Hill Ash House Care Centre 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. Hill Ash House Care Centre accommodates 36 people in one adapted building in the village of Dymock. At the time of our inspection there were 22 people living at the home. Hill Ash House Care Centre does not provide nursing care

At the time of our inspection Hill Ash House Care Centre did not have a registered manager. A manager has been in post since August 2017 and they told us it was their intention to apply to be registered manager. They told us they had completed their DBS application with the CQC. However, at the time of the inspection they had not submitted their registered manager application. Action needed to be taken to ensure a registered manager was in post to support the provider to meet the requirements of their registration. At our previous inspection in November 2016 the service was rated Requires Improvement. At this inspection we found the service was rated Good.

We found improvements to the storage and the records relating to people’s medicines. We also found improvements to the use of the Mental Capacity Act (2005) and with systems to monitor the quality and risks in the home.

We found the environment of the care home was clean and had been well maintained. At the time of our inspection visit the care home was warm and had been decorated for the festive season.

People received support from caring staff who respected their privacy, dignity and the importance of independence. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People received personalised care and had opportunities to take part in activities both in their accommodation and in the wider community. People were supported to maintain contact with their relatives.

People were protected from harm and abuse through the knowledge of staff and management. Sufficient staffing levels were maintained and staff were supported through training and meetings to maintain their skills and knowledge to support people. There were arrangements in place for people and their representatives to raise concerns about the service.

The inspection took place on the 28 and 29 November 2016 and was unannounced.

Hill Ash House Care Centre is a care home for up to 36 people, located in the village of Dymock. At the time of our inspection there were 33 people living at the home.

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

Some aspects of the management of people’s medicines around storage and transcription checks were unsafe with no significant improvement since our inspection in June 2015.

Systems in place to check the quality of the service provided had falied to address the issues with medicines.

There was an inconsistent approach to assessing people's mental capacity in relation to decisions about their care.

Hill Ash House 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 2008 and associated Regulations about how the service is run.

We heard positive comments about the care home such as “Nothing I can find wrong” and “Very, very contented”.

People were protected from the risk of being cared for by unsuitable staff because robust recruitment practices were operated.

Sufficient staffing levels were maintained and staff were supported through training and supervision to maintain their skills and knowledge to care for people. Risks to people’s safety were identified, assessed and appropriate action taken.

People had positive relationships with the staff team. They were treated with respect and kindness and their privacy and dignity was upheld, they were supported to maintain their independence as much as possible. People took part in a range of activities.

Staff received support to develop knowledge and skills for their role and were positive about their work with people. The registered manager was accessible to people using the service and staff. Surveys had been used to gain the views of people and their relatives.

Hill Ash House is located within its own grounds in Dymock which were well maintained. On entering the home we found the atmosphere warm and welcoming. The home is in the process of having the bathrooms upgraded. We were informed of the provisions in place to accommodate people who live in the home with information provided on the notice board.

We noted that some people were unable to communicate with us and we observed staffs understanding of the care and support needed. We spoke with people who used the service and family members who said that “it’s lovely here, so calming.”

We looked at people’s individual files which incorporated their personal profile, care plans and risk assessments and found they encompassed the safety and well-being of people who used the service.

People who used the service told us that they know how to raise a concern or complaint and felt confident in doing. They said if they had any issues or concerns they could “talk to the manager.” There were policies and procedures in place providing guidance and all staff had received safeguarding training which was identified on the training matrix.

Staff told us they were supported by management and had received all relevant training. We saw staff had regular supervision and had received notification of an annual appraisal due in September. People who used the service, family, local visitors and staff were given the opportunity to give feedback regarding the running of the service.

We found that there had been improvements at the home since the last inspection. A new manager had been appointed in the summer of 2012. The manager and staff had, and were continuing to conduct a review of how the home operated. The manager had introduced a number of changes which had benefitted people using the service. We saw evidence of how the format used for care plans was being reviewed, so as to ensure that they reflected the care and treatment choices of people living at the service. People told us that: "staff were caring and I can’t fault them". People also told us that: " staff had taken to time speak with me and find out what I did and did not like".

The home had a full-time activities co-ordinator. People told us that:" they enjoyed most of the activities and had been asked what activities they enjoyed".

We looked at all of the communal and some of the individual rooms at the home. There was a programme of redecoration and refurbishment which was ongoing. Staff training records showed they had access to suitable health and safety and specialist training, to enable them to care and support people living at the service. During discussions with staff they demonstrated that they understood the needs, likes and dislikes of people living at the home.

The inspection took place on the 9 and 11 June 2015 and was unannounced.

Hill Ash House is a care home for up to 36 people, located in the village of Dymock. At the time of our inspection there were 27 people living at the home.

Hill Ash House 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 2008 and associated Regulations about how the service is run.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report

Some aspects of the management of people’s medicines around storage and transcription checks were unsafe.

People were not protected from the risk of being cared for by unsuitable staff because robust recruitment practices were not consistently operated.

People were supported by sufficient numbers of staff who received appropriate training and had the right knowledge and skills to carry out their role. People were protected from the risk of abuse by staff who understood safeguarding procedures.

People were supported by staff with the knowledge and skills to carry out their roles, including knowledge of the Mental Capacity Act 2005.

People received support from caring staff who respected their privacy, dignity and the importance of independence. People received personalised care and there were arrangements in place for people and their representatives to raise concerns about the service.

The manager was accessible and open to communication with people using the service and their representatives. Quality assurance checks on the service including the views of people using the service and stakeholders had been completed as a way of ensuring the quality of the service provided.