About the service:

Hilltop is a home for people with learning and physical disabilities and/or autism. The home is registered to provide support for up to six people. There were four people living there at the time of the inspection. The size of service meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

People’s experience of using this service:

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and coordinated person-centred support that is appropriate and inclusive for them.

The outcomes for people using the service reflected the principles and values of Registering the Right Support. For example, people were supported to have access to local groups and activities in the community and staff promoted choice and inclusion.

• People were protected from avoidable harm by staff who had been trained to keep them safe.

• Staff knew people well and the risks associated with people’s care and health. They understood how to minimise risks to people and when and how to raise any concerns.

• Staff supported people to take their medicines safely and understood how to prevent the spread of infection.

• People received care from a consistent team of staff who had been safely recruited and trained to carry out their role. There were enough staff to meet people’s assessed needs and ensure they lived a meaningful life and have access to the community.

• People’s relatives told us they felt people were cared for by staff who were kind and compassionate. One relative said, “I would give them 10 out of 10 in everything they do.”

• People’s needs were assessed and care was delivered in line with current practices. Their care plans contained the information and guidance staff needed to support people. 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 were supported to make their own decisions about their care and were supported by staff in their best interests.

• People were supported with their nutritional needs and to maintain their health and well-being.

• Staff respected people’s rights to privacy and dignity and their independence and access to the community was promoted and encouraged.

• The provider had systems for assessing and monitoring the quality of the service and implementing improvement where required and managing complaints.

At this inspection we found the evidence continued to support the rating of good. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated good (Last report was published on 25 October 2016).

Why we inspected:

We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Good rating. Previous CQC ratings and the time since the last inspection were also taken into consideration.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

This was an unannounced inspection which took place on the 13 September 2016. Hilltop provides accommodation and personal care for up to four people with a learning disability and a sensory or physical disability and can provide respite care for another two people. At the time of the inspection there were a total of 12 people who were registered to stay for short term care at the home.

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 2008 and associated Regulations about how the service is run.

People received highly individualised care which reflected their complex health needs. Staff had received training to make sure they had the necessary skills to support and care for people. They worked closely with health care professionals to help people stay healthy and well. People’s experience of their care shaped the support they received. Key workers, relatives and advocates spoke on their behalf when planning and reviewing their care. Those people able to comment about their care were encouraged to do so. People’s rights were upheld and they received safe care. Any hazards had been identified and strategies put in place to reduce risks. Their environment had been adapted and equipment provided to keep them safe and as independent as possible.

People had busy lifestyles which reflected their lifestyle choices and likes and dislikes. Communication passports provided an overview of how they expressed themselves. Staff had a good understanding of people’s needs and were observed positively interacting with people. Good use was made of easy to read documents using pictures and photographs to help people understand information. People had access to sensory stimulation in their home and garden. They used local facilities to go swimming, to the gym and to yoga. They were treated with dignity and respect. They had positive relationships with staff sharing light hearted moments as well as being reassured when upset.

People benefitted from staff who had been through a satisfactory recruitment process and who felt supported in their roles. They said management was open and accessible and helped out when needed. There were enough staff who were flexibly employed to meet people’s needs. Quality assurance processes were in place to monitor people’s experience of the service. This included feedback from people, their relatives, staff and health professionals as well as visits by the provider. External organisations had also audited the quality of care provided. Comments about the service included, “Staff are very caring”, “Extremely caring and understanding” and “Staff work well with residents.”

When we inspected there were five people living in the home. We spoke with two people who use the service and four staff. We also made our own observations during the visit.

People told us they liked the service they received. People felt the staff supported them and met their needs. One person using the service said "I like it here."

People told us that staff treated them with dignity and respect. One person said “I can choose.” We saw staff speaking and responding to people in a kind and respectful manner.

The care records showed us that people's health needs had been assessed before they came to live in the home. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

Our observations showed that the service provided nutritious meals and sufficient drinks to the people using the service.

The staff had been regularly mentored and supervised to help ensure they had the right skills and were suitable to work with vulnerable people. The home trained their staff and had procedures which protected people from any form of abuse. People told us they were “happy here, thank you.”

The service and the building were monitored and risk assessed to ensure they were suitable for the people using them.

The evidence we collected showed us the service kept people safe and met their care needs in a suitable environment.

The people we spoke with were happy with the support they received from staff at Hilltop. One person told us that staff always shut the door to maintain their privacy during personal care. They said “staff are helpful. They will always give you a hand with what you get stuck with”. Advice from external health professionals was incorporated into care plans and was followed by staff when care was provided. People had appropriate access to preventative and specialist health care.

People's medicines were managed safely within the home and checks were carried out to monitor staff competency in this area. Staff recruitment procedures were followed appropriately and the required checks were carried out before staff commenced work. One person told us they could “have a laugh with the staff”. In feedback received by the provider a relative said staff and managers were “very good” and “we are grateful and satisfied with the care...”.

Systems were in place to monitor the quality of the service that people received. Staff and people's representatives were asked for their views about the service and there was evidence that learning had taken place in response to incidents.