What life is like for people using this service:

At our last inspection on 12 and 13 May 2016 we rated the service good overall. At this inspection we found that evidence continued to support a rating of overall Good but the rating for the key question Caring had improved to Outstanding.

Feedback from people who used the service, health and social care professionals and staff was consistently and unanimously positive. People told us they enjoyed living at the service because it was a friendly home. The registered person and staff consistently displayed outstanding empathy and compassionate care.

Relatives were unstinting in their praise of the service. They unanimously said that the home was exceptionally caring and they felt very fortunate their family members lived there.

All feedback we saw emphasised the excellent caring nature of the staff and the family like environment that existed at the service.

The service’s success was built on family values of kindness and care. The registered person’s enthusiasm, energy and compassion created a service that was indistinguishable from a family home. The registered person was driven by their passion for caring for people.

The registered person and staff had an excellent understanding of people’s needs. Staff supported people to continue to follow life-long interests. The people were from rural and farming communities and this was reflected in how the home and people’s rooms were decorated and furnished.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood their responsibilities to keep people safe from harm without restricting their choices about how they spent their time. They treated people with dignity and respect and involved them in decisions about their care.

Staff explained to people what their medicines were for and how they should be taken. People knew when they should have their medicines.

A robust recruitment and selection process was in place. There were enough staff to meet people’s needs. The registered person exercised great care in who they employed at the service. They employed only staff who demonstrated that caring and compassionate behaviour was possible without over-stepping professional boundaries.

We saw that people were comfortable in the presence of staff and the registered person.

Staff supported people with their nutritional needs. Staff arranged for people to be visited by GPs, nurses and other professionals when they were unwell.

Staff understand the importance of supporting people to live life to the full whilst they were fit and able to do so. People participated in activities that stimulated them and kept them physically active.

People contributed to plans about how they wanted to be cared for towards the end of their lives and their funeral arrangements.

Staff spoke consistently about the service being an exceptional place to work and one that was well led. The registered person worked in partnership with other organisations. The service had an excellent reputation locally and was sought after.

The registered person carried out regular checks to ensure people were safe and receiving the care and support they needed.

The home was well maintained, decorated and furnished to exceptionally high standards and kept clean.

People and relatives knew how to raise concerns or make complaints in the event they had any.

More information can be found in the detailed findings below

Rating at last inspection: Good (report published 4 July 2016)

About the service: Hillside Farm Care Home is registered to accommodate 10 older people. At the time of our inspection there were seven people living in the home.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

We inspected Hillside Farm Care Home on 12 and 13 May 2016. The inspection was unannounced.

Hillside Farm Care Home is a purpose built single floor building on the outskirts of the Nottinghamshire village of Bunny. The service provides residential care for up to ten older people with or without dementia. At the time of our visit, seven people were living at the service and had support needs associated with dementia and physical health conditions.

The service was managed by the provider who was registered with CQC to provide accommodation for persons who require nursing or personal care, therefore a registered manager was not required. 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 at Hillside Farm Care Home and did not have any concerns. Staff knew how to protect people from harm and referrals were made to appropriate authority when concerns were raised.

Risks to peoples safety were identified and managed and assessments carried out to minimise risk of harm. For example falls or environmental risks. The building was well maintained and regular safety checks, for example for gas and electricity, were carried out.

People received care and support in a timely way as there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began work at Hillside Farm Care Home.

People received their prescribed medicines when required and these were stored and administered safely. We informed the provider of issues we identified and these were rectified straight away.

People received effective care from staff who received training and support to ensure they could meet people’s needs. Ongoing training and assessment for care staff was scheduled to help maintain their knowledge.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005).

People told us they enjoyed the food offered and we saw they had sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.

People were treated with dignity and respect and their privacy was protected. We observed positive, caring relationships between staff and people using the service. Where possible people were involved in making decisions about their care and daily activities. Where they were unable to do so, their relatives were involved to ensure their best interests were protected.

Staff understood peoples support needs and ensured they received personalised responsive care. People had the opportunity to take part in enjoyable, constructive activities. They knew how to raise an issue and were confident these would be listened to and acted on.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Quality monitoring systems were in place to identify areas for improvement and ensure these were acted on.

We used a number of different methods to help us understand the experiences of people who used the service, because people had complex needs which meant they were not able to tell us their experiences. We spoke with one relative of a person who used the service. They said, “The care staff treat [my relative] in a dignified way, they are lovely and kind.”

We observed care staff were attentive to people’s needs. We saw people were spoken to and cared for in a kind and respectful manner. We observed people responding positively to the care staff’s interventions.

We found that the provider had appropriate systems in place for ensuring cleanliness and the protection of people from infections. However, we found the systems the provider had for identifying and managing maintenance and ensuring equipment safety was not working as required.

We found a number of concerns regarding medication. We found that medication was not always stored within acceptable temperature ranges. We also found inconsistencies in the way medication was being recorded.

We found the system the provider had in place for maintaining accurate records was not working as required.

One person’s relative said, “As far as I know everything is fine.” Another person’s relative said, “I am glad to see her well. She’s remarkably well. I have no concerns. I am delighted that we had found this home. It is good as it could be.”

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant not all were not able to tell us their experiences. We spoke to their relatives and friends. 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 visited the service over two days to gather information to help us to make our judgements. We found the environment to be calm, friendly, clean and welcoming. Staff were attentive to people’s needs however we did not observe staff consistently speak to people in a dignified and respectful manner.

People we were able to speak with told us they were treated well by the staff and that they felt safe living in the home.

One relative told us they were kept informed about the care and treatment their relative received. A number of relatives contacted us after our visit and were all very complimentary about the care their relatives received at the home.

People said they were given the choice of their preferred time to go to bed and get up.

We saw no activities going on during the time of our visits but we saw a list of activities available on the notice board for things like puzzles, massage and exercise. One person said, "I have had my nails painted by a member of staff." Another person told us they liked to play the piano and staff said they sometimes had a sing-along.

We carried out a responsive review inspection because we had concerns that we had not visited since March 2009.

One person commented, “I like living in this small home, it is very nice and I am encouraged to be independent. I often go out to see people who I know in the community. Sometimes people living here find it difficult to talk with you due to their condition but staff and other visitors are very friendly.”

People who use services told us they felt safe living at the home and they all told us staff treated them well.

One person told us, “Staff are very kind here.”

One relative told us, “If there are any issues I can ring the provider who is also the manager. I find her very respectful. All the staff are very good with my parent and are very welcoming. It feels like a lovely family. If I was in a position where I developed Alzheimer’s I would be happy to go to this care home for my care. I think the staff are so kind and loving to everyone.”