We inspected Hill House Care Home on 22 and 23 September 2016. The inspection was unannounced.

Hill House Care Home is registered to provide nursing and personal care for up to 58 adults. At the time of our inspection there were 53 elderly adults living in the home many of whom were living with dementia.

We previously inspected Hill House Care Home in September 2015 and found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to there being an insufficient number of staff to meet people’s needs, the lack of consistency with staff supervision and appraisal, the lack of person centred care and the lack of effective systems to assess the quality of care people received. We asked the provider to tell us how and when they would make the required improvements. These actions have now been completed.

The manager had applied to the Care Quality Commission (CQC) to be a registered manager for the service. A registered manager is a person who has registered with the 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 time of our inspection, the manager's application was being processed.

People felt safe. Risk assessments were conducted and management plans were in place to minimise the risk of people facing avoidable harm. Staff had been trained in safeguarding adults. They knew how to recognise the signs of abuse and how to report any concerns.

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The provider recruited staff using an appropriate recruitment process which was consistently used. The provider carried out thorough checks on staff and they received an induction before they began to work with people. The staff were experienced registered nurses and care workers who had the skills, knowledge and experience to care for people effectively.

There was a sufficient number of staff on duty to help care for people safely. Staff understood their roles and responsibilities and were supported by the management through relevant training, supervision and performance reviews.

There were procedures in place to ensure that people received their medicines safely. People’s healthcare needs were met by suitably qualified staff. Regular checks were carried out to maintain people’s health and well-being. People also had access to healthcare professionals and staff liaised well with external healthcare providers. People were supported to plan their end of life care which was provided with consideration and compassion.

Staff asked for people’s consent before delivering care. People were involved in their care planning and felt in control of the care they received. Staff understood the main provisions of the Mental Capacity Act 2005 and how it applied to people in their care.

People were satisfied with the care they received and told us they were treated with respect and kindness. Staff ensured people received a nutritious, balanced diet. People were given enough to eat and drink although there was not as much variety and choice as people would have liked.

There were activities for people to participate in and the provider had started to implement plans to improve the variety and frequency of activities on offer inside and outside the home.

People were supported to express their views. The management and staff used their learning from accidents and incidents to improve the safety and quality of care people received. There were a variety of systems in place to assess and monitor the quality of care people received and these were consistently applied by staff.

We spoke with people and their families using the service. One person told us ''My relative stayed here, I cannot find a fault with the service, and everyone is kind and patient." We observed that peoples consent and permission to provide care was sensitively and appropriately sought. A person using the service told us that staff were very respectful towards him.

People's care and treatment was carefully assessed to ensure their personal needs and preferences were addressed. One person who was due to go home soon said ''Oh dear how will I cope, I have been so spoilt.'' Another person using the service said ''Nothing in life is perfect, you have to be realistic. The food is very good and if you don’t like what they serve you can get something else. The chef even goes round the dining room to speak to people to see if they are happy.''

People using the service and staff were protected from infection through the use of safe clinical practice and thorough cleaning procedures.

Through effective recruitment procedures staff were appropriately appointed so that people using the service could be confident they would be cared for by the right people. One person using the service said '' Matron has high expectations of her staff and she makes sure she gets what she expects.''

Essential records were safely stored and maintained to ensure provision of safe care and effective communication.

During our visit in November 2012, we noted that although people were happy with the care and treatment provided, care plans were not always reviewed on a regular basis. Limited information was available regarding the involvement of people or their representatives in the care planning process.

During this visit we looked at the care records of three people and found them to be comprehensive. The care plans were reviewed regularly and any changes that were identified were addressed. Care plans showed that where formal consent had been required the relatives and families of people had been involved in the process.

Comments from people using the service were positive, indicating that staff were kind and helpful in meeting their care needs. People were observed to be treated with respect by staff and to have their privacy and dignity respected.

People told us that they felt safe and if they had concerns they would speak with a staff member, matron or the provider.

One person told us, “They are good to me and look after me well”; another person said “Staff are very good” and “I have no concern”. Everyone spoke positively about their care workers and felt that they fully supported their care needs.

The feedback received has been generally very positive, with favourable comments being made about the home and the support being provided by staff. Views expressed by relatives indicated that the home provides a safe, pleasant and welcoming environment and that there is good communication with relatives regarding residents’ health, welfare and support needs.

We inspected Hill House Care Home on 24 and 25 September 2015. The inspection was unannounced.

Hill House Care Home is a service which provides nursing and personal care to elderly adults. At the time of our visit there were 51 people using the service.

The service had a 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. The registered manager was not at work on either day of our inspection.

People felt safe. There were procedures and risk assessments in place which staff implemented to reduce the risk of harm to people. Staff had been trained in safeguarding adults. They knew how to recognise the signs of abuse and how to report any concerns.

There were procedures in place to ensure that people received their medicines safely which staff consistently followed. People were protected against the risk and spread of infection.

Appropriate checks were carried out on staff and they received an induction before they began to work with people living in the home. Staff understood their roles and responsibilities. However they were not adequately supported by the management through regular supervision and performance reviews.

There was not a sufficient number of staff on duty to meet people’s needs. Some people told us staff did not have time to speak to them.

People’s care records were not person centred and did not focus on people’s individual needs, personal preferences and dislikes.

Staff asked for people’s consent before delivering care. Staff understood the main provisions of the Mental Capacity Act 2005 and how it applied to people in their care.

Regular checks were carried out to maintain people’s health and well-being. People also had access to healthcare professionals and staff liaised well with external healthcare providers. People were supported to plan their end of life care.

People were treated with kindness and respect. Staff ensured people received a nutritious, balanced diet. People were happy with the quality of their meals and said they were given enough to eat and drink. There were a variety of group activities for people to participate in inside the home but few if any opportunities for people to leave the home unless they had the support of their relatives.

Comprehensive internal audits were conducted to check the quality of care people received. However, where areas for improvement were identified and an action plan put in place, management did not always implement the action plan.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to there being an insufficient number of staff to meet people’s needs, the lack of consistency with staff supervision and appraisal, the lack of person centred care and the lack of effective systems to assess the quality of care people received. You can see what action we told the provider to take at the back of the full version of the report.