This inspection visit took place on 12 December 2016 and was unannounced. At the last inspection on 6 October 2015, the service was rated as Requires Improvement overall with specific concerns that there were not enough staff to meet people’s needs and manage the risks associated with their care and to ensure people who needed help with decision making were appropriately supported. The provider sent us an action plan on 30 October 2015 which stated how and when they would make improvements to meet the legal requirements. At this inspection, we found that some improvements had been made but further action was needed to ensure people's mental capacity to consent to care or treatment was always correctly assessed and recorded.

Since our last inspection, refurbishment works have been carried out to extend Hillswood Lodge and the home now provides accommodation and or personal care for up to 21 people. At the time of our inspection, 19 people were living at the home, some of whom were living with dementia. There was a registered manager at the service. 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.

We found that people’s capacity to make decisions was being considered. Staff sought people’s consent before providing care and supported people to make choices over their daily routine. However, the provider still needed to make improvements where people lacked the capacity to make certain decisions for themselves to fully demonstrate that their rights were being upheld. We have recommended the provider seeks advice on best practice in this area. Where people were being restricted to the home’s environment in their best interests to keep them safe, the appropriate approvals had been sought.

We found the required improvements had been made and risks to people’s health and wellbeing were assessed and managed; staff understood the actions they should take to minimise any identified risks. The provider had taken action to ensure there were sufficient, suitably recruited staff to keep people safe and promote their wellbeing and staffing levels were kept under review to ensure they continued to meet people’s changing needs. There were effective systems in place to ensure people’s medicines were administered, recorded and stored safely.

People felt safe living at the home and staff understood their responsibilities to protect people from the risk of abuse. Staff received training so they had the skills and knowledge to provide the care people needed. People were encouraged to eat and drink enough to maintain a healthy diet and were able to access the support of other health professionals to maintain their day to day health needs. People were encouraged to keep in contact with family and friends and visitors were able to visit without restriction. Relatives they felt involved in people’s care and were kept informed of any changes.

Staff had caring relationships with people and respected their privacy and dignity. Staff knew people well and people received personalised care. People’s care was regularly reviewed to ensure it continued to meet their needs. Improvements had been made and people were offered opportunities to take part in social activities and follow their hobbies and interests.

There was an open and inclusive atmosphere at the home. People and their relatives were asked for their views on the service and were positive about the improvements made by the provider. People felt able to raise concerns and complaints and were confident they would be responded to. Staff felt supported by the provider and manager and were encouraged to give their views on the service to improve people’s experience of care.

The manager carried out

We inspected Hillswood Lodge on 6 October 2015. The provider is registered to provide accommodation, personal and nursing care for up to 16 older people. This includes care for people with physical needs and dementia care needs. At the time of our inspection, 13 people used the service. At our last inspection of the service on 19 December 2013, the provider was compliant with the regulations we inspected against.

The ownership of the service had changed recently and the new owners were in the process of carrying out improvements on the service. Service development plans were in place to ensure that improvements took place with minimal disruptions to the day to day lives of people who used the service and to the service as a whole.

There was 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 and associated Regulations about how the service is run.

People did not always have risk management plans in place to guide staff on how care should be provided in order to minimise identified risks. People’s risk management plans were not always updated when their needs changed.

People with mobility problems were at risk of trips and falls because access within the building was not always free of obstructions.

There were not always adequate numbers of staff to meet people’s individual needs. People were left unattended in lounge areas for long periods. Staffing shortages meant that staff carried out multiple roles that put people at potential risk of harm.

The provider did not always ensure that people who had been prescribed topical creams received them in order to maintain their skin integrity.

Staff did not always have the necessary training to enable them to carry out their roles effectively.

The provider did not consistently follow the guidelines of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to ensure that people were not being unlawfully restricted of their liberty. Staff did not always have a good understanding of the relevant requirements MCA and DoLS. The MCA and the DoLS set out the requirements that ensure where appropriate; decisions are made in people’s best interest.

The meal time was rushed. People who suffered with dementia were not given adequate support to make choices or change their minds about what they wished to eat.

The design, adaptations and decorations of the home was not always dementia friendly. People had limited opportunities to make use of the garden and outside surrounding area independently.

People were not always supported to engage in activities they enjoyed. People were sitting for long periods of time without meaningful activities to prevent boredom.

The provider did not have effective systems in place to regularly assess and monitor the quality of services provided. Risk assessments did not always identify potential environmental risks to people who used the service.

People told us they felt safe and protected from harm. Staff understood what constituted abuse and knew what actions to take if abuse was suspected.

People told us they liked the food. People were supported to attend healthcare appointments and staff liaised with their GP and other healthcare professionals as required in order for people’s health and social care needs to be met.

People told us and we observed that staff were kind and respectful. Their views about how they wished to be care for were respected. They and their relatives were involved in planning their care. There were systems in place to deal with complaints and concerns.

People who used the service, their relatives and the staff were very complimentary about the new owners of the service and the registered manager. They told us the new owners and the registered manager were always available and approachable. We observed that the registered manager had a hands-on management style. People and their relatives told us they provided feedback about services on a regular basis.

We identified that the provider was not meeting some of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 we inspect against and improvements were required. You can see what action we have told the provider to take at the back of the full version of the report.

This inspection was unannounced which meant the provider and the staff did not know we were coming. Hillswood Lodge supports older people who may have a dementia related condition. There were fourteen people in residence when we undertook our inspection. We spoke with three people living in the home, two staff on duty, two visitors and the registered manager.

We saw people received the care and support that met their individual needs. We saw that people looked relaxed and comfortable in their home and staff interacted with people in a positive and respectful manner. People told us they were treated with care and compassion and the staff responded well to their needs or concerns. One person using the service said, “You can’t fault it.” Another person told us, “I am happy and content.”

We looked at the suitability of the environment to ensure people lived in a home where the décor and environmental standards were appropriate. We found the home was clean, safe and well maintained.

We saw the provider regularly liaised with other agencies to ensure people’s health and wellbeing needs were met.

The provider had systems in place to check on the quality of the care people received. The service was well led because the manager supported the staff team, had quality monitoring systems in place and managed risks effectively.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

Sixteen people were in residence when we undertook our inspection. We spoke with seven people living in the home, three visitors, two staff and the registered manager. We were informed by a visitor that the staff were, “Obliging and responsive.” People using the service expressed their satisfaction and one person said, “I love it here, they look after you and it’s comfortable.”

Staff we spoke with were enthusiastic about their jobs. They knew about the people they were caring for and they felt that the management of the home was supportive and encouraging.

We looked at the way medication was managed and saw that medication systems and practices were safe and suitable.

We looked at the recruitment procedures for staff and found that appropriate systems were in place to protect people using the service.

We found there were systems in place to deal with complaints quickly and appropriately.

The atmosphere in the home throughout our visit appeared calm and relaxed. We saw people being cared for in a way that ensured their human rights were respected and people who did speak with us told us they felt safe. Observations enabled us to get an overview of the home because not all of the people living in the home were able to tell us about their experiences.

When we looked around the home we saw people's rooms were clean and suitably furnished. People had been able to personalise their rooms and bring in their own furniture if they wished.

We spoke directly with five people during our visit and people told us that staff were very caring towards them. People described the staff as 'kind and thoughtful'. One person who had lived in the home for several years told us they were very happy living at Hillswood Lodge and would not wish to be anywhere else. Another person told us they were settling in well and had been made to feel 'at home.'

During our visit we saw numerous examples of staff interacting well with people living in the home and it was clear from our observations that people reacted positively when the staff engaged with them.

People confirmed they felt safe living at Hillswood Lodge and considered it to be a good home.

Overall comments were positive and examples include:

“From my observations the carers are caring as well as helpful, supportive and without doubt patient.”

“Staff and residents get to know each other well and that can only be beneficial in meeting each resident’s needs and requirements.”

“I am comfortable, content and happy in my surroundings.”

“The atmosphere over the last few months has been enhanced.”

“I feel previous care was not delivered to a high standard but at the present time I know you have a caring team.”

“Families now feel comfortable when contacting Hillswood Lodge and I know my mother is in safe hands.”

“I find the staff very approachable, caring and understanding of all my mums needs.”

“Hillswood has risen from the ashes and the home is a pleasure to visit, residents are happy and relaxed.”