This inspection was undertaken on 26, 28 and 30 November 2018. The first two dates were unannounced which means the provider did not know we were coming. The final visit was announced. At our last inspection in October 2017 we rated the service as Requires Improvement overall.

Gold Hill 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.

Gold Hill accommodates up 40 people in an adapted property. There were 25 people living at the home at the time of the inspection.

The provider did not have a registered manager in place. A new manager had commenced working at the home seven weeks prior to our inspection. The manager had made an application to the Care Quality Commission (CQC) to become registered. 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 of the service on 25 and 26 October 2017 the service was rated as ‘Requires Improvement’ overall. The key questions Safe and Well led were rated as Requires Improvement. On this inspection we found improvements had taken place in the areas identified on the previous inspection. However, we identified other areas requiring improvement. Therefore, the rating remains as ‘Requires Improvement.’

Since our previous inspection improvements have taken place regarding infection control procedures and the cleanliness of the home.

The provider had not ensured all statutory notifications were sent to the Care Quality Commission in a timely way. The provider had failed to notify us of Deprivation of Liberty Safeguarding authorisations as they are required to do by law.

People were cared for by the staff who had knowledge of how to keep people safe and what to do if they believed people to be at risk. People’s wishes were taken into account to ensure people’s preferred life styles were met.

People were supported to have their medicines and checks were undertaken to ensure these were administered as prescribed. Healthcare professionals were consulted and involved in people’s care as needed to maintain their wellbeing.

People’s needs were assessed before they moved into the home and these were reviewed as to ensure they could be met. Staff ensured people had enough to eat and encouraged people to drink. Most people were complimentary about the food provided.

Staff received the training they needed to provide the care and support people required to keep them safe and maintain their wellbeing.

People were supported to have maximum choice about their lives and were supported in the least restrictive way possible. Staff spent time with people talking about important things in their life and had developed a caring relationship. People were encouraged to make decisions about their day to day life. People’s privacy and dignity was respected.

People were encouraged to take part in fun and interesting things while at the home. People were confident their views would be acted upon.

The provider and manager were working to make improvements in the home in areas such as refurbishment and decoration of the home environment and the heating facilities.

People who lived at the home as well as relatives felt able to approach the manager at any time. The manager was responsive during our inspection and gave assurances of their determination to make improvements including those needed to remedy shortfalls identified as part of the inspection. They had an ambition to achieve an outstanding rating to benefit people who lived at the home.

Full information about CQC's regulatory response to the more ser

The inspection took place on the 25 and 26 October 2017 and was unannounced.

Gold Hill provides accommodation, and personal care for a maximum of 40 older people. On the day of our inspection there were 27 people living at the home. Bedrooms, toilets and bathrooms were situated over four floors with stairs and a passenger lift providing access to all floors.

There was a new manager at this home who was in the process of applying to be registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 our last inspection in April 2017 we found the provider needed to improve how they supported people in a safe way and how they ensured people received person centred care. We also found the provider did not have effective arrangements in place to monitor and improve the quality and safety and welfare of people using the service. This was a breach in Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to tell us how they were going to make these improvements.

At this inspection we found improvements had been made however these had not been fully completed or sustained.

We found some areas of the home were not suitably clean. For example the kitchenette used for food preparation by staff and people living at the home was not regularly deep cleaned. We saw areas needed cleaning to ensure people were not put at risk of infection. The new manager responded straight away and took appropriate action to ensure improvements were made and implemented regular checks to sustain an improved environment.

People told us they felt safe because staff knew them well and were available when they needed them. Staff understood how to recognise potential abuse and where they needed to report any concerns to. People had risks to their wellbeing identified and staff knew how manage these risks to people’s safety. People told us there were sufficient staff to meet their needs. The provider used safe systems to recruit new staff. People’s medicines were stored securely and administered as prescribed. Staff had been trained and observed safe practice when administering medicines.

People told us they enjoyed the food and were offered healthy choices. We saw people were offered visual prompts to support their decisions about their meal choices. Staff adapted how they communicated with people to ensure they understood the choices they were offered.

People were asked their permission before they were supported and their wishes respected. Where people needed support with some decisions the new manager involved appropriate people who had the person’s best interests at heart. The new manager had regular meetings to ensure they maintained an over view to identify and changes in people’s needs.

People and their relatives were assured that health and social care professionals were involved when they were needed. The district nurse we spoke with said appropriate referrals were made and staff followed their guidance.

People had caring relationships with staff, and they knew each other well. People enjoyed the company of other people living at the home and staff supported them to do this. Opportunities for people to follow their own interests and social activities had increased, however this was still under development by the management team.

People had their individual needs met, and staff responded to changes in their care needs appropriately. People felt they were listened to and the management team had made improvements. Relatives were confident to report concerns and felt they were actioned appropriately. There were systems in place to manage people’s concerns and complaints and we s

The inspection took place on the 5 and 7 April 2017 and was unannounced.

Gold Hill provides accommodation, and personal care for a maximum of 40 older people. On the day of our inspection there were 29 people living at the home. Bedrooms, toilets and bathrooms were situated over four floors with stairs and a passenger lift providing access to all floors.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 our last inspection in April 2016, we found the provider needed to establish quality assurance systems to ensure people received a quality service. At this inspection we found further improvement was necessary.

The provider’s systems to avoid preventable accidents for people were not consistently effective. We saw staff practices were inconsistent when identifying preventable accidents.

People told us they felt safe because they felt staff knew them well and were available when they needed them. Staff understood how to recognise potential abuse and where they needed to report any concerns to. People had some risks to their wellbeing identified and staff knew how manage these risks to people’s safety. We saw when specialist equipment was needed to support a person’s mobility it was available to staff and they had been trained to use it. We saw there were plans in place to guide staff with these risks. People’s medicines were stored securely and administered as prescribed. Staff had been trained and observed safe practice when administering medicines.

People enjoyed the food they ate and told us they were consulted about changes with the menu. We saw people were offered visual prompts to support their decisions about their meal choices. Staff adapted how they communicated with people to ensure they understood the choices they were offered.

People were asked before they were supported and their wishes respected. Where people needed support with some decisions the registered manager involved appropriate people who knew had the person’s best interests at heart. The registered manager had a plan to increase care staff understanding of how people’s rights needed to be upheld and this would support her to monitor people’s capacity to make decisions effectively.

People and their relatives were assured that health and social care professionals were involved when they were needed. The nurse practitioner we spoke with told us staff made appropriate referrals to support people’s well-being.

People had caring relationships with staff, and they knew each other well. However staffing arrangements and lack of leadership had impacted on how people were supported to spend their day. Opportunities for people to follow their own interests and social activities were limited and often cancelled because of a lack of commitment to meet these needs.

The provider had not ensured everyone living at the home had hot water when they needed it. Some people had to wait for over 20 minutes before the water in their rooms ran hot. The provider was aware of this concern and had made some improvements, however some people continued to be delayed with having their needs met.

People felt they were listened to and the registered manager ‘tried hard’ to make improvements. Relatives were confident to report concerns and felt they were actioned appropriately. However sometimes the concerns returned and needed to be dealt with again. There were systems in place to manage people’s concerns and complaints and we saw these were completed and outcomes shared with staff.

People were regularly asked for their views about how the service could be improved, they told us they were happy at the home and staff tried

Gold Hill provides accommodation, and personal care for a maximum of 40 older people. On the day of our inspection there were 27 people living at the home.

The inspection took place on the 12 and 13 April 2016 was unannounced. At our last inspection on 29 July 2015 we asked the provider to take action to make improvements to protect people who lived at the home. The provider was not meeting three of the Regulations of the Health and Social Care Act 2008 (RA) regulations 2014. Care staff were not putting training into practice to ensure the safe care and treatment of people living at the home. The provider did not have sufficient numbers of suitable staff deployed effectively to meet people’s needs, and did not have effective arrangements in place to monitor and improve quality. Following this inspection the provider sent us an action plan to tell us what improvements they were going to make. At this inspection we saw that the actions required had been completed and these regulations were now met. However the systems for monitoring and improving the quality of care provision were not established at the time of our inspection therefore we were unable to see if the improvements could be sustained.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 who lived at the home and their relatives said they felt safe and staff treated them well. Relatives told us their family member was safe. Staff we spoke with understood how to support people in a safe way and to monitor identified risks.. They explained how they kept people safe from potential abuse, and systems were in place to guide them in reporting these concerns.

Staff were trained and there was an on-going program to keep training updated. The registered manager had implemented a system for monitoring staff competencies to ensure they delivered effective care. Staff were knowledgeable about how to manage people’s individual risks. The registered manager was monitoring staffing levels and reviewing people’s dependency levels, to ensure there were consistently sufficient suitable staff available. People were protected against the risks associated with medicines because the registered manager was embedding appropriate arrangements to monitor the management of medicines.

People were supported to make their own choices, and where possible involved in making decisions about their care. People received support with their decisions when they needed to. Applications had been submitted to the local authority for the people living at the home where their liberty was restricted, to ensure care was delivered in the least restrictive way. We saw staff treated people with dignity and respect whilst supporting their needs. People were supported with a balanced and healthy diet. People and their relatives told us they enjoyed the food. People were supported to eat and drink well. They had access to health care professionals when they were needed.

People were able to see their friends and relatives as they wanted. People had access to private areas at the home to see their visitors in privacy if they wanted to. People and relatives knew how to raise complaints and the provider had arrangements in place so that people were listened to and action taken to make any necessary improvements. People who lived at the home and staff were involved in regular meetings and one to one’s.

The registered manager was working with support from an external consultant to embed systems to drive up standards of care provision at the home. The registered manager was continuing to review and monitor care provision. However systems recently implemented were st

Gold Hill provides accommodation, and personal care for a maximum of 40 older people. On the day of our inspection there were 26 people living at the home.

The inspection took place on the 30 and 31July 2015 and was unannounced. At our last inspection in July 2013 we found the provider was meeting the all the regulations focussed on.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 who lived at the home and their relatives said they felt safe and staff treated them well. Relatives told us staff were kind and caring and thoughtful towards people. Staff we spoke with understood they had responsibility to take action to reduce the risk of harm for people. They demonstrated awareness and recognition of abuse and systems were in place to guide them in reporting these.

Staff had not always received effective training, and were not always monitored and their competency tested. Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. We saw the manager had a system to ensure there were enough staff on duty, however people and their relatives told us there were not always enough staff to respond in a timely way.

People were not always protected against the risks associated with medicines because the registered manager did not have appropriate arrangements in place to monitor the management of medicines.

People’s preferences were taken into account and respected. We saw staff treated people with dignity and respect whilst supporting their needs.

People’s ability to make specific decisions had been assessed. Applications had been submitted to the supervisory body for the people living at the home where their liberty was restricted. This was to ensure that any decision to restrict somebody’s liberty was only made by people who had suitable authority to do so.

People received a healthy diet. There was a relaxed atmosphere at meal times and people and their relatives told us they enjoyed the food. People were supported to eat and drink well and had access to health care professionals. People did not always receive support from professionals in a timely way.

People were able to see their friends and relatives as they wanted. There were no restrictions on when people could visit the home. All the visitors we spoke with told us they were made welcome by the staff in the home.

People and relatives knew how to raise complaints and the provider had arrangements in place so that people were listened to and action taken to make any necessary improvements. However these improvements were not always monitored to ensure they were effective.

People’s and staff views and concerns were not always acted upon or monitored effectively to improve service provision. People who lived at the home and staff were involved in regular meetings and one to one’s. There were concerns identified but full improvements had not been completed and some concerns found during the inspection had not been fully identified.

Although the provider had systems were in place to monitor and improve the quality of the service, these systems did not always identify short falls. For example in cleaning regimes and effective training. People were not always supported by staff who were confident to put into practice the training they received. People did not always benefit from an environment that was clean.

You can see what action we told the provider to take at the back of the report.

We spoke with five people who used the service. We also spoke with the deputy manager, the provider, two staff, and a social worker.

People expressed their views on how they wanted to maintain their independence. One person we spoke with said: “I prefer to stay in my room, but that’s my choice”. Staff that we spoke with told us they supported people in their choice and they promoted people's privacy and dignity.

People were complimentary about their home and the care and support they received. One person told us: “The staff look after me”. Another person told us: "I can't find any faults with them. I am lucky".

Staff knew about the needs of the people they were caring for. We looked at care plans for three people and found that these contained guidance for staff on how to meet people's needs. We saw that people’s care plans were reviewed regularly.

People told us that they felt safe living at the home and knew who to speak to if they had any concerns. Staff had received training on how to recognise signs of abuse and knew how to report concerns.

People were supported and cared for in an environment that was safe, secure and clean. We saw the provider had carried out improvements to the home and further improvements were planned to be completed.

We looked at audit records which showed that the provider was regularly monitoring the quality of its service.