Hillview Nursing Home is registered to provide nursing care for up to 40 people. It is one of four services run by Almondsbury Care Limited. The home specialises in the care of people with advanced dementia who may exhibit behaviours that are challenging to themselves and others, due to their condition.

At the last inspection in October 2014 the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good:

People received safe care and treatment in a well maintained premises. Individual risks were assessed and managed because there were effective systems in use which were closely adhered to by staff. Staffing numbers ensured staff were able to meet people’s individual needs. Recruitment, medicine and safeguarding policies and procedures protected people from harm.

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 a nutritious diet of their preference. People’s health care needs were understood and met through staff knowledge, skills and appropriate contact with external health care professionals as required. One described the staff as "superb".

Staff received training and supervision which helped them perform their roles to a high standard.

People, their family members and staff had formed close relationships. People were treated with dignity and respect. Families said how welcoming the home was. Family’s knew they could take any question or concern to staff. Many families spent considerable time at the home.

People’s needs were discussed and planned with them or their family members. Care plans were kept under regular review.

All kinds of activities to which people could become involved were available. This included themed events, entertainment and reminiscence. Interaction between staff and people using the service was of a high standard and demonstrated caring and compassion. The highest recommendation had been awarded for end of life care using the ‘Gold Standards Framework’.

The home was effectively managed by a registered manager and team of staff who felt fully supported. There were quality monitoring systems in place to reduce risk and identify ways to improve.

Further information is in the detailed findings below.

At our last inspection on 29 April 2013 we issued compliance actions for five essential standards. This inspection was to follow up on areas of non- compliance with the health and social care regulations. We spoke with 10 people who lived in the home and three visiting relatives. We also observed the care provided to other people and spoke with four members of staff.

We found the manager had taken action to address the non-compliance in all areas. We saw staff treated people with kindness and respect. We saw that people were helped to eat their lunch in a timely and appropriate manner.

We saw that care plans had been reviewed and up-dated and reflected people's current health needs. A new form had been devised to record the food and fluids that people received. The assistance they were given during the day was also recorded. The forms provided information that enabled care requirements to be implemented.

The manager had implemented a contingency plan so that in the event of staff shortage at lunch time all people would receive their meals on time. A "red tray" system monitored more closely the food taken by people who may be at risk of malnourishment.

Questionnaires had been sent to family and friends of people who lived in the home and to health and social care professionals. The responses received indicated that everyone who returned a questionnaire was satisfied with the standard of care delivered in the home.

We had been planning an inspection of the home in the near future when we received information of concern. We found the concerns that had been raised with us were unsubstantiated.

Many people living in the home were not able to tell us about their experiences of care. One person able to talk to us said they were ”quite happy here.”

We saw from care plans that some people had been in the home for several years. We heard one person who had been very frail and ill had recovered and was “much better.”

We observed 17 people in the communal lounges of the home and visited 7 people in their bedrooms.

We saw interactions between staff and people who lived in the home were kind and polite.

Three relatives spoke with us and said how pleased they were with the care provided in the home.

We were concerned that some aspects of the service of lunch did not respect people’s dignity or meet their nutritional needs. There were not sufficient staff available to provide assistance at lunch time to all people under the current arrangements.

We saw the home had a system of recruitment that resulted in employment of staff who were suitable and safe to care for people in the home. We saw evidence that staff were trained and supervised to assist them to deliver safe, appropriate care.

There were systems in place to maintain the health,welfare and safety of the home. Improvements were required to the way in which the provision of care was assessed and monitored.

We carried out this inspection due to concerns received and we found during our inspection the concerns that had been raised to us were unsubstantiated.

We spoke with three people who lived in the home. They all told us they were “very happy” living in the home. One person told us “staff are polite and helpful” and said that their relatives often visited them and would take them out for the day. Another person told us there was always plenty of staff around to help them if needed.

During the afternoon we observed staff offering people hot drinks and cake. We observed that one resident kept changing their mind on whether to have a drink. We saw the care worker was patient and encouraging with the person. We saw the person requested a drink that was not offered. We observed the member of staff encouraged this and made this specifically for them. This showed that the staff member was supporting their choice and independence.

The relatives we had spoken with told us they were involved in their relatives care decisions. One relative told us that their relative had recently been admitted to the home. They told us the home had been supportive of this transition and had involved them in their relatives care needs and decisions.

One relative told us their relative had lost their capacity to make a decision for themselves. They said they had been included in formal decision making with other professionals regarding the need for their relative to be restricted for their own safety. This had followed the procedures as detailed in the Mental Capacity Act 2005.

During our visit we observed two members of care staff assist a person who was sat in a chair into a wheelchair. We saw staff assist the person using a moving device called a hoist. We observed staff provided explanations during the process and reassurance was given to the person.

Three of the plans of care we reviewed gave clear and up to date information for staff on how each individual needed to be assisted to mobilise. One plan of care said; two staff needed to assist them when moving, staff needed to use a hoist, which size sling staff needed use and a wheelchair for transfers. This was detailed in moving risk assessment and handling technique and the mobility sections of the care plan.

Relatives spoken with told us that they did not have any concerns about their relatives care. They told us that if they had any concerns then they would feel comfortable to be able to raise it with management. They also said they felt any concerns would be dealt with appropriately by staff. One relative told us “you can’t fault the manager”.

Hillview Nursing Home specialised in the care of people who had a dementia. The majority of people were unable to fully express their views verbally.

At the time of the visit there were 32 people living at the home. We spent time during our visit observing care practices, talking with staff, management, relatives and visiting professionals.

Throughout the day of our visit there was a calm relaxed atmosphere in the home.

We were able to observe that people made choices about where they spent their time and the activities they took part in.

We noted that some people spent time in their rooms and others used the communal areas of the home. One person told us “I have my own schedule which the staff fit around. I can do what I like really.”

Relatives spoken with during the visit said that they were involved in the creation of care plans and invited to reviews. Relatives said that their views about care were always listened to and incorporated into care plans where appropriate. One visitor told us that the staff had asked about the likes and dislikes of their relative when they moved into the home. They said “They always treat them as an individual and know what they like and dislike.”

Throughout the visit we observed that people were treated with respect and everyone was supported in a way which promoted their dignity. One person said “The staff are always kind and polite.”

We spoke with three health and social care professionals and five relatives. All described the care provided at the home as “excellent.” One relative said “They discuss everything with me I couldn’t ask for anything better.” One professional told us “They seek advice and support appropriately to make sure that people have the best care possible.”

Healthcare professionals spoken with said that the home asked for appropriate advice with medication and medicine was regularly reviewed to ensure that it was still necessary for the person.

We saw that staff responded to requests for assistance promptly and in a sensitive manner. At one point in the day a person became agitated, the staff responded quickly and offered sensitive reassurance which appeared to comfort the person.

Staff appeared well organised, motivated and competent in their roles. Staff provided care in an unhurried and relaxed manner making sure that people were comfortable and content at all times. Relatives spoken with said that they felt the staffing levels in the home were adequate and that staff had the ‘right skills for the job.’ One person commented “There’s always enough staff and they know what they are doing.”

Visitors asked said that staff were always happy to listen to their views about the quality of care that people received.

This unannounced inspection was carried out on the 23 October 2014 and 3 November 2014. Hillview Nursing Home provides accommodation and nursing or personal care for up to 36 older people. On the day of the inspection there were 34 people living at the home, some of whom were living with dementia.

There is 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.

The registered manager was supported by the deputy manager and a team of nurses all of whom had worked at the home for some years. This gave clear lines of accountability and ensured senior staff were always available to people who lived at the home, staff and visitors. The registered manager had systems to monitor the quality of services and plans for ongoing improvements.

People received care and support which met their needs and took account of their likes and dislikes. Staff working at the home had an understanding of up to date guidance about how to support people to make decisions.

People received care that was personalised to their needs and preferences. Many people were not able to discuss these with staff because they were living with dementia. There was evidence relatives were consulted about people’s care and kept informed of changes. Staff knew people well and used their skills and understanding to try and ensure people received the attention they required so they felt comfortable and content.

There was a calm and welcoming atmosphere in the home. Throughout the day we saw staff interacted with people in a friendly and kind way. Many relatives we spoke with commented on the kindness of the staff who supported their family members. There were enough numbers of staff to make sure people received care and support promptly. A third of the people in the home had one to one staffing following assessment of their needs.

People were safe at the home because staff understood their needs and the possible risks to their well-being. Staff said they were able to recognise abuse and knew what action to take. Staff were confident that any issues raised would be taken seriously and prompt action would be taken to make sure people were protected. Staff worked in accordance with the individual risk assessments that were in place. This meant people were able to take part in activities and follow their chosen routines with minimum risk to themselves or others. Staff worked closely with health care professionals to ensure people received support for their long and short term health needs.

Catering staff understood the important role they played in maintaining people’s health. People were very complimentary about the food. People enjoyed their meals and people’s dietary needs and enjoyment of food were promoted. At lunchtime people received the support they required to eat and drink.