Hillcrest Resident Home 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.

Hillcrest Residential Home is a care service for up to 13 older people who may be elderly, have a physical disability or could be living with dementia. The service does not provide nursing care.

There were eight people living in the service when we inspected on 3 August 2018. This was an unannounced inspection.

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.

At our last inspection of March 2017, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service had failed to ensure the safe and proper administration of medicines. The service did not have an effective quality assurance monitoring process in place. There were no policies and procedures regarding the MCA and consent in place. The service had not informed us of important information as it is required to do.

In the key line of enquires questions for safe, effective and well-led we rated the service as ‘requires improvement’. In the key line of enquires for care and responsive we rated the service ‘good’. This resulted in the overall rating of the service for that inspection being ‘requires improvement’.

At this inspection of August 2018, we noted there have been improvements to the service but further improvements are necessary as the service remains at a rating of ‘requires improvement’. There were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In the key line of enquiries question for effective the rating has improved to ‘good’ but safe and well-led were still rated as ‘requires improvement’.

The administration of medicines had improved since our last inspection but still required further improvement to be safe. Medicines were now administered individually and staff completed the medication administration record (MAR) chart after each administration.

The formal monitoring and audit systems now in place continued to require further operational evidence to show how the registered manager and senior staff assessed the quality of the service, identified shortfalls and ensured that these were addressed promptly. This resulted in a lack of oversight of the whole service from the registered manager and identification of areas that required improvement. People using the service did not have a Personal Emergency Evacuation plan.

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 relation to the Mental Capacity Act 2005 (MCA) were up to date.

The service had sent notifications to the Care Quality Commission of important events that had happened at the service.

There were sufficient numbers of staff employed at the service to care for the people living in their home. The rota was clear with regard to which staff were working. The registered manager or senior staff on duty were cooking the meals for people to cover a vacancy in the catering team.

The recruitment process for the employment of staff was clear and safe procedures were followed.

There remained some gaps in training records but staff had received some training and supervision since our last inspection and further training and supervision was planned.

People had sufficient amounts to eat and their dietary nutritional needs were met. People were encouraged to attend appointments with health care profe

Hillcrest Residential Home is a care service for up to 13 older people who may be elderly, have a physical disability or be living with dementia. It does not provide nursing care.

There were nine people living in the service when we inspected on the 13 and 17 March 2017. This was an unannounced inspection.

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.

At our comprehensive inspection of 02 October 2014, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which was: Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Cleanliness and infection control. At our focussed inspection of 18 June 2015, we found that improvements had been made but needed embedding in the service.

You can read the report from our last comprehensive and focused inspection, by selecting the 'all reports' link for Hillcrest Residential Home on our website at www.cqc.org.uk. This comprehensive inspection was undertaken to check that further improvements to meet legal requirements had been made.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were needed to ensure that medicines were administered safely and in line with best practice.

There were insufficient numbers of staff and improvements were required in the recruitment process to check that staff were suitable to work with vulnerable people. Staffing issues had been identified by the manager and they were trying to address this.

There were some gaps in training records and staff required refresher training to ensure that they were knowledgeable and could support people safely and effectively.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in relation to the Mental Capacity Act 2005 (MCA) were not up to date. Whilst the service had made reference to people's ability to consent within their care records, there were no formal capacity assessments in place to determine people's level of understanding in accordance with the MCA. Staff understanding of what the MCA meant in practice was limited.

People told us that they had good relationships with the staff that supported them and people were encouraged to be as independent as possible by a staff team who knew them well. People cared were not always able to call for assistance if needed.

People had sufficient amounts to eat and their dietary nutritional needs were met. However, where people’s needs changed, these had not always be re-assessed to ensure that the people were having enough fluids to keep them well.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

There were no formal monitoring or audit systems in place to show how the registered manager assessed the quality of the service, identified shortfalls and ensured that these were addressed promptly. This resulted in a lack of oversight of the whole service and areas that required improvement from the registered manager. The service had failed to notify us when a person using the service sustained a serious injury.

We carried out an unannounced comprehensive inspection of this service on 2 October 2014. We found a breach of a legal requirement related to Infection control. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to the breech.

We undertook this focused inspection to check that they had followed their improvement plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to the breach. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillcrest Residential Home on our website at www.cqc.org.uk.

Hillcrest Residential Home provides care for up to 13 older people who may be elderly, have a physical disability and or be living with dementia. It does not provide nursing care.

There were nine people living in the service, when we carried out our unannounced inspection 18 June 2015.

A registered manager was in post at the service. 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.

Significant progress had been made to improve the systems in place to protect people from the risks associated with infection control. This included maintaining appropriate standards of cleanliness and hygiene. A planned programme of refurbishment and decoration to the premises was underway and people were positive about the changes made. However at the time of our inspection not all of the provider’s actions had been completed. Following our inspection the provider submitted to us a revised action plan that assured us the outstanding actions were in progress or had since been completed.

The progress we found through the introduction of new and improved systems mitigated the risks to people. However these need to be embedded and sustained over time to ensure people are provided with a consistently safe service.

This inspection was unannounced and carried out on 2 October 2014.

Hillcrest Residential Home is a care service for up to 13 older people who may be elderly, have a physical disability or be living with dementia. It does not provide nursing care. At the time of our inspection there were 11 people who used the service.

A registered manager was in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At the last inspection on 15 April 2014, we asked the provider to take action to make improvements relating to records and assessing and monitoring the quality of service provision. Following the inspection the provider sent us an action plan to tell us the improvements they were going to make.

During this inspection we found that improvements had been made with further plans in progress to strengthen the management team to improve and maintain overall quality in the service. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to protecting people by maintaining the home to a clean and hygienic standard. You can see what action we told the provider to take at the back of the full version of this report.

People that we spoke with told us they felt safe, were treated with kindness, compassion and respect by the staff and were happy with the care they received.

Staff had the knowledge and skills that they needed to support people. They received training and on-going support to enable them to understand people’s diverse needs and work in a way that was safe and protected people. Risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to keep people safe. Systems were in place to provide people with their medication in a safe manner.

There were sufficient numbers of suitably skilled staff to meet people’s care needs. Staff received an induction, ongoing training, regular supervision, an annual appraisal and opportunities for professional development.

People’s care records were up to date and provided clear guidance to staff on how to meet people’s individual needs, promote their independence and maintain their health and well-being.

We found that people were supported to attended appointments with other healthcare professionals such as opticians, physiotherapists, dentists and chiropodists. This showed that people were supported to maintain their health and well-being.

CQC monitors the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals.

We found the service was meeting the requirements of the DoLS. The registered manager had a full and up to date knowledge of the MCA 2005 and DoLS legislation, and when these applied. Documentation in people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests. This meant that people who could not make decisions for themselves were protected.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People told us they liked the food and were provided with a variety of meals including both hot and cold options. We observed that people were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner

Throughout the inspection we observed staff interacting with people in a caring, respectful and professional manner. Where people were not always able to express their needs verbally we saw that staff were skilled at responding to people’s non-verbal requests promptly and had a good understanding of people’s individual care and support needs.

People were supported with their hobbies and interests and had access to a range of personalised, meaningful activities which included access to the local community. People knew how to make a complaint and felt that their choices were respected.

Improvements had been made to assess and monitor the quality of the service provided.

During our previous inspection on 23 October 2013 we found shortfalls with consent to care and treatment, care and welfare of people who used the service, supporting workers and complaints.

As part of our inspection on 15 April we followed up on the non-compliance found at the last inspection. We found that improvements had been made to address our previous concerns. However we found shortfalls with assessing and monitoring the quality of the service and records. We have asked the provider to submit an action plan telling us how they will address these concerns.

During this inspection we spoke with nine people who used the service. We also spoke with three members of staff including the registered manager. We looked at five people’s care records. Other records seen included: care plans and risk assessment reviews, complaints log, fire safety checks, maintenance logs, water temperatures, and safety checks on equipment.

We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe, Is the service effective, Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff asked to see our identification and asked us to sign in the visitor’s book. This meant that appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access the service.

People told us they felt safe, protected and their needs were met. One person said, “They (staff) are very on the ball and look after me very well. I have no complaints. I feel safe and secure here, nothing troubles me.”

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, we saw that policies and procedures were in place. The registered manager confirmed that relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded.

Records seen confirmed that staff were booked onto upcoming or had received training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and DoLS. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Records seen confirmed external checks were carried out to ensure the safety of the premises and equipment was maintained and serviced.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Records showed that staff supervision and training was planned and delivered as required. This meant that staff had the support and skills to deliver care effectively.

Is the service caring?

Staff interacted with people who used the service in a caring, respectful and professional manner. People told us they were happy with the care they received and their needs were met. One person told us, “The staff can’t do enough for you they are very attentive, kind, and all round decent people.”

Staff had a good understanding of the people’s care and support needs and knew them well.

Is the service responsive?

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor, district nurses, mental health teams and chiropodists.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and were supported and trained to meet people’s needs.

People's care records and risk assessments were accurate and up to date.

Records seen were kept securely. However during our inspection the registered manager had difficulty accessing certain records we requested and these could not be located promptly when needed.

The provider did not have systems in place to show how feedback from people who used the service about their views and experiences was valued, taken into account and influenced the running of the service.

The provider did not have systems and procedures in place to monitor and assess the quality of the service provided. There were no records to identify shortfalls in the service and how they had been addressed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvement they will make in relation to their records.

We spoke with five people who used the service, three members of staff and the registered manager as part of this inspection. People who used the service told us, that they liked the service and they felt safe. One person said, “This is really nice here and we have a pet cat.”

Three people told us the food was well cooked and lots of choice. One person said, “The cakes are first class.”

We found that the service was meeting the social needs of people and worked in co-operation with other providers of care to meet people’s needs. The service had not recorded that it had sought people’s consent when their care plans had been reviewed and updated. The environment was undergoing refurbishment of the roof and double glazed windows with internal decorating with which the people who used had selected the colours used.

The service had not provided regular staff training or supervision which meant that staff may not have been u to date with the requirements of current practices. We also found that the complaints policy was out of date. We were not aware that anyone wanted to make a complaint at the time of us visit and service did not have any outstanding notifications of which needed to be informed to us.

People told us that staff were polite and that they treated people with respect. People told us that they were able to decide what to do with their time and that they were able to go to bed whenever they preferred. Several people expressed a wish to be able to go into town more and to have more opportunities to go on day trips.

One person using the service told us, “The staff here are fine. The food is usually good and, if I want to be alone, I can be.”

We were told that people were well cared for and they received their medicines at the times they expected them.

People said that there were always enough staff available to help them and that they rarely had to wait for assistance.

Resident meetings were sometimes held and people confirmed they could attend if they wanted to.