At our last inspection in November 2016 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 on-going 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.

Hillcrest Manor Nursing Home is a nursing home for 43 people. The home comprises of two units, The Manor and The Granary. The Manor provides general nursing care for up to 33 people and The Granary provides nursing care to 10 people who are living with dementia. The Granary is situated on the ground floor and accommodation in The Manor is arranged over two floors with a shaft lift giving access to bedrooms on the first floor.

People felt safe living at the home. People were protected from the risk of harm or abuse because the provider had effective systems in place which were understood and followed by staff. There were enough staff to help keep people safe and meet their needs. People received their medicines when they needed them from staff who had been trained to carry out the task. There were effective systems in place to reduce the risk of the spread of infection.

People were cared for by staff who had the skills and training to meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People were supported to eat well in accordance with their needs and preferences. People’s health and well-being were monitored and met.

Staff interacted with people in a kind and respectful manner and they knew people well. People’s privacy was respected and staff supported people to maintain their dignity. The provider’s procedures relating to confidentiality were understood and followed by staff.

Activity staff provided people with opportunities for social stimulation and people were supported to maintain contact with their family and friends. Staff ensured people saw healthcare professionals when they needed. People could be confident that they received a service which met their needs and preferences. Concerns and complaints were taken seriously and responded to.

There were effective management systems in place and there were systems to monitor the quality and safety of the service provided. People were supported by a team of staff who felt supported and valued.

Further information is in the detailed findings below.

This was an unannounced inspection carried out on the 04 November 2016.

Hillcrest Manor Nursing Home provides general nursing care and specialist dementia care for up to 47 adults. People were cared for in two units known as The Granary and The Manor House. The Granary, which was the specialist dementia unit, could accommodate up to 10 people. The Manor House or nursing unit could accommodate up to 37 people.

There was a registered manager in place. 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.

This service was last inspected on the 08 September 2015. During that inspection, we found the home needed to make improvements in a number of areas. These included safeguarding, Mental Capacity Act, people’s dignity, communication, training and competency of staff and effective quality assurance systems. During this inspection, we found improvements had been made by the home to address these concerns.

Staff were able to describe what action they would take if they had any concerns and demonstrated a good understanding of the different types of abuse.

Risks to people's safety were assessed and minimised.

There were enough staff to support people safely at the home.

The provider had appropriate arrangements in place to manage medicines safely. People were supported to take their medicines as prescribed.

Staff received regular supervision and training appropriate to their roles.

We found people’s mental capacity to make decisions had been assessed and appropriate Deprivation of Liberty Safeguards (DoLS) applications had been made.

The provider supported people to access a variety of health professionals to ensure they received effective treatment to meet their specific needs.

People were happy with the standard of support they received and spoke positively of their relationships with staff.

People were treated with respect and dignity at all times.

People and relatives were actively involved in making decisions about their care and were listened to by the provider.

People's care and treatment was provided by a staff who were able to describe in detail each person's needs and abilities.

The provider routinely and actively listened to people to address any concerns or complaints.

People told us the home was well-led and both staff and the management team were very approachable.

The provider had a positive culture that was person centred and inclusive.

There were systems in place to gain people’s experiences and to continually monitor the quality of the service provided.

The inspection was carried out on the 8 September 2015 and was unannounced.

Hillcrest Manor Nursing Home provides general nursing and specialist nursing dementia care and treatment for up to 47 adults. There were 29 people living at the home on the day of our inspection. People were cared for in two units The Granary and Manor House.

There was no registered manager in post however, the new manager started work 15 June 2015 and had submitted an application to become the registered manager of the home. They were present during the inspection. 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.

We found that the provider needed to make improvements to ensure appropriate measures were put in place to ensure people were protected from harm or abuse. We saw that the provider had not reviewed the information about the outcome of a referral to the local authority safeguarding team. We therefore could not be assured that appropriate action had been taken to protect the person.

Staff did not have a full understanding about the mental capacity act (MCA) and we could not be assured that decisions that had been made were made in people’s best interest.

People’s dignity had not been consistently protected. We observed that people on Granary unit were not given knives and forks to eat their lunch with due to a blanket approach by staff based on the perceived risks posed by one person.

People did not always benefit from effective communication by staff. We observed that staff did not always explain to people what they were going to do with them.

Audits completed by the manager were not driving improvements because they had not identified the shortfalls that we had found and did not identify who would take action and when.

Current arrangements for monitoring staff competency and staff approach were not effective in identifying shortfalls in the quality of care people received.

People felt that staff were able to support them safely. Staff had received training in safeguarding and knew how to identify and report abuse. Staff knew how to deal with accident and incidents and there were systems in place to reduce risks.

People received appropriate support to take their medicines and there were safe systems in place for the ordering, storage and disposal of medicine. People had access to health care professionals as and when required.

People nutritional needs had been assessed and reviewed and they were given a choice of what they wanted to eat. People told us they enjoyed the food and we observed that they were given support to eat where needed.

People were spoken to in a kind and polite manner. People were supported to remain as independent as possible and could choose how they wished to spend their time. Whilst some chose to sit in the lounge and take part in activities others liked to have some private time in their rooms.

People felt the manager was friendly and approachable and that they could speak to them direct if they had any complaints or concerns. People and staff felt that they could confidently put their views on the service forward and that they would be listened to.