This inspection took place on 29 August 2018 and was unannounced.

Hill Barn provides, accommodation and personal care for up to 26 people, some who are living with dementia. At the time of this inspection 22 people were living in the home.

Hill Barn 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.

At our last inspection in April 2017, we found two breaches in regulation and rated the service as requires improvement. Not all areas of the building were sufficiently cleaned and this posed an increased risk of infection and some systems and processes to monitor the quality of the service were ineffective. After the comprehensive inspection, the provider wrote and told us what they would do to meet legal requirements in relation to the breaches. At this inspection, we found the service had made improvements under the questions is the service caring, responsive and well-led? The service is now rated as good.

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 2008 and associated Regulations about how the service is run.

People were safeguarded from the risk of harm. There were effective safeguarding procedures in place and staff had received safeguarding training.

There were sufficient numbers of staff deployed to meet people's needs. Safe recruitment practices were followed.

People were supported to eat a healthy and balanced diet to help maintain their wellbeing. People were assisted to access a range of healthcare professionals.

People were asked to consent to their care and support. The service operated within the principles of the Mental Capacity Act 2005 (MCA). Staff felt well supported and received training relevant to their roles.

People were comfortable and relaxed when engaging with staff and managers. Staff were positive about their work and the support provided. People were treated with dignity and respect.

Staff knew people they supported and provided a personalised service in a caring way. Care plans provided information to staff on how to meet people care needs. People were given opportunities to make choices about their daily lives. They were able to choose whether or not to participate in a range of activities within the service and received the support they needed to help them to do this.

The service had an open and inclusive culture and staff were positive about the support they received from staff and the registered manager.

Compliments were received about the service and complaints investigated, responded to and resolved where possible to the complainants’ satisfaction. The registered manager and their staff team worked together with other organisations to ensure people’s well-being.

Quality monitoring systems and processes were in place to help drive continual improvements. An action plan had been developed which recorded where action needed to be taken. Feedback was being sought to capture people views on the overall quality of the service.

Further information is in the detailed findings below.

The inspection took place on 5 and 6 April 2017 and was unannounced.

Hill Barn is registered to provide care for up to 26 people. At the time of the inspection 21 people were living at the home. The home supports older people, some of whom are living with long term conditions. The accommodation comprised of a series of refurbished barns and an extension over one floor, set in a large garden.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. For the purposes of this report we will refer to the registered manager as the manager.

At our last inspection in April 2016, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the safe care and treatment of people who were living at the home. We found issues with how people’s medicines were administered and stored. We found the medicine audits were not effective. We also found that staff had limited guidance about how to meet people’s needs.

At this inspection on 5 and 6 April 2017 we found improvements had been made in these areas, so the service was no longer in breach of this regulation for these reasons. However, at this inspection we found two new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of our report.

Some communal areas of the home were unclean and some staff used unsafe practice that increased the risk of the spread of infection. People’s medicines were kept secure however; people’s prescribed thickeners for drinks were not kept in a secure place. This was a risk to people’s safety.

The manager and provider did not always have robust quality monitoring systems in place. We found issues relating to the monitoring of the hygiene of the home, and how staff interacted with people who lived at Hill Barn. We also found issues with how staff and the manager protected people’s confidential information. The manager also did not have effective systems to monitor staff knowledge and practice.

Staff did not have enough time to spend chatting to people or to engage with them in a social way throughout the day. The manager had not considered ways to encourage social stimulation within the home. There were no real plans in place to ensure people’s individual social needs were going to be met. People had not been consulted with about their social needs with action taken to meet these needs.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service had made applications for authorisation to the local authority DoLS team. However, there was a lack of understanding around when a DoLS was required.

We have made a recommendation about the management of the home seeking advice and guidance about DoLS.

People received their medicines in a safe way. The administration of people’s medicines was audited and checked. The manager and staff were proactive in responding to a change in people’s health needs. The manager and staff knew about the risks which people faced and how to respond to these. The manager ensured that the equipment used was safe.

People spoke positively about the food and drinks they had. The chef had a good knowledge of people’s likes and dislikes and people’s specialist dietary needs. People also had good access to drinks and snacks.

People were supported to meet their spiritual needs and there were times when people were supported in a way which met their social and emotional needs.

Hill Barn provides accommodation and personal care for up to 26 older people including those living with dementia. Accommodation is located on one level. There were 21 people living in the home during this inspection.

This inspection was unannounced and took place on 21 April 2016.

The home did not have a registered manager in post. The previous registered manager left in December 2015. 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 and associated Regulations about how the service is run.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Some staff had yet to receive training in this subject and those spoken with during this inspection were able to demonstrate that they were aware of the principles of the MCA or DoLS and their obligations under this legislation.

Care plans did not contain all of the relevant information that staff required so that they knew how to meet people’s current needs. We could not be confident that people always received the care and support that they needed. Whilst risk had been identified detailed information on how to reduce the risk had not been recorded.

The provider had a recruitment process in place and staff were only employed within the home after all essential safety checks had been satisfactorily completed.

People’s privacy was respected at all times. Staff knocked on people’s bedroom door and waited for a response before entering.

People were provided with a varied and balanced diet. Staff referred people appropriately to healthcare professionals. People received their prescribed medicines in a timely manner. Although medicines were not always stored in a safe way.

The provider had a complaints process in place and people were confident that all complaints would be addressed.

The provider did not have effective quality assurance systems in place to identify areas for improvement. Therefore, they were not able to fully demonstrate how improvements were identified and acted upon.

We found two 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.

We considered all of the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:-

Is the service safe?

People living in the home told us that they felt safe. The environment was safe, clean and hygienic. Equipment used at the home was well maintained and had been regularly serviced. There were enough care staff on duty to meet the needs of the people living at the home. However, a member of the cleaning staff team had to work in the kitchen due to staff absence. This meant that there were less people carrying out cleaning duties, for part of the day.

Staff personnel records contained all of the information required by the Health and Social Care Act. The provider demonstrated that they employed staff members that were suitable and had the skills and experience needed to support people living in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) that applies to care homes. The provider showed us that, when necessary, (DoLs) applications had been made. Records, policies and procedures were held and relevant staff had been trained and knew how to submit an application.

Is the service effective?

People told us they received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that staff understood the care and support needs of each person. One person told us. “This is a lovely, comfortable home and the staff will do anything to help you. You only have to ask.” Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that care workers were patient and encouraged people to be as independent as possible. People told us that the staff were often very busy but did not rush them. Our observations confirmed this. A visitor told us. “I am so happy with the care given to my relative. The members of staff are so polite and respectful, even when the people living here are agitated. Wonderful place and staff.”

Is the service responsive?

Care and risk assessments had been completed before people moved into the home and when their needs had changed. A record was held of their preferences, interests and diverse needs. People told us that staff members consulted them and encouraged them to make their own decisions. People had access to planned activities on four days a week. One person told us. “I am sometimes bored if there are no activities.” The provider demonstrated that they were currently arranging for a staff member to organise and increase the activities provided.

Is the service well led?

All of the staff spoken with had a good understanding of the whistleblowing policy. Quality assurance processes were in place and people told us they had just completed a customer satisfaction survey. Most visitors and all staff said they had felt listened to when they made a suggestion or raised their concerns. People living in the home told us that their views were listened to and they were included in discussions about any planned changes within the home.

We spoke with 10 people who told us that they were cared for appropriately. One person said, "I have no complaints about the care or staff who work here." A second person commented, "I have everything I want to hand. I go out when I want and get the support from staff when I need it." Nearly all of the people spoken with had lived in this home for a number of years and told us they were content with their lives. Another person using this service stated “Sometimes we have to wait when we buzz for help but we understand if they are helping someone else we have to wait."

As part of this inspection we looked at the management of medication. We observed medication being administered, looked at the storage of the medication and checked the procedures for controlled medication. We found that medication was stored, administered and recorded safely ensuring people were supported correctly with their medication.

The staffing levels within this home supported the needs of the people who lived there. We noted the numbers of staff on duty, discussed with them their training and knowledge and people who received the service told us their needs were met by a competent staff team.

Concerns and complaints were dealt with appropriately when they arose. The majority of the people that we spoke with were content and did not have any concerns. There was a complaints procedure that could be used and was available to all the people who lived in the home if and when required.

The eight people we spoke with who were living in this home all gave us positive comments about the care and support offered. Many of them had lived in this home for three years or more and were able to give us a full picture of the way they were supported.

They told us how the staff were kind and courteous. They said their skills and experience ensured they were looked after appropriately. Comments such as “I feel safe” and “I cannot fault the staff in any way, they know exactly what to do,” were just some of the positive remarks received.

We were told how they interact with staff and management through meetings or on a one to one basis to express their preferences and how decisions were made over the day to day running of the home such as menu planning and activities.

They said the home was comfortable and how much they liked their bedrooms. We were told that the bedrooms were decorated and new carpets were fitted when anyone new was moving in.

People told us that they were pleased to be able to have their belongings around them and they felt this helped to make their rooms more homely. “I’ve got my own things around me.”

People said that the staff were “kind” and helped them when they needed it. One said, “There’s not a one of them wouldn’t do you a good turn.”

People were satisfied with the quality and choice of food. They said that, “What I have I enjoy.” Another said, “The food is very good.”