About the service: Hillsborough Residential Home (“Hillsborough”) is a residential care home that was providing accommodation and personal care to 21 people aged 65 and over at the time of the inspection. Hillsborough Residential Home Limited also provided personal care to people in their own home. They were providing support to five people; four of whom received personal care.

People’s experience of using this service:

•People did not always receive their medicines safely and were not always protected by infection control practices.

•People did not always have the required risk assessments in place relating to their health and social care needs, to help keep them safe.

•Staff were not always recruited safely to ensure they were suitable to work with vulnerable people.

•Systems of leadership and governance did not ensure that there were effective checks of the quality of the service taking place.

•Staff had not always received the appropriate training, professional development, and supervision to carry out their duties.

•People and relatives were positive about the service and the care given in the residential home and in their own homes. People told us the food was delicious.

Rating at last inspection: The rating at the last inspection was Requires Improvement (Report published 05 April 2018).

We found seven breaches of the Health and Social Care Act (2008), and made recommendations in respect of the environment, and the Accessible Information Standard (AIS).

Why we inspected: We inspected the service in line with our inspection methodology. We followed up on the breaches of Regulations and the recommendations from the previous inspection.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this registered provider is requires improvement. Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated requires improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out an unannounced comprehensive inspection on the 06 and 11 of December 2017.

Hillsborough Residential Home is registered to provide residential care for up to 22 people. At the time of our inspection there were 22 people living at the service. The provider was also registered to support people with personal care within their own homes; known as a community care service. At the time of our inspection, there were nine people receiving support.

Prior to our inspection we had received concerns about the safety of the building and people’s access to the kitchen. We looked at these concerns as part of our inspection and found that improvements were required.

Hillsborough Residential Home had a registered manager who was also the registered provider. 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. The provider was supported by a deputy manager. The deputy manager was in the process of undertaking a qualification in leadership and management to enable them to become the registered manager of the service.

At our last inspection in June 2015 the service was rated Good. However, at this inspection we found the service to require improving.

Overall, people living at the care home were supported by sufficient numbers of staff to be able to meet their needs. However, staff told us that sometimes they were understaffed because the provider did not find additional cover when staff were on annual leave or unwell. Staffing rotas also showed this. People were looked after by staff who were trained to meet their needs. New members of staff completed an induction to introduce them to the day to day aspects of the service, and to relevant policies and procedures.

People’s care plans and personal risk assessments contained good detail about how important it was that their physical care needs were safely monitored. However, when people had a specific risk relating to their healthcare, risk assessments were not always in place to help guide staff to provide safe and consistent care. The provider had not considered whether the format of people’s care plans met with their individual communication needs.

Accidents, incidents and falls were monitored to establish if there were common trends, so as to help minimise repetition. People had personal emergency evacuation plans (PEEPs) in place. This meant the emergency services would know what to do, for each person living in the home in the event of an emergency such as a fire.

Policies relating to the environment were not always being adhered to by staff. For example, the kitchen door which should have been closed to ensure people’s safety was found to be open. We also noted the environment was cluttered, with many items of furniture which impeded people’s movement. People were not always supported in the environment because signage was not always clear and may not have always been in a suitable format for people to understand.

People’s medicines were managed safely, with good recording processes in place. People’s health needs were met. Staff worked closely with external health and social care services to help ensure a co-ordinated approach to people’s care.

People were protected by the providers safeguarding processes, staff knew what action to take if they suspected someone was being abused mistreated or neglected. Overall, people were supported by staff who had been recruited safely to ensure they were suitable to work with vulnerable people. However, we did note for one employee the provider had not followed their own recruitment policy, by ensuring their employment history had been obtained.

People living in the care home told us the food was nice. However, some people who received

We spent time talking with staff and observing care practices as well as talking to people who used the service. Comments included “They look after me.” and “I like being pampered.”

We observed that staff spoke with people in a friendly and respectful manner. People told us that they were able to make choices about their day to day lives. One person told us “It’s brilliant here.”

The care plans we looked at were personal to the individual and gave staff clear information to follow. This made sure that people received care and support which met their individual needs.

The environment was clean and there were systems in place to minimise the risk of infection.

There were robust systems in place to ensure that before staff began working in the home that they were safe and trained to look after the people.

The home kept a log of all complaints and concerns raised. One person told us “I have no complaints, but I could talk to staff if I did.” We read the log and saw that all concerns were responded to promptly.

We also inspected the Hillsborough Domiciliary Care Service which is managed from the care home. We found that care plans provided information for people using the service and staff to ensure people’s needs were met.

We found that there have been improvements made to the way medicines are looked after in the home. We did not speak with people in the home on this visit, as we were following up on areas of concern from previous inspections. We observed the way some medicines were being given and checked medicines records for people in the home. We spoke with the manager and deputy manager about the work they had done to make these improvements. We saw that they had improved the way medicines are stored, administered and recorded.

We (the Commission) carried out this inspection as part after concerns were sent to CQC. We made an unannounced visit to the home on 17 September 2012 as part of the inspection, in part to follow up information we had received that suggested the home might not be fully compliant with the essential standards of quality and safety.

We reviewed all the information we held about this provider. We talked with people who use services, relatives, staff and talked with a visiting health professional. We checked the provider’s records, and looked at six care records of people who use services.

We talked with fourteen people who lived in the home and the staff on duty. We saw people’s privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. People living at the home were all complimentary about the home environment, food, staff and the care they received. Their comments included,

“More than happy with everything” and “The food and care is excellent”, “It is fit for royalty”.

People said that they would feel able to complain if they needed to. We talked to people using the service and staff about how people are kept safe. People told us, “I feel safe here and I like the staff”. A relative said, “We are always kept informed and couldn’t ask for a better place”. “Maria, the manager, is wonderful”

Staff were clear about the actions they would take should they have any concerns about people's safety.

We pathway tracked six people who use the service. Pathway tracking means we looked in detail at the care six people received. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them.

We spoke with one visiting health professional who confirmed that the staff at the home were helpful.

We looked at medication systems and we found that the management of prescribed and controlled medication was not managed consistently. The management of prescribed creams was not well managed and the registered manager assured us that this would be addressed promptly.

We found that many parts of the home to be unclean, untidy and there were offensive odours in some areas.

We found no auditing systems in place. Auditing systems put in place would ensure all areas would be monitored and any issues would be addressed.

All of this information helps us to develop a picture of what it is like to live at Hillsborough House Residential Home.

The inspection took place on 11, 12, and 22 June 2015 and was unannounced to the care home and announced to the domiciliary care part of the service.

Hillsborough Residential Home provides care and accommodation for up to 22 people who are living with dementia or who may have physical difficulties. On the day of the inspection 20 people were living at the care home. The home is on two floors, with access to the upper floor via stairs or a stair lift. Some bedrooms have en-suite facilities. There are shared bathrooms, shower facilities and toilets. Communal areas include two lounges, a conservatory, two dining rooms and an outside garden and patio area.

The service also provides domiciliary care services to adults within East Cornwall. On the day of our inspection 12 people were using the service. The home care service provides palliative care, as well as supporting people with physical disabilities, sensory impairments and mental health needs, including people living with dementia.

At our last inspection in December 2013 the provider was meeting all of the Essential Standards inspected.

The service had 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 were protected from avoidable harm and abuse that may breach their human rights. The registered manager and deputy manager understood how the mental capacity act and deprivation of liberty safeguards protected people to ensure their freedom was supported and respected. This meant decisions were being made for people with proper consultation. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision should be made involving people who know the person well and other professionals, where relevant. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty.

People’s medicines were managed well which meant they received them safely.

People were supported by sufficient numbers of staff who had the knowledge, skills and experience to carry out their role. The registered manager provided support and training for staff. Staff supported people with their individual nutritional needs and took appropriate action when concerns were identified. Drinks were offered to people regularly. People could access health care services and the registered manager had systems in place to ensure staff shared information about people’s health care to help ensure prompt action was taken when required.

People were supported by staff who promoted and showed positive and inclusive relationships. Staff were kind, caring, compassionate and tactile in their interactions with people. People were encouraged and empowered to remain independent. Staff were considerate and respectful which helped to ensure people’s privacy and dignity were promoted. People’s views were valued and used to facilitate change. The registered manager welcomed feedback to enable learning and improvement, for example, complaints were considered positively.

People received care which was personalised to their needs. Care plans and risk assessments did not always give clear direction to staff about how to meet a person’s needs and activities were limited. However, from our observations and conversations with staff it was clear they were knowledgeable about people. People received a co-ordinated approach to their care when they moved between services because people had in place summary care plans which were shared with other professionals to help ensure continuity of care for people.

The registered manager and deputy manager promoted a positive culture that was open, inclusive and empowering to people, staff and visitors. The quality monitoring systems in place helped to ensure continuous improvement.