Hill Grove is registered to provide accommodation and personal care for up to 20 people, some of whom live with dementia. The service is located in the small Norfolk village of Cringleford. When we visited there were 15 people living at the service.

This unannounced inspection took place on 26 October 2016.

A registered manager was in post when we inspected the home. 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.

At the last inspection of 05 May 2016 the service was rated ‘Good’. At this inspection the service remained ‘Good’ and met all relevant fundamental standards.

We brought forward this inspection due to concerns of which we became aware. Those were that people were being got up very early in the morning and had not given their consent for this. Also there was concern about the moving and handling techniques used at the service and the care and management of a person’s catheter.

At this inspection people that we up at 07.30a.m. had given their consent. We found that all staff had been trained in moving and handling when they joined the service and had completed refresher training on a yearly basis. Staff were knowledgeable about the equipment in the service, how it was to be used safely and for those people that needed assistance how this was to be achieved. This was reflected accurately in people’s care plans and we saw staff moving people during the inspection with courtesy and safely.

Staff were aware of what to do should there be any problems observed with catheters and this was recorded in the person’s risk assessment. Changing of the catheter was planned by the district nursing staff and the service staff were aware that should they have any concerns they could call upon the district nursing staff at any time.

Each person had their own written risk assessment and related care plan to inform staff how to support people to meet their need. Staff had received training in safeguarding people and knew how to make referrals should the need arise.

Staffing levels were appropriate to support people meet their individual assessed need. There was a robust recruitment process for employing staff appropriately to care for vulnerable people. Processes and procedures were in place to receive, record, store and administer of medicines safely. There were individual protocols for the administration medicines.

Staff received supervision, training and a yearly appraisal.

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 encouraged people to eat sufficiently and have drinks of their choice. A range of healthcare professionals visited the service as requested by the staff to support them and the people to meet their needs.

People were supported by staff to make day to day decisions about their care and act upon their choices. This included the time they got up and went to bed. People’s dignity and privacy was respected by the staff. Care was delivered in an understanding and empathic way to meet people’s needs.

There was a care plan in place for each person which was based on an individual needs assessments and took into account people’s preferences. The care plans were reviewed regularly to remain relevant and up to date. People were encouraged to engage with a variety of activities. Complaints were recorded and acted upon and compliments had also been recorded.

There were systems in operation designed to ensure the service was managed effectively and to monitor the quality of the service provided.

Further information is in the detailed findings below.

Hill Grove is registered to provide accommodation and personal care for up to 20 people, some of whom live with dementia. The home, which is on one level, is located in a small Norwich village of Cringleford. When we visited there were 17 people living at the home.

The unannounced inspection took place on 5 May 2016.

A registered manager was in post when we inspected the home. 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.

People were safe living at the home as staff were knowledgeable about reporting any harm. There were a sufficient number of staff employed and recruitment procedures ensured that only suitable staff were employed. Arrangements were in place to ensure that people were protected with the safe management of their medicines.

The CQC is required by law to monitor MCA and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA so that people had their rights protected by the law. Assessments were in place to determine if people had the capacity to make decisions in relation to their care. When people were assessed to lack capacity, their care was provided in their best interests.

Staff were supported and trained to do their job and demonstrated how their training was applied to their practice.

People were supported to access a range of health care professionals. Health risk assessments were in place to ensure that people were supported to maintain their health. People were provided with adequate amounts of food and drink to meet their individual likes and nutritional and hydration needs.

People's privacy and dignity were respected and their care was provided in a caring and attentive way.

People's hobbies and interests had been identified and a range of activities supported people with these.

People's care records and risk assessments were kept up-to-date. A complaints procedure was in place and this was followed by staff. People knew who they would speak with if they needed to raise a complaint. Complaints were responded to the satisfaction of the complainant.

The provider had quality assurance processes and procedures in place to improve the quality and safety of people's support and care.

One adult social care inspector inspected Hill Grove. At the time of the inspection there were 18 people using the service.

We spoke with one of the providers, the operational manager, the registered manager and three care staff. We also spoke with seven people who used the service and three people’s relatives. We reviewed the care records for three people. We also reviewed a selection of other records including staff rotas, audits and the provider’s policies and procedures.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) monitors the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted at the time of our inspection, policies and procedures were in place in case an application was necessary. We saw evidence that the provider had acted in accordance with the law in relation to the Mental Capacity Act (MCA), 2005, and the DoLS. People who used the service had received appropriate mental capacity assessments and a number of ‘best interest’ decisions were recorded.

The people we spoke with told us that they felt safe living in Hill Grove. We saw evidence that there were effective arrangements for reporting safety incidents. The manager showed us how accidents and incidents were audited and action plans were put in place to help reduce the risk of further occurrences.

Risk assessments had been completed for people and were reviewed on a monthly basis. The purpose of these was to minimise the risks to people in relation to their needs. Examples of this included people’s risks in relation to malnutrition and pressure area care. This helped to ensure people’s safety and welfare.

There were systems in place to reduce the risk and spread of infection. Hygiene and cleanliness were monitored on a daily basis.

There were enough qualified, skilled and experienced staff to meet people’s needs all of the time. All of the people we spoke with said that they were attended to in a timely manner and never rushed.

The manager showed us the audit schedule for the service. This tested the reliability of systems, processes and operating procedures. Environmental audits had been undertaken. These were not always effective in ensuring people’s safety. Two radiators that were not guarded. This meant there was a risk that people could suffer burns. We found that there were gaps in records in relation to the recording of the temperatures for the fridge and freezers. We also found that the provider’s policy in relation to the Control of Substance Hazardous to Health (COSHH) regulations, 2002, was not always followed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service.

The provider had effective arrangements in place to manage and mitigate foreseeable emergencies. These included procedures in relation to fire, flood and loss of utilities. The provider had a mutual aid agreement with their sister home for the safe evacuation of people if this was necessary.

There were procedures in place to gain people's views and people felt that any concerns they raised were acknowledged and acted upon.

Is the service effective?

All of the people we spoke with told us that they were satisfied with the care and support they received. We spoke with seven people who used the service and they all told us that they were happy living in Hill Grove. One person said, “I am happy here thank you. The staff are nice.” Another person said, “I am enjoying the music. There is enough to do here and I feel well cared for. I have no complaints and feel safe. The food is good.” A third person said, “All my needs are attended to. The care here is wonderful.”

People’s needs were assessed, and care and support was planned and delivered in order to meet their needs. We saw evidence that the care and support given, was effective in meeting people’s needs. Nationally recognised screening tools were used to assist staff to determine if people were at risk of malnutrition or pressure ulcers. The care and support delivered by staff reflected what had been documented in people’s care plans. People’s records and risk assessments were regularly reviewed and included any changes in their needs.

During the review of four people’s care plans we saw evidence that the provider worked closely with other health professionals. These included speech and language therapists, dieticians, continence advisors and district nurses. This meant that people received care from a multidisciplinary team that helped to address all of their needs.

Is the service caring?

We spoke with seven people who used the service and three people’s relatives and everyone said that the staff were kind and compassionate. One person said, “The staff are lovely to me. They are so kind. It’s a lovely place to live.” People told us that they felt well supported and well-cared for. They said that besides staff attending to their personal needs, they spent time sitting chatting with them and encouraged them to undertake the activities that they enjoyed doing.

Throughout our inspection we observed staff treating people with respect and dignity at all times. It was evident that staff knew the needs of people well. Staff were kind towards people and demonstrated a caring attitude. We observed staff behaving in a friendly and positive manner towards people’s relatives who visited the home. The staff were available to discuss any issues that the relatives might have had.

Is the service responsive?

People’s care plans responded to and reflected all of their needs. These included their health needs, their needs in relation to their activities of daily living and their social and emotional needs. There were plans in place to instruct staff what they should to respond to any deterioration in people’s health. We saw that these had been effectively followed.

People living with dementia received care and support that was relevant and individualised. Staff had a good awareness of dementia. We saw staff reminiscing with people and encouraging them talk about their lives and interests. There were numerous activities that people could join in with at the home. Everyone we spoke with said that they enjoyed the different things that they could do.

People and their relatives knew how to complain and who to speak with if they had any concerns or issues. It was evident that the provider took account of complaints and comments to improve the service.

Is the service well-led?

The service was well-led. All of the people we spoke with who used the service and their relatives spoke positively about the management of Hill Grove. The staff told us that they felt well supported and were encouraged to voice any issues or concerns. One care worker said, “I feel confident to raise things. I feel listened to by the manager and the manager acts on any concerns.”

The service has a system in place for monitoring the quality of the service. This included audits in relation to care plans, medicines management, the reporting of accidents and incidents and environmental audits.

We found that there were detailed assessments and care plans for the four people whose records we reviewed. People received care in line with what was care planned, with the exception of one person who did not always receive the repositioning they needed to maintain their skin integrity. One person we spoke with told us, "Well, we're very well looked after." One other person using the service told us, "I can't complain about anything here."

We found that people were protected from the risks of malnutrition or dehydration, because the service provided people with suitably nutritious food and drink. People had a good choice of food and drink and were supported to maintain a healthy diet.

We found that there were enough suitably qualified, experienced and skilled staff on shift to meet people's needs. We observed staff having time to sit with people on a one to one basis and meet their social needs. Staff we spoke with told us they felt the staffing level was appropriate and they did not struggle to meet people's needs. People were very complimentary about the staff at Hill Grove. One person told us, "Nothing is too much trouble." Another person told us, "They can't do enough for you."

We found that there was an appropriate complaints policy and procedure in place, and two complaints had been investigated fully and in line with this policy.

We found that appropriate records were kept by the service for staff and people using the service. These were kept securely.

People living in Hill Grove were treated with respect and their dignity was preserved. We heard and observed conversations that were encouraging, polite and offering choices. We saw people had their needs assessed, care plans were constructed and reviewed and any risks were identified and acted upon to reduce or remove the risks.

The support offered to people living in the home was carried out safely by staff who understood and had received training in the protection of vulnerable adults. Recruitment procedures ensured the correct staff were employed to work with vulnerable people.

Induction, training and ongoing support enabled the staff to carry out their roles correctly with the opportunity to develop their skills as they continued to work in this home.

All people involved with this home had the opportunity to comment on the quality of the service. Any comments or complaints would be acted upon and dealt with quickly. All the comments we received were positive such as, "I am always asked what I would like to do and where I would like to sit. The staff are so kind." "The staff are always attentive and polite. I have no concerns."