Hill House Nursing Home is ‘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. Care is provided in one adapted building for up to 29 adults, including older people and some who may be living with dementia.

At our last inspection we rated the service as 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. At this inspection we found the service remained Good. There were 24 people accommodated, including 13 people receiving nursing care.

People continued to receive safe and effective care from staff who were trained, supported and deployed to ensure this.

Staff understood and followed the provider’s risk management systems relating to people’s care, medicines, environment and any equipment used for their care. This helped to protect people from the risk of harm or abuse in the least restrictive manner.

The provider took regular account of people’s safety needs and acted promptly to review and prevent any reoccurrence when things went wrong. This helped to ensure people’s safety, including from lessons learned when needed.

People needs were assessed before they received care and their related care choices were taken into account to inform their care provision at the service. People’s consent or appropriate authorisation was lawfully obtained for their care to ensure their rights and best interests.

People were supported to maintain and improve their health and nutrition, in consultation with external health professionals when needed. Partnership working with relevant external agencies and care professionals helped to ensure effective, informed care practice and related information sharing.

People continued to receive care from kind, caring and compassionate staff, who ensured people’s dignity, independence and rights in their care. Staff consulted with people and their representatives and followed what was important to people for their individual care, preferred daily living routines and lifestyle preferences.

People continued to receive timely, individualised care, which was agreed and reviewed with them or their representatives when required. Staff understood and followed their role and responsibilities for people’s care and knew how to communicate with people in a way they agreed and understood.

People were provided with information about their care and regularly supported to engage in home and often community life as they chose. Work was in progress to quality assure and optimise this for people.

People and relatives were informed and knew how to raise any concerns, or make a complaint if they needed to. The provider used any related investigation findings and feedback they regularly sought from people, relatives and external professionals to help inform and improve people’s care when needed.

The service continued to be well led. The provider operated effective systems to ensure the quality, safety and effectiveness of people’s care, and ongoing service improvement and relevant information sharing.

Further information is in the detailed findings below.

This inspection took place on 3 December 2015 and was unannounced.

Hill House Nursing Home is registered to provide nursing and personal care for up to 26 people. On the day of our inspection 22 older people were receiving care. A number of people were living with dementia.

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. The provider had recruited a new manager who intended to register with the Care Quality Commission.

At our last inspection on 11 and 12 June 2014, we found the provider was not meeting one regulation. This was in relation to people receiving inappropriate or unsafe care because staff did not consistently receive adequate training or supervision.

At this inspection we found improvements had been made. Staff received training, support and supervision they required to carry out their respective job roles and responsibilities.

People told us they felt safe and staff had a good understanding of how to keep people safe. People’s relatives and staff had confidence that any concerns would be treated seriously.

People and their relatives were happy with the care and support provided. People were treated with compassion and respect and their needs were being met.

Staff were knowledgeable about people’s needs. People’s individual rights, needs, choices and preferences were all respected by staff. Staff assisted and cared for people in a kind and friendly manner.

Staff understood and followed the requirements of the Mental Capacity Act 2005 (MCA) to obtain people’s consent or appropriate authorisation for their care.

People were encouraged and supported to make choices and decisions in relation to their care and daily living arrangements. Where people were unable to make decisions, staff recorded how decisions had been made in people’s best interests.

People were supported to maintain relationships with their families and friends. There was a range of social and recreational activities which people were supported to take part in.

We saw there was enough staff available to respond to people’s requests for help and assistance in a timely manner. Staffing arrangements were regularly reviewed to ensure people’s needs could be safely met.

The provider’s arrangements helped to make sure that staff were safely recruited and fit to provide people’s care at the service. We saw pre-employment checks were completed for all staff, these included Disclosure and Barring Service (DBS) checks, proof of identity and written references.

The provider’s systems helped to ensure medicines were stored, administered and disposed of in a safe way. Registered nurses administered medicines and training was provided to ensure their practice was safe.

There were auditing systems in place to assess and monitor the quality of the service being provided to people. Any concerns or complaints were responded to and resolved by the manager and the wider management team.

This inspection took place on 3 December 2015 and was unannounced.

Hill House Nursing Home is registered to provide nursing and personal care for up to 26 people. On the day of our inspection 22 older people were receiving care. A number of people were living with dementia.

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. The provider had recruited a new manager who intended to register with the Care Quality Commission.

At our last inspection on 11 and 12 June 2014, we found the provider was not meeting one regulation. This was in relation to people receiving inappropriate or unsafe care because staff did not consistently receive adequate training or supervision.

At this inspection we found improvements had been made. Staff received training, support and supervision they required to carry out their respective job roles and responsibilities.

People told us they felt safe and staff had a good understanding of how to keep people safe. People’s relatives and staff had confidence that any concerns would be treated seriously.

People and their relatives were happy with the care and support provided. People were treated with compassion and respect and their needs were being met.

Staff were knowledgeable about people’s needs. People’s individual rights, needs, choices and preferences were all respected by staff. Staff assisted and cared for people in a kind and friendly manner.

Staff understood and followed the requirements of the Mental Capacity Act 2005 (MCA) to obtain people’s consent or appropriate authorisation for their care.

People were encouraged and supported to make choices and decisions in relation to their care and daily living arrangements. Where people were unable to make decisions, staff recorded how decisions had been made in people’s best interests.

People were supported to maintain relationships with their families and friends. There was a range of social and recreational activities which people were supported to take part in.

We saw there was enough staff available to respond to people’s requests for help and assistance in a timely manner. Staffing arrangements were regularly reviewed to ensure people’s needs could be safely met.

The provider’s arrangements helped to make sure that staff were safely recruited and fit to provide people’s care at the service. We saw pre-employment checks were completed for all staff, these included Disclosure and Barring Service (DBS) checks, proof of identity and written references.

The provider’s systems helped to ensure medicines were stored, administered and disposed of in a safe way. Registered nurses administered medicines and training was provided to ensure their practice was safe.

There were auditing systems in place to assess and monitor the quality of the service being provided to people. Any concerns or complaints were responded to and resolved by the manager and the wider management team.

During our last inspection of Hill House Nursing Home in July 2013 we found that people were not always being asked for their views or consent in relation to their care and treatment. We observed that people's care plans did not always consider their capacity to consent or their best interests.

We also found that whilst improvements had been made to the systems in place to manage risks in the home, action plans in place as a result of audits were not always completed and that where issues had been highlighted, these had not been addressed with staff.

During this inspection we found that people's care plans had been reviewed and updated to consider their capacity to consent to treatment or their best interests. We also observed that a large number of staff working in the home had received further training on mental capacity to help them understand people's needs and provide more appropriate support to people living in the home.

The Registered Manager had reviewed the systems in place for conducting audits in the home to help simplify the processes and we saw that appropriate audits were being completed and followed up in a timely manner. We saw that where issues had been identified, these had been raised with the individuals concerned - including staff members and the provider.

People we spoke with told us that they liked living at the home and felt their needs were met. One person told us "they do a good job of looking after me here". We found that care records were reviewed monthly and contained relevant information to ensure people’s care needs were met.

We found that the environment was secure and measures were in place to take into account identified risks. Staff we spoke with told us that they enjoyed working at the home and were supported to develop in their roles through regular training.

Personnel files contained information to demonstrate that staff had been recruited safely, and were stored securely, however we found that people's care records were not stored securely.

The provider had systems in place to seek the views of people using the service. However we found that the systems for assessing and managing the risks relating to the health and welfare of people using the service were not effective.

As part of our inspection we spoke with two people receiving care, two relatives, the acting manager and five staff working at the service. We also observed people receiving care and examined records at the service. Below is a summary of what we found.

Is the service safe?

People told us that they felt safe living at Hill House. One person said, “If I feel unwell [staff] will immediately get a doctor.” People’s personal files included a range of risk assessments and these included procedures to safely manage risks.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards. People’s human rights were therefore properly recognised, respected and promoted.

People said they thought that staff were recruited safely. One person spoke positively about the ‘phasing in’ of new staff. We read documents that showed appropriate checks being undertaken before staff began work.

Is the service effective?

People told us that staff encouraged them to be as independent as possible. One person said, “[Staff are aware of] my preference to get myself in and out of bed myself.”

People were involved in planning their care. One person told us, “I’ve been to [care review] meetings and I’ve read and signed [the care plan].” Staff also confirmed this involvement and one staff member told us, “Families are given a ‘My Life Story’ pack to complete [on behalf of their relative].”

Half of the staff group had not completed a course in First Aid. This meant that staff may not all be able to appropriately respond to injuries suffered by people who use the service. We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to ensuring staff receive training appropriate to their role.

Is the service caring?

People’s privacy and dignity were respected. One person told us, “[Staff] knock on my door and usually wait until I answer.

People told us that staff respected their personal preferences and interests and thought that their needs were being met. Staff confirmed this and one member of staff told us that, “One person likes to draw. We ensure their pencils are sharp.”

Is the service responsive?

People told us they felt listened to by staff and there were meetings for the people who use the service. Staff told us they felt listened to by management. One staff member said that improvements to activities equipment had followed recommendations made by staff.

We heard ‘old time’ music being played in one lounge area that clearly reflected people’s preferences: we saw people smiling and moving to the music.

Is the service well-led?

Staff described a sound set of values upon which the service was based. These included meeting people’s holistic needs, involving people in decision making and valuing staff.

The service had a quality assurance system which identified, assessed and managed risks to people’s health, safety and welfare.