About the service:

Hillbro is a 42 bedded service providing nursing or personal care to older people, people living with dementia and people living with mental health issues. At the time of our visit there were 40 people using the service.

People’s experience of using this service:

Improvements to medicines management, consent to care and treatment and quality audits have been made since our last inspection in October 2017.

Staff were exceptionally caring. Everyone we spoke with was very complimentary about the service and said they would recommend the home. There was a strongly embedded culture within the service of treating people with dignity, respect, compassion and love.

Activities were on offer to keep people occupied both on a group and individual basis. Trips out were also organised in line with people’s preferences.

Medicines were being administered safely and people’s dietary and healthcare needs were met.

Staff were recruited safely and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training which was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs.

Care plans were up to date and detailed the care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. Appropriate referrals were being made to the safeguarding team when this had been necessary.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The registered manager provided staff with leadership and was described as being very approachable. Audits and checks were carried out and used to drive continuous improvements to the service people received.

People’s feedback was used to make changes to the service, for example, to the menu’s and activities.

More information in Detailed Findings below:

Rating at last inspection:

Requires improvement (report published 10 January 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection and the service has met the characteristics of good in four areas and outstanding in caring.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection was carried out on 16 October 2017 and was unannounced.

Hillbro 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.

Hillbro accommodates a maximum of 42 people in one adapted building. At the time of our inspection there were 41 people living at the home.

There was a change of registration in December 2016, a new provider was registered. This was the first inspection of the new provider.

The service had a registered manager. 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 they felt safe and staff knew how to recognise and report any concerns about people’s safety and welfare. We found the correct safeguarding reporting procedures were not always followed and people’s money was not always managed properly.

Overall there were enough staff deployed. We recommended staffing levels should be kept under review to make sure people always received appropriate care. All the required checks were done before new staff started work and this helped to protect people. Staff were trained to meet people’s needs.

People who used the service did not have any concerns about the way their medicines were managed. However, we found some improvements were needed.

Individual risks to people’s health and welfare were identified and managed. However, improvements were needed to the emergency evacuation procedures to ensure people’s safety.

The home was clean and well maintained. Some parts of the home had recently been refurbished and we saw the provider had taken account of the needs of people who used the service.

We found people’s capacity to consent to their care and treatment was assessed. However, when people lacked capacity the correct processes were not always followed to ensure those making decisions on their behalf had the legal powers to do so.

Most people told us they liked the food. People were offered a variety of food and drink which took account of their likes and their medical, cultural and religious needs.

People were supported to meet their healthcare needs and had access to a range of healthcare professionals. People’s needs were assessed. However, their care plans were not always detailed enough and this created a risk they would not consistently receive appropriate care which met their needs.

People were treated with respect and kindness and were supported to maintain their independence. People were given the opportunity to take part in a variety of social activities.

Information about complaints was displayed in the home. People told us the registered manager was approachable and listened to them. People were supported to share their views about the service in meeting and by means of surveys.

People told us they would recommend the service and some people told us they had already done so. People had confidence in the management team.

We found the providers quality monitoring systems were not always working as well as they should be. We were assured of the provider’s commitment to making the required improvements.

We found four breaches of regulations in relation to the management of medicines, consent to care and treatment, person centred care planning and good governance. You can see what action we told the provider to take at the back of the full version of the report.