on the day of our inspection was calm and relaxed. Some people did exhibit challenging behaviour on occasion due to their health condition and we saw that this was recorded and information provided in the care plan of what staff were to do in such circumstances. However talking with staff we drew the conclusion that they had not received sufficient training to deal with people’s behaviours and conditions or the training had not provided them with the depth of knowledge or confidence they were seeking.

Safe recruitment procedures were followed to make sure staff were suitable to work with the people at the home and there were processes in place designed to safeguard people from abuse.

People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and were complimentary about the care their relatives received.

During this inspection, we found a breach of regulation relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report

This is a summary of what we found;

Is the service safe?

When we arrived at the service the registered manager greeted us and noted our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs.

We reviewed training records regarding The Mental Capacity Act (MCA) 2005 in relation to Deprivation of Liberty Safeguards (DoLS) and found staff had received training. The CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Applications have been submitted and proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

There were systems in place to audit medication and care plans which ensured effective organisation in the delivery of care.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were reviewed monthly and updated appropriately which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring and professional manner. One person told us: 'I like the roasts on Sunday, the toad in the hole and the lasagne.'

Is the service responsive?

The views of the people who used the service and staff had been sought. The registered manager and deputy operated an open door style of management so they were available to people who used the service and staff to support and resolve issues.

The service had an effective complaints procedure in place. We examined five people's care records and noted that risk assessments were reviewed and updated in in response to events. This ensured people received safe and appropriate care.

Is the service well-led?

There were systems in place to assess and monitor the quality of the service provided. The manager visited each of the units when on duty and staff informed us that they were supportive and approachable. We inspected monitoring records of the care people received regarding fluid balance charts. We saw that the service had introduced a system which was checked by the respective senior staff throughout the day.

One person told us, 'The food is nicely cooked.' Another person said, 'The meat was tough but it has been better recently.'

We inspected six outcomes and found people's consent had been sought about how they wished their care to be provided. The care plans were up to date and the service had co-operated with other services to provide the assessed care people required. The premises had undergone a major refurbishment and update since our visit. There were sufficient staff on duty for the level of needs of the people that used the service. The quality of the service provision was monitored by a visiting area manager to support the registered manager of the service, which included some aspects of care planning and safeguarding arrangements. We also spoke with the activities co-ordinator and learned their hours had been increased to full-time and we saw the variety of activities available.

Since our last inspection the service has successfully de-registered as a nursing home and now provides residential care.

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