R O'Connell and Ms M Shanley – Hillside Rest 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. R O'Connell and Ms M Shanley – Hillside Rest Home is registered to provide accommodation and personal care for up 26 older people some of whom are living with dementia. At the time of our inspection 18 people were living at Hillside Rest Home.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People’s relatives told us that they were confident that people were safe living at Hillside Rest Home.

We have made a recommendation about staff training on the subject of dementia.

Risks to people were appropriately assessed and protected people from harm.

The provider operated a thorough recruitment processes which helped to ensure that staff employed to provide care and support were fit to do so.

There were sufficient numbers of staff available to meet individual needs and the service provided was flexible.

Staff received training, support and development to enable them to carry out their role effectively. The service is required to update records in relation to meeting the requirements of the Deprivation of Liberty Safeguards (DoLs).

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. People received appropriate support to maintain healthy nutrition and hydration.

People were treated with kindness by staff who respected their privacy and upheld their dignity. People’s relatives were encouraged to be involved with people’s lives where appropriate, to provide feedback on the service and their views were acted upon.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

We found that records written in a positive and respectful way we found that records provided guidance on how to support people.

We were told that staff listened to people and responded to them in a positive way. People who lived at Hillside Rest Home and their relatives knew how to raise concerns if they needed to and told us they were confident that the registered manager would take appropriate action to address any concerns in a timely way.

The registered manager had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided.

We found that records were sufficiently maintained and the systems in place to monitor the quality of services provided were effective.

The registered manager had created an open and inclusive atmosphere within the service. People who used the service, their relatives, staff and external health professionals were invited to contribute their views in relation to further developing the service.

The inspection took place on 29 January 2016 and was unannounced. At our last inspection on 3 April 2014, the service was found to be meeting the required standards in the areas we looked at. However at this inspection we found that the provider was not meeting all the standards and was in breach of the regulations.

Hillside Rest Home provides accommodation with nursing care for up to 26 older people. At the time of our inspection 21 people lived at the home. Some people who lived at the home were unable to verbally communicate with us so we observed how care and support was provided in communal areas such as the lounge and dining area.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the provider worked within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. Unfortunately we found that people who had been identified by the manager and staff as not having the ability to consent had not been formally assessed or reviewed under the remit of MCA. This meant that some people who lived at the home could be being deprived of their liberty.

People told us that they felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made efforts to ascertain people’s wishes and obtain their verbal consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their family’s access independent advice or guidance.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders very were complimentary about the manager and staff on how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.

As the home is small the inspection team was made up of one inspector. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

We found that the home was meeting all areas.

If you wish to see the evidence supporting our summary please read the full report.

You can see our judgements on the front page of this report.

Is the service caring?

We found that the people were cared for in relaxed, comfortable environment by caring staff. We observed care and saw that there were sufficient staff on duty to spend time with the people. We saw affection between the staff and the people. There was a homely atmosphere, with the people at the centre of all activities.

Is the service responsive?

We were told by the people who lived in the home that ‘the manager will do anything for you as soon as you ask’. We saw that staff were vigilant at all times and were ready to respond to the wishes and needs of the people. People who were confined to bed had staff visits every 20 minutes to ensure they were comfortable and for ‘a chat’. Some of the people liked to have an afternoon walk when the weather was nice. We were told that calls for assistance were responded to in a timely manner.

Is the service safe?

We saw that there was sufficiently appropriately recruited staff to meet the needs and wishes of the people. We saw that staff were aware of risk management and the balance between promoting independence and keeping people safe. We saw that equipment had been serviced in the last few weeks, and that the premises was secure. Staff had been trained to recognise and respond to signs and allegations of abuse.

Is the service effective?

We looked at the care plans of four people and found that people had been involved in establishing what care they needed and how they wanted it delivered. We saw that care plans gave detailed directions to staff to ensure the care they gave was effective. We saw that people who had long periods of inaction were protected from the risk of pressure areas. People had access to the local community and where necessary were accompanied by staff. A recent survey showed that all the people who responded were either very happy or happy with all aspects of the quality of the care provided by the home.

Is the service well led?

The home was managed in the best interests of the people who live there. Staff told us that the manager was available to them should they need assistance. The manager supervised the staff while they are delivering care and if there were issues they were addressed. Staff were well trained in all aspects of care delivery. The people told us that the manager was always there should they need anything they “only have to ask and it’s done”, one person said “that the manager seems to know what we want before we do”.

Staff were supported in a relaxed manner and had time to spend with the manager so that they could raise issues that may impact on how they cared for people.

The people who lived in the home told us that they were happy there and that they were looked after. They said that they would not stay there if they were not happy. All the people who lived in the home funded their own care.

We found that people were included how the home was run and were included in menu planning.

We saw that people were well presented and well groomed. Care plans contained good information and guidance for staff.

People were safe and we found that the home had systems in place that ensured the home was well run and managed in the best interests of the people who lived there.

The people who lived at Hillside Rest Home told us that the manager of the home looked after them very well. They said that she managed the staff well and that she ‘didn't miss a thing’ when it came to ensuring they were well cared for. They said that the manger liked to make sure they ate very well therefore there was always plenty of variety in the food served, and that the food was very good.

Other people said that the home was very nice and the care was 'tip top'. We were told that there was always a member of staff around to assist you if needed. People said that it was nice that the staff did not change much and that some of the staff were there as long as they were. People told us that they felt very safe in the home.

We found that the people were looked after in a caring and relaxed manner. There were systems in place that ensured their care needs were recognised and met in a manner that promoted their safety, independence and dignity. We saw that the care plans had been drawn up with the person so that the home could be sure they were meeting the person’s needs and wishes. The manager had systems in place that ensured all aspects of the running of the home, and meeting people’s needs had been regularly audited. People’s relatives had been invited to comment on how the home was meeting the needs of their relatives.

The people of Hillside Residential home and their representatives told us that they were well cared for. They told us that staff care for them in a manner that promoted their independence, dignity and heath. They said they were always treated with respect.

They told us that if there is something they are not happy with they talk to staff and it is addressed straightaway. The representatives of the people who live there told us that they never had to make a complaint about any aspect of the service.

They told us that the home is always clean and fresh and that their bed linen is always fresh and very clean. They told us that their personal belongings are looked after well and that they have lockable private storage.