This was an unannounced inspection carried out on the 15 May 2017.

Hillcrest residential is registered to provide personal care for up to 32 older people and is located within a mile of the village of Frodsham. The service has bedrooms over two floors and some bedrooms have en-suite facilities. Shared facilities include three lounges, one dining room, a conservatory and bathing and toilet facilities. The home has a garden and patio area. At the time of our visit there were 26 people living at the service.

On our last visit on 20 and 21 January 2015 the service was rated as good. This inspection identified that the service continued to meet all the relevant fundamental standards and the rating remains good.

People felt safe living at the service. Staff understood what was meant by abuse and they were aware of the different types of abuse. Staff knew the process for reporting any concerns they had and for ensuring people were protected from abuse.

People's medicines were managed and administered safely.

Individual risk assessments were completed to ensure people supported, relevant others and staff were protected from the risk of harm.

People's health care needs were monitored. Records confirmed that where people's health needs had changed they had access to appropriate healthcare professionals.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were cared for by kind and patient staff who respected their privacy and dignity and helped them to maintain their independence. Comments about staff included, “I feel very lucky to have such lovely people caring for me” and “They are very patient and very respectful of my dignity”. People felt involved in decisions about their care.

Care plans were person centred. They contained good information of the person's preferred daily routines, methods of communication, likes and dislikes. Records showed care plans were reviewed regularly and any changes to care updated.

People were supported to access sufficient amounts of food and drink that met their dietary requirements and nutritional needs. People told us they like the food they received and were offered choices. The service liaised with dieticians and other health care professionals to ensure people's bespoke dietary requirements were met.

People were encouraged to participate in a range of activities of their choice. The service provided both in-house and community based activities for all, in line with their choices and preferences. Staff were aware of the importance of ensuring people were not socially isolated.

People were aware of how to raise concerns or complaints to the service. People told us they felt comfortable raising issues with staff or management. The service had processes in place to respond to complaints in a timely manner.

The registered manager and provider carried out regular audits to drive improvements. Records showed audits were undertaken by both the registered manager and provider and where issues were identified, action was taken in a timely manner. Quality assurance questionnaires were sent to people, their family members and staff to question the service provision.

Further information is in the detailed findings below.

We spoke to four people who used the service, four staff and two relatives. The people using the service and the relatives gave us assurances that staff knew the needs of people and knew how to deliver the care and support effectively. Our observations of the service showed that care staff spoke and interacted with people who used the service in a warm and kind manner. Care staff set aside time to engage in activities with the service users.

Three people who used the service commented that staff were “lovely”. Their relatives were also just as pleased with the care. They said that the staff made it very “homely”. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

The provider took accounts of complaints and comments to improve the service. For example, they had recently reorganised the layout into three lounges and two separate dining rooms. This allowed for a dementia unit which was locked and all doors were alarmed to ensure the safety of the people with dementia. The two relatives we spoke were next of kin’s of people residing in the dementia unit. They felt the unit was safer and they were happy that the people with dementia were able to receive more ‘one-to-one’ care.

The people using this service without dementia had the choice of where they wanted to sit. There was the option of the old lounge where people with dementia were sat, in a lounge with a television or a quiet lounge. It was found to suit both people with dementia and the general residents. The four people who used the service, the four staff and the two relatives we spoke to were all pleased with the separation. Staff said they found the work load easier and more ‘organised’. One of the staff also told us they were also pleased to be able to provide more ‘one-to-one’ care to those with dementia.

We spoke to five people who used the service. They said they were well looked after and happy with the service received. They were positive about the staff who supported them. Some comments made were:-

“I would recommend this home and I have done. We are well looked after.”

“Staff are nice and they are helpful. The food is good. We are safe and well looked after.”

“I enjoy it here. I get the help I need.”

We spoke to three relatives who told us that they were happy with the care and support provided.

Records showed that people had a care plan in place that provided information on the support the people who used the service needed.

Staff were aware of the action to be taken to safeguard vulnerable adults from abuse.

A tour of the home indicated that the service was clean. Checks were undertaken to ensure the safety of the home environment.

There were systems in place to obtain the views of the people who used the service and their relatives about how the service operated. Records showed that action was taken to address any shortfalls identified.

Cheshire West and Chester Council had been involved in investigating some concerns that had been raised about the home within the last twelve months. They found that the home had taken appropriate action.

People living in the home said they were generally happy with the staff and services provided. They told us that they know all the staff as they had been there for a long time and that they were all very respectful and always knocked on their bedroom door and waited to be invited in.

Some comments made included for example,

“Staff go out of their way to be kind”.

“They are always very patient”.

“They provide us with love and care”.

People told us they had a care plan that held details of what care and support everyone needed.

One person said they had visited many homes before making Hillcrest their choice. The decision was made because of the smiling faces of the staff.” If they were happy there then I knew I would be.”

People told us they felt well cared for by the staff that supported them. Everyone we chatted to was positive about the support provided.

People told us that they feel safe and have no concerns about the care and treatment they receive from staff. They said staff were always available to talk to if people had any concerns.

The inspection took place on the 20 and 21 January 2015 and was unannounced. This meant that the provider did not know we were coming.

We last inspected Hillcrest Residential Care Home on 12 October 2013. At that time we found them to be meeting the regulations.

Hillcrest is registered to provide personal care for up to 32 older people. The home has bedrooms which are situated over two floors. Some bedrooms have en-suite facilities. There is a passenger lift and a stair lift. Shared facilities include three lounges, one dining room, a conservatory and bathing and toilet facilities. The home has a garden and patio area. The home is within a mile of the village of Frodsham.

The location is required to have 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.’ There was a manager in place who has been there for five months. They had applied to CQC to become the registered manager.

Those who lived at Hillcrest told us that they felt safe and that staff were caring. They felt reassured because staff had worked there for a long time; they knew them and were “Good at their jobs”.

The environment was safe, clean and homely. We saw that improvements had been made over the last few months following suggestions made by those who lived there, relatives and the new manager. There had been refurbishment of some bedrooms, replacement floors and a new wet room.

Staff had a good relationship with those they supported. On both days of the inspection we heard lots of laughter and banter and saw people had fun when they joined in the activities. Staff and people appeared at ease with each other.

Staff displayed a genuine warmth and care towards people and treated them as individuals. Care was given with dignity and respect. Staff explained to people what they were going to do, did not rush and were discreet.

Care and support was planned and delivered in line with individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. Community health professionals were contacted where help and support was needed.

Staff were supported through ongoing training and supervision. They were all being encouraged to develop further skills.

There was involvement and consultation with people who lived at the service, their relatives and staff about all aspects of the service including what improvements they would like to see. They were supported to attend meetings as were their relatives. There were quality audit systems in place to ensure that the care and service was effective.