Hillcrest Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is situated in Tyldesley, Greater Manchester and is registered to provide accommodation for up to 17 people who require personal care and support. At the time of this inspection 17 people were living at the home.

At our last inspection 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 ongoing 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.

During the last inspection, although the home was rated as good overall, it was rated as requires improvement in the KLOE safe, as we identified a breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to medicines management. During this inspection we found the provider had addressed the previous regulatory breach and was now meeting all requirements of the regulations.

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 living at Hillcrest Residential Home. Relatives were also complimentary about the standard of care provided. Staff had received training in safeguarding and knew how to report concerns.

Care files contained detailed risk assessments, which were regularly reviewed to reflect people’s changing needs. This ensured staff had the necessary information to help lessen risks to people living at the home.

Staffing levels were determined based on people’s dependency levels. People, their relatives and staff all told us enough staff were on duty to safely meet people’s needs.

Medicines were managed safely. The home had effective systems in place to ensure medicines were ordered, stored, received and administered appropriately.

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.

The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role.

People were encouraged to make decisions and choices about their care and had their choices respected. People's consent to care and treatment was also sought prior to care being delivered.

People’s nutrition and hydration needs were being met. Meal times were observed to be a positive experience, with people having a choice into both what and where they ate.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect.

Care plans contained detailed, personalised information about the people who lived at the home and how they wished to be cared for. Each file contained detailed care plans and risk assessments, which helped ensure their needs were being met and their safety maintained.

The home had a complaints procedure in place and whilst people told us they had no cause to complain, they knew how to do so, should they need to.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Action plans were drawn up, to ensure any

During our inspection we spoke with five people living at Hillcrest and two visitors. All of the people who we asked told us that they were happy with their care and support and they thought they were well looked after. One person told us "I can make my own choices about what I do. I am OK here.” Another person said; "The food is good, mealtimes are very important in a place like this.”

People told us that staff asked for their permission before giving care and support. During our inspection we saw many examples of this taking place.

We looked at the systems in place for the ordering, storage, administration and disposal of medicines. We found that there were appropriate procedures in place and that staff were aware of their responsibilities to ensure that medicines were given safely.

Staff told us that they were supported and that they had received sufficient training for their role. We saw that staff had received regular training and there were plans in place to ensure that all staff members were updated on important aspects of care.

We checked the systems in place for monitoring the quality of care provided at the home and found that an effective system was in place. Some aspects of the system had been updated and had not been fully implemented but the plans were almost completed. Most people we spoke with could not think of anything that needed to be changed or improved.

During the visit, we spoke with two people who use the service. They told us the staff kept them involved in the review of their care and always explained what they were doing. They told us they were happy with the care they received and that the staff were friendly, helpful and supported them well.

The people we spoke with told us they felt there were enough staff around to help them and that they did not have to wait long for assistance. They also told us that they had no concerns about the care they received and would speak to the registered manager if they had any concerns.

People living at Hillcrest Residential Home told us that they felt that they were treated with respect and liked receiving support from the service. People said that they were able to make choices and encouraged to take control of their lives.

People also told us that staff were kind and knew what to do to meet their needs. People told us that they liked the food and they enjoyed the activities that were offered.

People said that they felt safe and confident with the staff and that the manager and owners of Hillcrest were approachable, accessible and listened to what was said.

Comments included:

‘It’s smashing here –feels like they’re all related to me.’

'The staff are nice.’

‘I’m quite happy with everything so far I’ve no concerns I’m happy with what we’re getting here.’

‘It’s alright thank you staff are alright they’re human beings…’

And

‘If I wasn’t happy I would tell one of the owners.’

This inspection took place on 16 and 18 November and was unannounced.

We last inspected Hillcrest Residential Home on 03 September 2013, when the service was found to be meeting all standards inspected.

Hillcrest Residential Home is based in Tyldesley, Greater Manchester. The home is registered to provide accommodation for up to 17 people who require personal care and support. At the time of our visit there were 17 people living at the home.

There was a registered manager in post who was also a director of the company. The acting manager was in the process of registering with CQC. 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 this inspection we found one breach of the regulations in relation to safe care and treatment. You can see what actions we told the provider to take at the back of the full version of this report.

We received positive feedback about the service and the staff from the relatives and people living at the home we spoke with. There was a consistent staff team and relatives told us the staff were very caring and approachable. Relatives told us there was a high standard of care at the home.

People’s needs had been assessed before they moved into the home. We saw that care plans had been regularly reviewed. There were more frequent reviews of risk assessments and care plans during the first few weeks of someone moving in, which allowed an accurate assessment of needs and preferences to be developed.

Staff demonstrated that they knew the people they supported well, and were aware of people’s preferences as documented in their care plans. Staff were able to give examples of how they had worked flexibly to meet people’s needs and preferences.

Staff had received training in a range of areas including health and safety, the Mental Capacity Act (MCA) and deprivation of liberty safeguards (DoLS) and dementia. Staff told us they were well supported and received regular supervision from their manager.

The acting manager told us a holistic model of dementia care was used in the home. This placed emphasis on activity and sensory stimulation. Staff were aware of the additional support needs people living with dementia may have and how to meet these effectively.

We saw a singing activity taking place during our visit. People told us they took part in other activities such as hand massage and regular trips to the local pub and social clubs. The relative of a person cared for in bed told us the staff frequently checked on their family member, and would put the radio on for them or read the newspaper to them.

The service was meeting the requirements of the MCA and DoLS. Some people had an authorised DoLS in place and details about this were included in people’s care plans.

Medicines were administered and stored safely. However, there were no plans in place that detailed how and when ‘when required’ (PRN) medicines or covert medicines should be given. There were also gaps in some of the records, so it was not always possible to tell whether people had received their medicine as prescribed. This was a breach of the regulations.

Staff, relatives and people living at the home told us they thought there were sufficient numbers of staff to meet the needs of people living there. During our inspection we saw that people received support as required.

People told us they liked the food and had enough to eat and drink. We observed the mid-day meal and saw people received the support they required to eat and drink. People’s weights were monitored and referrals to other health professionals were made when required.

We looked at staff personnel files and saw references were missing from one person’s file. We could not see evidence that consideration had been given to another person’s criminal records check certificate although the provider assured us this had been discussed at interview.

The manager and provider undertook regular audits to help monitor and improve the quality and safety of the service. The service had acted on feedback received at the last CQC inspection.

Staff were organised and well managed. Staff told us they worked well together as a team and felt valued.

We saw the service kept a record of complaints. This showed that complaints had been investigated and responded to appropriately. None of the people or relatives we spoke with told us they had raised a complaint, but said they would feel confident doing so if required.