Hill House 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. The home is registered to provide accommodation and personal care for up to 76 people with a range of needs including physical disability, age related fragility and people who live with dementia. At this inspection there were 68 people living at the home.

When we last inspected the service on 09 November 2016 we found that the provider was in breach of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to ensure that people were always protected from risks and avoidable harm. Staff had not always operated safe moving and handling practices and had not always identified concerns and reported them appropriately. The provider did not have effective governance systems and procedures in place and had failed to identify some of the concerns we found during our inspection.

Following the inspection, the provider wrote to us to tell us how they would make the improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements to help ensure that staff operated safe moving and handling practices and had put additional measures in place to monitor and audit the quality and safety of the service which helped identify any shortfalls which were then addressed in a timely way.

There was a registered manager in post. 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 told us that they felt safe living at Hill House. Staff demonstrated they understood how to keep people safe and we noted that risks to people's safety and well-being were managed through a risk management process. We observed people's needs were met in a timely way by sufficient numbers of skilled and experienced staff. However people told us they would like staff to be able to spend more time chatting with them. The provider had a robust recruitment process in place which helped to ensure that staff employed were of good character and suited to the roles they were employed for. People's medicines were managed safely and kept under regular review. Infection control measures were in place to help reduce the risks of cross infection.

Staff received regular support through team meetings, one to one supervision and an annual appraisal from a member of the management team which they told us made them feel supported. People received support they needed to eat and drink sufficient amounts to help maintain their health and well-being. People’s health care needs were taken care of with access to a range of healthcare professionals and where required appropriate referrals were made to external health professionals such as dieticians or physiotherapists.

People and their relatives were very complimentary about the staff and management at the home. They told us staff were kind, caring and compassionate. Staff members, including the management team, were knowledgeable about individuals' care and support needs and preferences and people and where appropriate their relatives had been involved in the planning of their care where they were able. Visitors were welcomed at all times and people were supported to maintain family relationships.

The provider had systems in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were encouraged and supported to raise any concerns with staff or management and were c

The inspection took place on 09 November 2016 and was unannounced. The inspection was a focused inspection which was in response to concerns raised about the safety and well- being of people who used the service.

Hill house is registered to provide accommodation and personal and nursing care for up to 76 people who live with dementia, age related fragility, physical and or learning disabilities. There were sixty four people living at Hill house at the time of this inspection.

The home had a manager who had applied to CQC to become the registered manager. 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.

When we last inspected the service on 21/1/2016. We found the provider was meeting all the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

However during this inspection we found that the provider had failed to provide safe care and treatment that protected people from harm. Staff did not always have the necessary skills, experience and competencies to meet people’s needs safely. There had not been an effective system in place to assess, monitor and update people’s care plans and risk assessments and staff did not always have the opportunity to read and follow the instructions contained within the care records. Quality monitoring systems and process were not effective in identifying some of the shortfalls we found during our inspection.

Some of the people we spoke with told us they felt safe living at Hill house. Although we found that staff did not always understood how to keep people safe and risks to people's safety and well-being were not always identified and managed effectively to reduce risks. People's needs were met in a timely way by sufficient numbers of staff, however staff did not always have the right skills and experience to provide safe and effective care. There was a heavy reliance on the use of agency and bank staff to cover shifts and recruitment was on-going at the time of our inspection. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were suitable to work in a care home environment. However in the case of agency staff pre-working profiles were not always assessed in advance of staff working. People's medicines were managed safely. People told us they received their medicines regularly from staff who had been trained in the safe administration of medicines.

Staff received individual supervision from their line manager, for care staff this was the nurse who led the shift. Staff told us they felt supported and gave them an opportunity to discuss any training and development needs. People received appropriate support to have a healthy diet and their health needs were met with appropriate referrals made to health professionals when required.

People and their relatives were complimentary about the staff telling us they were very caring. Staff knew about people’s basic care needs. Some of the staff were able to tell us about people’s care and support needs and their daily routines. People were sometimes involved in the planning of their care as much as they were able. People's relatives and other visitors to the home were encouraged and supported to visit at any time they wished.

The provider had systems and processes in place to receive feedback from people who used the service and their relatives about the quality of services provided. People and their relatives were confident to raise any issues or concerns with the management team and felt they would be listened to.

The provider had arrangements in place to monitor the quality of the care and support provided for people who used the s

This inspection was carried out on 21 January 2016 and was unannounced.

Hill House Care Centre is registered to provide accommodation and nursing care for up to 76 people, with age related frailty, physical disabilities and people who live with a dementia. There were 69 people living at the service on the day of our inspection.

There was a registered manager in post. 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.

At the last inspection on 20 and 23 November 2013, the service was found to be meeting the standards. At this inspection we found that the provider had continued to meet the standards.

People were protected from the risk of potential abuse. Staff had received training and demonstrated a good understanding of how to recognise and report concerns. Risks were assessed and reviewed and actions were in place to reduce risk where possible without restricting people’s right to make informed decisions.

People were supported by appropriate levels of staff who had the right skills and experience. There was a robust recruitment process in place and staff received regular training and supervision.

People were supported to eat and drink sufficient amounts to keep them healthy, and had regular access to various health care professionals when required including their GP.

The leadership in the home was strong and staff were valued. Staff had been given individual areas of responsibility to ensure the smooth running of the home. There were systems and processes in place to monitor the quality of the service and actions in place to address any issues.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted DoLS applications which were pending an outcome.

During our visit we spoke with ten of the people who lived at Hill House and visiting relatives. People were positive about the level of support that staff provided them with. One person said Hill House was “excellent” and “all their needs were catered for”. A relative told us the staff were “lovely” and that they were glad their relative was living at Hill House because they were “safe and happy”. People told us they felt safe and were confident in the staff who supported them. One person, who had recently come to stay at Hill House, said the service was “very good” and they had chosen to join in with some of the activities available. Another person told us the staff were "very good" and put things right if they had a concern. People told us that the staff understood their needs and treated them with dignity. We noted that people had access to a wide range of social activities that included support to meet their individual religious or cultural needs. People were complimentary about the management of the service.

People told us that they enjoyed their meals and were offered choices. Suitable arrangements were in place to assess people’s nutritional needs and ensure they received the food and fluids they needed.

We identified that there were appropriate arrangements in place to manage people's medicines safely and ensure that suitable staff were employed.

We observed that people were living in a fresh, clean environment.

People who use the service told us that their privacy and dignity was respected. They also said that they were happy with the care, treatment and support they received and that the staff were attentive, respectful and supportive. People who use the service told us that they were involved in deciding how their needs should be met and felt that the care, treatment and support they received promoted their welfare. Relatives spoken with commented that they were happy with the care and support people received and that they did not have any concerns or complaints.

We spoke with five people who used the service. All were happy with the care that they had received. A person that we spoke with said ‘the staff are very good, they look after me well’. A relative we spoke with told us that the staff were respectful and very caring. We observed people looked comfortable in their personalised rooms. People were observed to be doing their own thing and had a routine that suited their individual needs and preferences. We found that people had consented to care treatment and support although this was not always recorded. In most cases care plans contained a pre assessment although in some cases we found these had been removed and archived. People had care plans and risk assessments in place. Hill house had recently undergone a refurbishment programme, although there were still a few areas that required completion. Staff were supported in their role, although some “team meetings” were not recorded making it difficult to evidence what had been discussed and any actions that were required. We were shown the complaints policy and found complaints were recorded appropriately. We found that notifications were processed as required and sent to the care quality commission (CQC). We found that records were not always immediately accessible and this meant that we were not able to evidence specific records during our inspection visit. However alternative records were provided on the second day of our inspection visit.