This inspection took place on 11, 12 and 13 April 2017. It was an unannounced visit to the service.

We previously inspected the service on 1 and 2 March 2016. We found two breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. We asked the provider to send us an action plan on how they would make improvements to the service. They told us they would implement the improvements by 31 May 2016. At this inspection we checked to see what improvements had been made. We found the home had made significant improvements in both of the areas identified.

Hillside is a nursing home for adults. It is registered to provide care up to 68 younger and older adults. At the time of our inspection 59 people lived at the home.

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 who were prescribed medicines and were unable to take these independently had support from staff who had received training. General medicines were stored securely, however stock control required improvement for medicines that had potential to be abused. We have made a recommendation about this in the report.

People were supported by staff who had been recruited through robust procedures. People told us they felt there were enough staff on duty for them to receive safe care.

Staff had access to training to equip them with the right skills to support people. Staff were appraised and development plans were in place. We noted people who lived at the home were encouraged to assess new staff and help them develop.

People had good access to external healthcare professional and a GP visited the home each week. People were confident any changes in health would be responded to by staff.

Consent was sought from people or their legal representative. Where required the service made applications to the local authority to deprive someone of their liberty. The registered manager was aware of the need to inform CQC of certain events and had done so when needed.

People had access to a wide variety of activities both inside the home and the local area. We noted some people attended regular support groups outside of the home. The home had a virtual reality headset where people could enjoy different experiences. One person had gone deep sea diving and another had gone on a bird flight. People spoke positively about their experience.

Positive caring relationships had developed between staff and people they supported. We observed there was good team work among staff.

People were involved in developing their care plans. Care plans were comprehensive and reviewed regularly.

This inspection took place on 01 and 02 March 2016. It was an unannounced visit to the service.

We previously inspected the service on 22 July 2014. The service was meeting the requirements of the regulations at that time.

Hillside provides nursing care for up to 67 people, including older people and younger adults. 54 people were living at the service at the time of our visit.

The service did not have a registered manager in post. The previous registered manager left the service in May 2015. 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. A new manager started at the home on 7 March 2016.

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Individual risks were managed well at the service but we found people had not been protected from hazards they may come into contact with around the building. For example, clinical waste was accessible in a sluice room as the door was not always kept locked. Standards of food hygiene and general cleanliness also needed attention to prevent the spread of infection.

Staff were recruited using robust procedures to make sure people were supported by workers with the right skills and attributes. Staff received appropriate support through a structured induction, regular supervision and an annual appraisal of their performance. There was an on-going training programme to provide and update staff on safe ways of working.

People told us it took a long time for their call bells to be answered when they rang for assistance. A typical comment was “It takes them 20 minutes or more to come, not good at all.” We checked the call bell log and did not find evidence of this. However we have asked the service to monitor this and make further investigations.

Care plans had been written to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s circumstances. Staff were able to tell us about people’s needs and how they supported them. Referrals were made to external agencies where people needed specialist support.

Systems were in place to monitor the quality of the service. Some staff were fully aware of the values and visions of the provider.

Staff did not always respect people’s privacy and dignity as staff did not always knock prior to entering a person’s room.

We found whilst there was a process for recording formal written complaints, no record was kept of any day to day concerns and complaints raised by people who live at Hillside. We have made a recommendation about the recording of complaints or any issues raised by people who live at the home.

Mental capacity assessments took place where needed. Deprivation of liberty safeguards (DoLS) applications had been approved by the local authority and had been reported to CQC as required. However consent and user involvement was not routinely recorded. People told us they did not feel involved in decision about their care and treatment. We have made a recommendation about seeking and recording consent from people or their legal representative.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to processes about medicine, infection control practice and risk management. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

Hillside is registered to provide accommodation and nursing care for up to 67 people. This includes people living with dementia. There are six units over two floors, including ‘Lowry’ unit which provides care and nursing to 17 adults with long term disabilities. At the time of our visit there were 65 people living in Hillside.

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

People told us there had been times when there were not enough staff. They said there were too many different agency staff. This meant they didn’t always know them and had to tell them each time how they liked their care provided. People and their relatives also said the majority of staff were very caring and that, despite being very busy, they were patient, kind and considerate. "I am well cared for" was what one person told us having also told us there were too many agency staff used.

A high turnover of staff meant training and supervision had become inconsistent across the staff team. Staff told us however, they felt supported by the management and thought they; "worked well as a team". One member of staff told us whilst they knew staff turnover had been high, this "Was a good thing if they kept the right staff for the home and the others left".

We observed relaxed and respectful interaction between staff and people. People told us they had no concerns over their safety. People who provided a range of health services into the home were mostly positive about both the standard of care they saw. They were also positive about the communication and co-operation they received from the manager and staff.

Staff had received training in how to identify and report abuse of any kind. The manager had reported any incidents of concern promptly and in line with good practice requirements.

People were offered choice about their care and could influence how it was provided. This process was supported by a system of assessment, review and care planning which ensured people’s needs were met in a way which reflected their wishes and respected their individuality.

People knew who to speak to if they had any concerns or wished to make a complaint. People felt the staff and manager were approachable. We found there were systems in place to seek people’s views about the quality of the service. Where issues or concerns were identified they were addressed wherever possible. For example, concerns about the decorative order of the home had resulted in a programme of redecoration and refurbishment which was already underway.

When we visited Hillside on the 27 June 2013, we found the provider did not have suitable arrangements in place to ensure all persons employed for the purpose of carrying on the regulated activity had received appropriate training or supervision. We set a compliance action and required the provider to tell us how and when they would become compliant.

We received an action plan which set out what actions had, or were to be taken, to achieve compliance by the end of September 2013. We carried out a visit on the 16 October 2013 to see if the action plan had been implemented as planned and the necessary improvements made.

We looked at supervision and training records. We spoke with the manager and staff, including two who were responsible for supervision.

We found, against a background of significant staff changes, the frequency of staff supervision and training had been improved and was now satisfactory. We judged this meant current staff were now being supported effectively. This was through regular training and supervision which enabled them to carry out their challenging roles, at a time when staffing levels had been and remained under pressure.

We spoke with eight people who lived in Hillside and with three relatives. They told us they felt they were involved in all significant decisions about their own care or the care of their relatives. One relative told us how reassured they were to see how well their relative was being supported; "They are safe and have all the help we were no longer able to give them". People told us the nurses and care staff were considerate and respectful.

We looked at four care plans. We saw they included an initial assessment of the person's needs and were subject to regular review to make sure they remained up to date and relevant. This showed people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Although the decorative order of the home was not good in places, we saw no evidence the premises were unsafe. When we spoke with two people on the Lowry unit they told us they thought the premises were quite good and comfortable. They offered to show us their own rooms. These were furnished and fitted out with items of their own and reflected their individual tastes and interests.

People we spoke with had a positive view of the staff team and felt they had the skills and experience required to provide appropriate, safe and effective care and support. Staff told us they felt there was a good ‘team spirit’ in the home, however, not all staff training and supervision was up to date

Each of the five people we had conversations with told us they had been given plenty of information about the service and that they were able to make an informed choice about the care they received in the home.

They confirmed they had been involved in the ongoing assessment of their care which had identified their religious/cultural, physical care, nutritional and relationship needs and they had agreed with the level of support to be provided. They told us that their views about how they wished their support to be delivered had been listened to and respected.

One person told us: “I can stay in my room as I like my own company, but staff do encourage me to mix with other people especially at lunch time.” Another said: “You are always offered a choice of food if you do not like what is on the menu.”

We spoke with three people who were visiting relatives. They all said they were satisfied with the care their relative received. All confirmed they had been involved in the planning of care for their relative and were kept informed if there were any changes to that care.

One relative told us: “We have a meeting four monthly to discuss the care provided. I always sign the care plans to say I agree with any changes in care required.” Another said; “I do attend the relative meetings – this is a way I can influence how the home is run”. A third relative stated: “I have an excellent relationship with the manager. I can discuss any of my concerns and tell them what I think.”

We received positive feedback from all the people we spoke with and observed good interactions between people and staff during our visit.

We spoke with five people who lived at the home and with three relatives, who were visiting on that day. We were told that the staff team provided sensitive and flexible personal care and support and the people we talked with felt they, or their relative, were well cared for. A relative confirmed they had been included in the planning of care.

One person told us: “You get well treated here, I have no complaints.” Another said: "The staff are very good, they will do anything for you."

A relative told us: “She always has her hair done and looks nice. I am quite happy and do not have any problems with the care provided.”

When we had conversations with five people who live in Hillside on the 03 May 2012 they were complimentary about their rooms and the physical environment of the home in general.

When we looked at minutes of relatives meetings we saw that one person who lives in Hillside had raised a question about the poor continuity of hot water supply.

All the people we spoke with told us that staff were very attentive and knew their needs and care requirements. One person said that: "The staff are brilliant. They are always so kind." Another commented that: "The staff are very attentive, they always come very quickly when I need help."

One relative told us: "Staff cope very well with my relatives deteriorating condition. I have every admiration for them as they never loose their cool and are so patient."

Three of the five people we spoke with told us that they felt their concerns or complaints were listened to. They told us they had been involved in decisions about their care and could ask for changes to be made if they did not feel happy with it.