We inspected Hillersdon Court on 10 and 11 April 2018 and our visit was unannounced. Hillersdon Court 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.

Hillersdon Court accommodates up to 20 people who require assistance with personal care. The service specialises in providing support to older people and people with dementia. At the time of this inspection 15 people were living in the service. People had varying levels of care and support needs. Some people were independently mobile and others required assistance with all aspects of their care. The home was on two floors with seven bedrooms on the ground floor and 11 bedrooms on the first floor.

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 the last inspection in January 2017 the home was rated requires improvement, there was a breach of regulation and a requirement notice was issued. The breach was in relation ineffective systems to assess and monitor the quality of services and in relation to record keeping. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in well-led to at least good.

We carried out this inspection to check the provider had made suitable improvements and to ensure they had met regulatory requirements. We found improvements had been made in relation to the areas identified at the last inspection but we made a recommendation to improve record keeping.

There were good recruitment procedures and enough staff to meet people’s individual needs. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Incidents and accidents were well managed. People’s medicines were managed safely.

People’s needs were effectively met because staff had the training and skills they needed to do so. Staff were well supported with training and appraisal. Staff supported people in the least restrictive way possible. People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them. People were supported to attend health appointments, such as the GP or dentist. People had enough to eat and drink and menus were varied and well balanced. Feedback from visiting professionals was very positive. One professional told us, “I have always found that the staff at Hillersdon are friendly and appear to go about their business in a caring and professional manner.”

People were supported to take part in a range of activities and regular one to one time was provided to people. Visitors told us they were welcomed and people were supported to maintain important relationships and friendships.

The environment was clean and well maintained. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks were all up to date. There were on-going improvements to the environment, for example the dining room and lounge areas had been swapped and feedback received regarding this change had been very positive.

Feedback was regularly sought from people, relatives and staff. People wer

The inspection of Hillersdon Court took place on 10 and 11 January 2017 and was unannounced.

Hillersdon Court provides accommodation for up to twenty older people, some of whom are living with dementia. At the time of our inspection there were 18 people living at the service. People had varying levels of care and support needs. Some people were independent with regards to their mobility and others required assistance with all aspects of their care. The home was on two floors with seven bedrooms on the ground floor and 11 bedrooms on the first floor. The ground floor also included a kitchen, the dining room, a communal lounge with access to the garden and an office.

There was a registered manager at the home. 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 2008 and associated Regulations about how the service is run.

Throughout our inspection, people spoke positively about the home. Comments included, “We are happy living here.” and, “The staff are very caring and patient to everyone in the home.” Although staff and managers knew people well and had a good understanding of their individual needs and choices the lack of consistent recording of information meant people’s records did not always reflect the care they required or received. People’s individual risk assessments and care plans were person-centred and reviewed monthly however these were not always updated to ensure that people received care based on their current needs.

Aspects of medicine management needed to be improved. There was no guidance for staff to understand where to apply topical creams and a lack of clear person centred PRN guidance to ensure that people only received these medicines when they needed them.

People told us they felt safe living at Hillersdon Court. There were sufficient levels of staff to protect people’s health, safety and welfare. The provider had recently increased staffing levels based on the increased dependency of people’s needs.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. Staff encouraged and supported people to eat and drink well. One person said, “I thoroughly enjoy the food here.”

Staff knew the individual personalities of people they supported. We saw staff were kind, compassionate and patient and promoted people’s privacy, dignity and choice. People were encouraged to be as independent as possible and we saw friendly and genuine relationships had developed between people and staff. A staff member told us, “We know the residents like family. I love working here.”

Training schedules confirmed staff had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected. Staff had received regular supervisions with their manager to discuss additional training needs and development and annual appraisals.

Robust recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. Staff received an induction followed by a week of shadowing experienced staff.

People’s health and wellbeing was monitored and staff regularly liaised with healthcare professionals for advice and guidance. A healthcare professional told us, “They are very responsive and proactive. If they have any concerns they are on the phone straight away.”

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place. The registered manager was familiar with the processes involved in the application for a DoLS, and had made the necessary applications to the authorising authority. Where people lack

This follow up inspection was to check on the non-compliance identified during the previous inspection, regarding the safety and suitability of the premises.

During this inspection we found that significant improvements had been made throughout the home and people who used the service stated they were happy with the changes. One person told us "“It’s lovely here now, so much brighter everywhere”.

During our inspection we found that the premises were clean and the atmosphere was relaxed and homely. However we found that procedures for maintaining the premises, including monitoring the physical environment, were inadequate and inconsistent.

We found that comprehensive and well maintained person centred support plans enabled care workers to meet people's assessed needs in a structured and consistent manner.

Care workers had developed awareness and a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

In accordance with their individual care plans, people were supported to make choices about their daily lives. They had input into how the home was run and were able to influence decision making processes.

Positive comments from people using the service indicated satisfaction with the home and the services provided:

“I’m happy living here. I’d rather be in my own home of course but it’s comfortable here, the food’s good and the staff are all so caring”.

“There is everything I need here and always company when I need it. I like my room and the staff are very kind”.

Appropriate arrangements were in place in relation to storing, administering handling and recording medicines.

People who could give us their views told us they were happy living at the home. They told us they enjoyed the food and the activities on offer. They told us they could make their own decisions about when they got up, how they spent their time, what, where and when they ate and when they went to bed.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed that people were engaged in a range of activities with staff and each other which they clearly enjoyed. It was evident from the laughter and conversations we observed that people had established good relationships and were comfortable in their surroundings.

It was clear that staff knew the people who lived in the home well and were aware of their support needs. We observed staff treating people with dignity and respect and displaying patience and understanding whilst supporting them.

Two people commented on how much they liked their rooms and accommodation.

One individual said how happy she was in the home and said ‘I really like the fact that if I ask a question I get an answer’. Another described how he was involved in his admission to the home and that he had chosen this home as his wife was already here and ‘nicely settled’.

Two further people said that they liked to be on their own and have some quiet private time. This was seen to be respected by the home both having time alone in their own rooms.

All people who were spoken with during the visit to the home expressed a satisfaction with the care provided. Comments included ‘the home is marvellous’ ‘I am well looked after’.

Three people expressed a satisfaction with the food. One person said ‘the food is good and this is seen because of the empty plates. There is also a good variety in the food’.

Everyone spoken with were happy with the home and facilities and one person complimented the laundry service. ‘The laundry service is good we get clean towels regularly and our laundry is well completed.

People expressed a high satisfaction with the staff in the home with comments including how nice the staff are and that they are always courteous.

Hillersdon Court is a residential home providing care for older people and people living with dementia in Seaford. People required varying levels of care and support. Some were independent with regards to their mobility and just required some assistance or prompting with washing and dressing. Whilst others required assistance with all care needs.

The service is registered to provide care for up to 20 people. At the time of the inspection there were 18 people living at the service.

This was an unannounced inspection which took place on 6 and 7 July 2015.

The last inspection took place on 21 October 2013. This was a follow up inspection and the service was compliant.

Hillersdon Court had a registered manager. 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 2008 and associated Regulations about how the service is run.

New style care documentation had been implemented in recent months. Care plans reviews had not been kept up to date, and some care files had not been reviewed since they had been re-written in the new format in March 2015. A lot of work had been completed by the registered manager to improve care documentation and there were plans to delegate some of the reviews to senior care staff, however, this had not yet been implemented. We have made a recommendation about care documentation.

There was no overview or auditing by the provider which would identify shortfalls in the new auditing or care planning documentation. Provider visits had not been documented to identify how they were supporting the registered manager to fulfil their role within the service.

There was no guidance in place for ‘as required’ medicines to ensure consistency in administration. We have made a recommendation about the management of some medicines.

There was no available guidance for a night time evacuation, as staffing numbers were not the same as in the daytime. There was a robust evacuation procedure for staff to follow in the day in the event of emergency evacuation being required. We have made a recommendation about fire safety.

Portable appliance testing (PAT) had not been completed for all areas of the service.

Risk assessments both environmental and individual were in place for all identified needs.

Staff training took place regularly with staff attending relevant training to meet the needs of people living at Hillersdon Court. Staff felt that the training they received was effective and enabled them to provide good care. We received positive feedback from visiting professionals about the registered manager and staff. People were looked after in a kind and caring manner and staff knew how to respond in an emergency situation or when people became unwell.

New staff worked through a period of induction. With staff receiving regular supervision, appraisals and support including staff meetings. Relatives and visiting professionals told us they were particularly impressed with staff knowledge and how they responded when people became unwell.

People living at Hillersdon Court and their relatives spoke positively about the care provided at the service. People felt involved and supported to make decisions.

The registered manager and staff knew people well telling us about people’s likes dislikes and preferences. Staff understood the importance of tailoring their communication to meet the needs of people and supporting them to make their own decisions.

People told us that they enjoyed the meals provided and were able to pick an alternative if they did not like the meal on that day. Staff provided appropriate support and encouragement to people at mealtimes. Snacks and drinks available throughout the day. Meal times were a social occasion with people supported appropriately. When people’s appetite was small or they lost weight referrals were made to the GP in a timely manner.

Care staff were responsive to people’s needs. Identifying promptly when people were unwell.

Staff displayed an obvious affection for people, and people responded positively to staff interaction. Relatives spoke highly of staff and their knowledge of people’s needs.

Activities were provided, with access to games, books and flower arranging equipment. People told us they enjoyed the visiting activity provider. Some people spent time in their rooms watching television or listening to music and organised their time independently.

The registered manager carried out a number of audits to identify concerns. Not all documentation had been kept up to date. We have made a recommendation about the continued improvement of the service.