This comprehensive inspection was carried out on 27 November 2018 and was unannounced.

Hill House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hill House is registered to provide accommodation and personal care for up to eight people who have a learning disability. There were six people living at the service when we visited on 27 November 2018. The service is situated in a rural area in the village of Pulham St Mary near Diss in Norfolk. People who lived in the service had differing levels of communication including people who used non-verbal communication.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There continued to be sufficient staff to meet people’s needs. Risks continued to be appropriately assessed and mitigated to ensure the people safety was considered. Medicines were managed safely and records evidenced that people had received their medicines as prescribed.

Staff worked well with external health care professionals and people were supported to access health services when required.

Staff received ongoing support from the management team through a programme of regular supervisions and appraisals and they had received trained to ensure they had the knowledge and skills to care for people effectively. Staff treated people with dignity and respect and were caring towards them.

The service continued to be well led. Staff enjoyed their job roles and were clear on the expectations of them to support people in a person centred way. Quality assurance processes are used to continuously improve the standard of care and support people received.

We inspected this service on 6 April 2016. The inspection was unannounced.

Hill House is a care home which provides accommodation, care and support for up to eight adults with a learning disability. Six people were 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 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.

Systems were in place to manage risks to people using the service. This included safeguarding matters, behaviours that were challenging to others and medication This protected people from harm.

Risk assessments were detailed and gave staff clear direction as to what action to take to minimise risk. This was done in a consistent and positive way and which protected people’s dignity and rights. This showed that the provider had a positive attitude towards managing risk and keeping people safe.

Staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. The registered manager had made appropriate DoLS applications to the local authority to ensure that restrictions on people’s ability to leave the service were lawful.

There was sufficient staff on duty to keep people safe. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service.

People experienced a good quality of life because staff received training that gave them the skills and knowledge to meet their assessed needs.

Staff talked passionately about the people they supported and knew their care needs well. People were involved in determining the kind of support they needed. Different communication methods had been used to support people to understand information about their care. Staff offered people choices, for example, how they spent their day and what they wanted to eat. These choices were respected. People were supported to carry on with their usual routines, shopping and accessing places of interest in the community.

People were provided with sufficient to eat and drink to stay healthy and maintain a balanced diet. People had access to health care professionals, when they needed them.

There was a strong emphasis on promoting good practice in the service. Staff were clear about the vision and values of the service in relation to providing compassionate care, with dignity and respect. We observed staff putting these values into practice during our inspection.

The provider had a range of systems in place to assess, monitor and further develop the quality of the service. This included quality monitoring visits of the service and monitoring of incidents, accidents, safeguarding concerns and complaints.

During our inspection we spoke with one of the six people who used the service. Although their verbal communication was limited they were able to tell us that they were happy with the care and support they received and well cared for. We observed staff working with other people who used the service. They spoke appropriately to the person they were with at all times, and showed that they understood non-verbal communication.

We looked at care records. These were held electronically and showed the needs of people who used the service and how those needs were safely met. We discussed safeguarding procedures with the manager and with two care staff. Appropriate measures were in place to ensure that any allegations of abuse were properly investigated and the necessary people informed.

We looked at recruitment records which showed that suitable staff were employed and checks made to ensure that people had not been barred from working with vulnerable people. Other records we looked at included training records and, maintenance records and these were accurate and up to date.

We spoke briefly with two of the six people who used the service but their feedback did not relate to the standards we looked at.

We found that care plans were comprehensive, containing details of the needs of people who used the service and how those needs were met. The care plans all contained detailed risk assessments to minimise the risks around daily living and events and activities.

The staff team had received a range of training to equip them to carry out their role and were well supported by the service. We spoke with two staff members and with the deputy manager. They told us how well they all worked as a team.

People who live in the home are not always able to directly answer questions due to certain communication difficulties, we therefore spent time with people, observed staff interaction and saw how support is provided. We saw people interacting in a relaxed manner with members of staff. People living in the home were sitting with staff and approached them in a confident way, with staff allowing time for a response. On arrival we were greeted by two people who live in the home plus a member of staff and people were fully included in our inspection throughout this visit.