About the service: Hill House is a residential care home that provides accommodation and personal care for up to 13 people who have a learning disability or autism. At the time of our inspection, there were 12 people living at Hill House.

People’s experience of using this service:

•People told us that they were happy living at Hill House.

•Staff were kind and caring and encouraged people to be as independent as possible.

•People were protected from the risk of harm and abuse by a team of trained staff who knew people’s needs well.

•Risks were planned for and managed well. The service encouraged positive risk taking.

•People received their medication on time and in a safe way.

•People had access to healthcare.

•Assessments and care plans were personalised and detailed. Staff used People’s care records to guide them to care for people in an person-centred way.

•Staff had a good working knowledge of the Mental capacity Act and it’s principles.

•The service worked well with other agencies and organisations to ensure people received the right level of care and support.

•People and relatives knew how to make a complaint.

•The registered manager had made significant improvements throughout the home to provide effective outcomes for people.

Rating at last inspection: At the last inspection, the service was rated as Requires Improvement. (Last inspection report published 31 October 2017) At this inspection we found that improvements had been made and the service now meets the characteristics of Good in all areas.

Why we inspected: This was a planned inspection based on the date and the rating of the last inspection.

Follow up: We will continue to monitor the service through information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 26 and 27 July 2017 and was unannounced. During our last inspection in November 2016, we identified five breaches of legal requirements relating to people’s care at the home. This was because people were not treated with dignity and respect or in line with their consent and consideration of their choices. People’s needs and risks were not always met and managed safely, and staff had not been provided with the guidance and direction needed to help do so. Systems to monitor and ensure the quality and safety of the service had not been robust. Our concerns at our last inspection led to a rating of ‘Inadequate’ in three out of five key questions and a rating of ‘Requires Improvement’ in two key questions.

Following our last inspection, we met with the registered provider and they assured us that the identified concerns would be addressed. The registered provider sent us a written action plan outlining how they intended to address and meet the breaches of regulations. A new manager joined the service in January 2017 and had registered in May 2017. At this inspection, we identified improved practice at the home and found that the previous breaches had been met, although further improvements were required. These improvements had been identified and were being addressed through systems in place at the home.

At the time of our inspection, Hill House was registered as a care home with nursing for up to 13 people who have a learning disability or autism and eight people were living at the home.

The registered manager of the home was present throughout 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. People, staff and healthcare professionals we spoke with described the home and impact of the new registered manager positively.

People showed that they felt safe at the home and in the company of staff. Staff showed awareness of types of abuse that people could experience. Staff were confident they could approach the registered manager with any safeguarding concerns and that their concerns would be addressed. There were enough staff available who had been suitably recruited to help protect people living at the home.

Incidents were investigated and people’s support needs reviewed to help reduce risks. Risk assessments and staff knowledge required further development in some areas to further promote people’s safety. Health and safety audits were in place and routine maintenance checks had been introduced. Medicines management was safe and further identified areas of improvement were being addressed.

People were supported by staff who showed understanding of their needs and wishes and how to help meet these. Further guidance and training was planned to develop staff knowledge of people’s needs and to help build on the improved practice we observed.

People were supported to make choices and their consent sought and improvements had been made to ensure adherence with the requirements of the MCA. Further progress was required around staff understanding of the MCA to help build on the improved practice we observed.

People were offered choices around their meals and told us they enjoyed food at the home. Further improvements were required to help ensure all people’s dietary and hydration needs were always met. People were supported to have their care needs and health monitored with the support of additional health and social care professionals.

Improvements had been made in ensuring people were treated with respect and dignity. People often had a positive rapport with staff and showed they were comfortable and at ease at the home. People were being supported to make decisions about their care and we saw that plans

This inspection took place on 15 November 2016 and was unannounced. During our last inspection of this service in April 2016, we identified a breach of one legal requirement. This was because systems in place were not effective to monitor and improve the quality and safety of the service that people received. During this inspection, we found that this had not improved.

The home is registered to provide personal care and accommodation for up to 13 people who have a learning disability or autism. At the time of our inspection, ten people were living at the home.

The registered manager had left the service in October 2016 and a new manager had joined the service and was in the process of completing their application to register. 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 could not be confident that they would always be kept safe at the home. People were not always protected by safe practices or effective risk management at the home. Appropriate action was not taken to prevent future incidents occurring at the home where people and staff had been put at risk of harm. People could not be confident that they would be supported to use safe equipment or that they would be protected by safe infection control practices.

People were not always supported to receive their medicines as prescribed or to ensure that the correct amounts of medicines were available to keep them well. People were not always supported by staff with the right mix of skills and knowledge to meet their needs.

People were not supported in line with the principles of the Mental Capacity Act (2005). People’s consent was not always sought and some people were stopped from moving freely or as they wished around the home. Concerns were not resolved by the manager and some staff had not received training or guidance in relation to the Mental Capacity Act (2005).

Some staff we spoke with demonstrated an understanding of people’s needs, however we saw that this knowledge was not always applied in practice. Staff had not been equipped with specific training by the registered provider in relation to people’s needs. Staff practice was not led or overseen by the manager or informed by clear guidance.

People were not always supported to eat enough or to maintain a balanced diet to stay healthy. Care had not been taken to plan people’s mealtimes so that people’s preferences were met in terms of how they were offered choices and ensuring that mealtimes were a positive experience. People could not be confident that they would always be supported to access healthcare support or monitor their ongoing health needs as required to stay well.

Whilst we observed some positive interactions from staff towards people living at the home, this was not consistent practice. Planned action was not taken to meet people’s communication needs and staff failed to always address people directly or involve people in their care. Care had not been taken to ensure that people resided in a safe and comfortable environment, we were informed that this was being addressed. Staff failed to promote people’s dignity at all times.

People did not always receive care that was responsive to their needs or in line with their care plans. People were not always supported to participate in activities of interest to them. An activity coordinator had recently been recruited and provided examples of how they had supported some people with activities. We saw that people responded positively to the activity coordinator’s encouragement and support.

Relatives we spoke with told us they felt comfortable raising concerns and most relatives told us they felt that the manager would act on concerns to improve the service. A heal

We inspected this home on 27 April 2016. The visit was unannounced. The home is registered to provide personal care and accommodation for up to 13 people who have a learning disability or autism. At the time of our inspection 3 people were living at the home. There was a registered manager at this location. 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 and associated Regulations about how the service is run.

The service was last inspected in 13 July 2013, and was meeting the regulations. Since that time the provider has undertaken significant changes to the property, to the people they support, and the type of service they provide. The registered provider made the necessary application to CQC to enable them to do this. Although a care service had operated from this address for many years, the service offered, people accommodated and the management team had significantly changed since our last inspection. The service was very new, and still under development.

Staff had been provided with training about the Mental Capacity Act 2005 (MCA). However the staff we spoke with were not all sure how this act applied to their work. Where it had been identified that people had been restricted of their liberty applications to the local supervisory body had been made.

People we spoke with told us they felt safe living at Hill House and our observations showed people felt happy and relaxed in the home and with the staff who were supporting them. Staff were not aware of all the actions they needed to take to ensure people stayed safe. Risks people experienced had not all been well assessed or planned for.

People could not be certain they would always receive their medicines safely and as the Doctor had prescribed.

There were enough staff on duty. Staff had been provided with training to ensure they had the competencies required to meet the needs of the people living at the home.

People were supported to attend a wide range of health appointments. This helped to maintain their physical and psychological well-being.

People told us they enjoyed the food provided and we observed people receiving the help they needed with eating and drinking.

Everyone we spoke with told us, and we observed that staff worked with kindness and compassion. The staff provided people with the support and reassurance they required to help them stay calm and to feel settled.

People had not been supported to make plans for their life or to regularly undertake activities that were of importance and interest to them.

The registered provider sought feedback from people, and had used this to further improve and develop the service.

The registered manager was aware of his responsibilities and people we spoke with told us he was approachable.

On the day of our unannounced visit 11 people were living at this care home. We spoke with most of the people who lived there, four of their relatives and four members of care staff.

People were complimentary about the care staff who supported them. Comments included, “I like it here” and “I’m ok thanks.”

We spoke to relatives of people who lived at the home about the care and support being provided. Comments received included, “They take my relative out to the Mandir (Hindu temple) as well” and “The service is actually very good.”

From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support. We examined care plans and found that people’s needs were properly assessed and that care was planned and delivered in line with individual care plans.

We found that people who use the service were protected from the risk of abuse, as the provider had taken reasonable steps to prevent it from happening.

There were enough qualified, skilled and experienced staff to meet people’s needs. The provider had an effective system to regularly assess and monitor the quality of service that people received.

Overall, we found the service to be a good, pleasant and effective service, well managed with enthusiastic, caring and committed staff.

We found significant improvements had taken place at 17 Park Avenue since we visited in July 2012. People we spoke with all told us they were happy with the service, and their comments included, "This home is perfect, I don't want any changes" and "I am happy with everything, no complaints at all."

We found people were able to attend the Gurdwara, Mosque, Temple and Christian places of worship as they chose. One person said, "I am encouraged to go to the temple, they book me a taxi." People told us they like having staff available who can speak in their preferred languages. One person said, "My staff explain in my language, and I give them the answers." One staff member told us there were at least ten different languages spoken by the staff team, and on some shifts there were also staff who could use sign language.

We found the furnishing and presentation of the home improved. We found the home was clean. Some furniture had been replaced and a plan to improve the remaining furniture was in place. One staff member said," I think people are happier. It is certainly a much nicer place to work."

People had a wide range of health care needs. We found people were supported to attend the appointments they needed. Care records showed that plans had been developed to inform staff how these needs should be met and monitored.

We did not find that all staff had the training they needed. We have required the provider to improve in this area.

Prior to this visit on June 20 2012 we had visited the home on 2 May 2012. In may we found the systems in place to assess and monitor the quality of care being provided were not effective, and they had failed to ensure people who used the service benefited from safe, quality care and support. We issued a warning notice about this. The notice made clear the areas that had to improve and required the registered manager and the provider to take action by 11 June 2012. In particular the warning notice raised concerns about excessively hot water, the lack of risk management in respect of work underway to replace flooring in the ground floor of the home, the failure to audit and follow up on accidents and incidents that posed an actual or potential risk to people, and the failure to maintain essential records as required by regulations.

We found evidence that some progress had been made to address risks to people using the service. The problem with the excessively hot water had been addressed. The problems noted with the management of risk relating to the new floor that was being fitted during the May inspection visit had been addressed as the new floor had been fitted.

When we returned to the home to see how things had improved on 20 June 2012, we did not spend time with people who used the service. We found evidence that people were being consulted with and the provider had actively commenced seeking out their views via a survey. The survey to people using the service asked them about their experiences of the home and gave them a chance to say how they thought things could be improved. 13 people living at the home had responded. The surveys stated people were either happy or very happy. Suggestions about how the service could improve included people being more involved in running the home and more opportunities for different activities. The provider had used the surveys to write a report. This stated the issues raised would be addressed by having more regular surveys and feedback,and that staff would review people's activity plans and provide more activities of choice.

When we arrived at the home most of the people who use the service were present however we had limited opportunities to speak with people. The main lounge and dining area of the home were being refurbished and people at home were resting in their rooms or the two small lounge/kitchenette areas within the home. A short while after our arrival a number of people left the home to spend a day out on a community activity.

We spoke at length with one person. They were very positive about the care and support they received. We spoke with them in their bedroom, and saw the room was very attractively decorated and furnished to their taste. The person told us staff were kind, and provided the help and support they needed. We asked the person how they got on with other people who live in the home. They told us they had little time for the other residents, but that they did not feel intimidated or afraid in the home.

During this visit, we talked to people living at the home, and asked staff about people’s needs. We also looked at people’s care plans. An expert by experience joined us on this visit. Experts by experience are people who have experience of using services; either first hand or as a family carer and so have a better understanding of how the needs of people could be met. The expert by experience who joined us on this visit was able to interpret what the people who lived at the home were saying. This helped us get a clearer picture of what it is like to use the service.

The expert by experience spoke with most of people living at the home during our visit. The overall message conveyed by the people who lived at the home was positive, with one lady saying, ‘It’s quite nice and cosy here at the home’. We found that the home promoted people's rights and choices and supported people’s independence. The people who lived at the home told us that they were allowed to attend college, go the library, see their relatives, go shopping, and go to the Mosque and Gurudwaras.

Many people due to there health conditions were not able to tell us about the care they receive. One person told us that he liked living in the home and that he had been there for many years and was happy. He said that staff took him out regularly to the mosque and he liked the food and staff.