This inspection was unannounced and took place on 10 and 11 July 2017. Hillcrest is a residential care home that provides accommodation, care and support for up to 52 older people some of whom may be living with dementia. It does not provide nursing care. At the time of our inspection 42 people were living in the home.

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.

People living in the service told us that they did not always feel the care provided took account of their individual needs and preferences. Some improvements were needed to ensure activities met people’s individual needs and interests. Further work was also required to improve signage in the home to help orientate people living with dementia to their environment and to support them to meet their needs independently. There was limited opportunity for people to discuss their care plans including how they wanted their support to be delivered and any concerns they might have.

Care records did not always contain sufficient detail regarding people’s personal histories and preferences; they were not always updated sufficiently when people’s needs changed. Systems in place did not always sufficiently monitor records in the service and we have made a recommendation that the provider reviews how this is managed.

Complaints were responded to thoroughly although it was not clear that everyone living in the service felt comfortable raising concerns.

People were safe living in the home. Risks to people including those from the premises were responded to and managed. Staff demonstrated an awareness of adult safeguarding and knew how to identify possible concerns. The service reported safeguarding concerns appropriately and when required.

There was mixed feedback regarding staffing levels as some people felt staff were not always visible in communal areas of the home. However, we found staffing levels were sufficient to meet people’s needs and keep them safe.

Medicines were managed and stored safely, although we found some improvements were required regarding the recording of medicine administration in the service. Regular audits were completed on medicines to check and ensure they were managed safely.

Staff received appropriate support and training to effectively undertake their roles. The registered manager had oversight of staff training and a training plan was in place to ensure staff received updated training when required.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. The registered manager understood their responsibilities under the Act and the service was working in accordance with this legislation.

People received appropriate support to eat and nutritional risks to people were managed. People had a choice of what they wanted to eat and told us they enjoyed the meals provided.

Staff worked closely and proactively with health care services to ensure changes in people’s health care needs were responded to and people were supported to access a range of health care services.

People were supported by staff who cared for them and treated them respectfully. Staff supported and encouraged people to be as independent as possible.

People, relatives, and staff spoke positively about the service and the registered manager. Staff found the management team approachable and supportive, with clear direction being provided regarding their roles and responsibilities. Although some people and relatives felt communication in the home could be improved.

There were systems in place to manage and monitor the quality of th

Hillcrest provides accommodation and personal care for up to 52 older people including those living with dementia. Accommodation is located over two floors. There were 40 people living in the home during this inspection.

This inspection was unannounced and took place on 2 June 2016.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had yet to receive training in this subject and those spoken with during this inspection were not able to demonstrate that they were aware of the principles of the MCA or DoLS and their obligations under this legislation.

Care plans did not contain all of the relevant information that staff required so that they knew how to meet people’s current needs. We could not be confident that people always received the care and support that they needed.

Staff deployment was not well managed which meant that people could not always be assured that their needs would be met in a timely manner

The provider had a recruitment process in place and staff were only employed within the home after all essential safety checks had been satisfactorily completed.

People were cared for by staff that understood their care and support needs. People’s privacy was respected most of the time. Most staff were seen to knock on the person’s bedroom door and wait for a response before entering.

People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Although we noted that menus were not available in appropriate formats so not all people were aware of the options on offer. Staff referred people appropriately to healthcare professionals. People received their prescribed medicines in a timely manner and medicines were stored in a safe way.

The provider had a complaints process in place and people were confident that all complaints would be addressed.

The provider did not have effective quality assurance systems in place to audit all areas of the home to identify areas for improvement. Therefore they were not able to demonstrate how improvements were identified and acted upon.

Hillcrest is registered to provide accommodation and non-nursing care for up to 52 older people, some of whom are living with dementia. Short and long stays are offered. The home has two floors and is located close to the centre of Norwich city. When we visited there were 43 people living at the home.

A registered manager was in post at the time of the inspection and had been in her position for four years. 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.

At our previous inspection on 08 August 2013 the provider was meeting the requirements of the regulations that we had assessed against.

People were felt safe living at the home and staff were knowledgeable about reporting any abuse. People were looked after by enough staff to support them with their individual needs. Pre-employment checks were completed on staff before they were judged to be suitable to look after people at the home. People were satisfied with how they were supported to take their medicines and medicines were safely managed.

People were supported to eat and drink sufficient amounts of food and drink. They were also supported to access a range of health care services and their individual health needs were met.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS applications had not been made to ensure that people’s rights were protected and there were inadequate assessments in place to assess people’s capacity to make decisions about their care and to justify why DoLS applications had not been made.

People were supported by staff who were trained and supported to do their job, which they enjoyed.

People were treated by kind, respectful and attentive staff but this was not consistent. Staff sometimes failed to respect the privacy and dignity of people.

People and their relatives were involved in the review of people’s individual care plans. Support and care was provided based on people’s individual needs and they were supported to maintain contact with their relatives and the local community. People were invited to take part in a range of hobbies and interests. There was a process so that people’s concerns and complaints were listened to and these were acted upon.

Staff enjoyed their work and were supported and managed to look after people in a safe way. The culture of how people were being looked after needed to be more caring. People and their relatives were able to make suggestions for improvements and actions were taken as a result. Quality monitoring procedures were in place but were not always effective.

Those people who were able to speak with us said that they liked living at this home and that the staff were very kind and helpful. One person told us that they were, "Cared for by a host of angels." They went on to tell us that they received, "Excellent care." Other people were able to tell us that they could choose what they had to eat and that the staff were, "Lovely." We were also able to speak with two visitors who said the service was, "Like a five star hotel." They were able to visit when they wished and were made welcome.

We observed how staff interacted with people and saw that they were kind, caring and patient. People were spoken to politely, using their preferred name. People were offered choices and staff were seen and heard to respect the choices people made. Care and support was provided discreetly.

We looked at care documents and these set out how the person wished to be cared for. The care plans were kept under review, although some were overdue an update. Medication records were up to date and there were no unexplained gaps in the administration records. Medicines were stored securely. We also looked at staff records and saw that they were up to date and demonstrated sound recruitment and selection processes. Records were stored securely and were readily available to staff and also for inspection. Records were audited by the home to ensure they were kept up to date and also to demonstrate that all maintenance of the environment was undertaken on time.

We spoke with six people living at Hillcrest and six members of staff. We toured the building and checked a sample of records to ensure that people were cared and supported appropriately.

We saw people in all areas of the home being treated with respect and dignity by staff. Some people were taking part in a reminiscence group activity, another group were arranging flowers and some preferred to stay in their own room. People told us "I have lived here for a long time and enjoy the company." "The staff are very good and help me when I need it, nothing's too much trouble." Another told us they enjoyed the meals because it was 'good wholesome food'.

We checked people's care records and found them to correspond with what they told us. We looked at records of people's finances and complaints. We were aware of past complaints and found they had been investigated appropriately. None of the six people raised any concerns when spoken with. We spoke with various staff members who told us they knew their residents needs and could support them to be as independent as possible. One comment we received regarding a member of staff had been passed to the manager to deal with.

We observed how people were treated, we saw staff knock on people's doors before entering and when assisting people sat with them when assisting with their meal and drinks. We saw that bedroom doors were being converted into front doors with a post box and door knocker added with each a different colour.

People we spoke with told us they liked living at this home. They said that staff were very good and were always about. People using the service said they had no complaints or concerns, but if they did have they would “Speak to the boss.” People said they felt safe at Hillcrest.

People with whom we spoke told us they enjoyed the food, which they described as “Good.” They said that there were always choices of food and that it was plentiful.

People told us there were activities taking place that they could join in with if they wished. One person said they could “Do what you like when you like.”