The inspection took place on 28 August 2018 and was unannounced. The last inspection was in December 2015 where we rated the service ‘Good’ and found no breaches of the legal requirements. This inspection found seven breaches of the legal requirements in relation to risk management, reporting of incidents, care planning, governance, consent, fees and statutory notifications. You can see what action we asked the provider to take at the end of this report.

Hillside Care 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.

Hillside care home provides support to up to two people in one adapted building. People living at the service had learning disabilities, autism and mental health conditions. At the time of our inspection, there were two people living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager, but they resigned from their post after the inspection. 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.

Risk plans lacked detail and we found instances where measures to manage known risks were not robust enough. There was a lack of monitoring of accidents and incidents and these were not always being reported to the appropriate agencies to safeguard people. The provider had also failed to notify CQC of an incident that they were statutorily required to.

There was a lack of clarity about people’s fees and what they paid for. We also found instances where the mental capacity act had not been followed in relation to people’s finances. Activities that were planned for people often did not take place and care plans sometimes lacked detail about people’s needs. People’s healthcare appointments were not always tracked and changes to people’s health had not always resulted in referrals to healthcare professionals.

Audits were not robust enough to identify the issues we found during this inspection. People’s records were not always readily available and the provider did not have oversight of incidents at the service. The complaints policy lacked accuracy and was not always accessible to people. We made a recommendation about the information provided to people about complaints.

Staff felt supported by management and we found that there were sufficient numbers of staff to support people in the daytime. Checks were carried out on new staff but we found instances where information gathered through recruitment checks was incomplete. We made a recommendation about recruitment checks.

Where people were not able to consent to their care and accommodation, we saw that the correct legal process had been followed. Information had been gathered and an assessment was carried out before they came to live at the service. Staff involved people in tasks and encouraged them to be independent. People’s privacy and dignity was promoted as staff provided care respectfully. People were supported to make meals based on their food preferences and dietary needs.

Hillside is a residential home which provides care and accommodation for two older adults with moderate learning difficulties and autism. The home, which is a semi-detached house, is located in residential area of Caterham. On the day of our inspection two people were living in the home.

This inspection took place on 22 December 2015 and was unannounced.

The home was run by a registered manager, who was present on the day of the inspection visit. ‘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 and associated regulations about how the service is run.

Staff had written information about risks to people and how to manage these. We found the registered manager considered additional risks to people in relation to community activities and changes had been reflected in people’s care plans.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. They knew of types of abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

Care was provided to people by a sufficient number of staff who were appropriately trained. Staff were seen to support people to keep them safe. People did not have to wait to be assisted.

People who may harm themselves or displayed behaviour that challenged others had shown a reduction of incidents since being at the home and the number of staff on duty were adequate for their individual needs.

Processes were in place in relation to the correct storage and audit of people’s medicines. All of the medicines were administered and disposed of in a safe way.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for them had been completed. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. We were told by the registered manager that people could go out for lunch if they wished.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when people could visit the home.

People took part in community activities on a daily basis; for example trips to the shops. The choice of activities was specific to each person and had been identified through the assessment process and the regular house meetings held.

People had an individual care plans, detailing the support they needed and how they wanted this to be provided. We read in the care plans that staff ensured people had access to healthcare professionals when they needed. For example the doctor, learning disability team or the optician.

The registered manager told us how they were involved in the day to day running of the home People felt the management of the home was app

We carried out an inspection at Hillside Care Home to look at the care and treatment that people who used the service received.

As part of our inspection we spoke with the people who used the service. We also spoke with staff about their role and responsibilities.

We considered our inspection findings to answer 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?

Is the service safe?

We saw that people who used the service had been involved in the planning of their care and their choices and wishes were respected. For example, we saw that one person attended church every Sunday.

Recruitment practice was safe and thorough and ensured that only staff suitable to work with vulnerable people were employed by the service.

People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although no applications were in place at the time of inspection.

Is the service effective?

People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their care plans. People said that they had been involved in the planning of their care. Staff we spoke with demonstrated they had a good understanding of people's needs and this mirrored the information included in their care plans.

The people who used the service told us that they were "Happy" with the care and support provided. One person said "I'm very happy living in this lovely home."

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

One person said, "This is a very pleasant home to live in with pleasant and nice staff."

People's preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that people's plan of care had been reviewed regularly and updated when their care and support needs had changed.

Staff were attentive and supported people quickly when they needed assistance.

People knew how to make a complaint if they were unhappy and there was an open door policy in the home to help people raise any concerns immediately.

Is the service well-led?

Staff we spoke with were clear about their roles and responsibilities. They told us that they worked "Well" together as a team and were "Supported" by the manager.

The manager spoke with people on a daily basis to gain their views and suggestions for improvement regarding the care and support they received.

Regular checks had been completed in the home. These included health and safety, fire and maintenance to ensure the environment that people lived in was safe and appropriately maintained.

We spoke with one person who lived at Hillside Care Home. Due to communication difficulties, we were unable to discuss matters at length, however we were told by people at the home that they liked living there.

Some of the people who used the service had more complex needs which meant that they were not able to tell us about their experiences of using the service; we therefore used our observations to help inform our judgements. We observed staff interacting with people who used the service in a respectful manner, calling people by their first names and promoting their dignity and privacy.

People who used the service appeared relaxed, content and at ease in their surroundings. We found the property to be in a good state of repair. Following our inspection the provider took action to address the fact they were not routinely screening their water system for the presence of legionella bacteria.

Records demonstrated that staff had been well trained, knew how to meet the individual needs of people and provided care which was consistent with people's care plans.

The provider also demonstrated robust procedures for effectively monitoring the quality of the service to ensure that people received safe and appropriate care and support.

The two people who use the service told us their views and they spoke positively about living there. Each person said they liked living at the home and were happy.