This inspection took place on 7 March 2017 and was announced.

At our last inspection we found breaches of Regulations 9, 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in how medicines were managed, the content of care records, supporting people with choice and the systems for ensuring the safety and quality of the service. At this inspection we found that appropriate action had been taken to address these issues.

The service is registered to provide care and support for up to 10 people of all ages who have learning disabilities and mental health needs. On the day of our inspection there were seven people living in the service.

The service had a registered manager who was also the provider. 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.

Staff had been trained in safeguarding people from abuse. They demonstrated that they understood the signs of abuse and how to safeguard the people. Staff said they felt confident that the registered manager would take appropriate action to adequately protect people.

There were sufficient numbers of staff to meet people's needs. Staffing levels were determined by looking at people's needs and activities including appointments. Risks to people were assessed and managed appropriately to ensure that people's health and well-being were promoted. Action plans to manage risks were in place and staff followed them.

People received their medicines safely and medicines were managed in line with procedures. Medicines were administered to people appropriately, clear records were maintained and medicines were stored safely.

People's choices and decisions were respected. People made decisions about their day-to-day care and support and were actively involved in their care planning. The service understood their responsibility under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff understood people's needs and treated them with respect, kindness and dignity. Staff communicated with people in the way they understood. People's individual care needs had been assessed and their support planned and delivered in accordance to their wishes. People's needs and progress were reviewed regularly with the person to ensure it continued to meet their needs.

People were encouraged to follow their interests and develop skills. People participated in a variety of activities within the service and the wider community. These included attending college and other social activities.

The service held regular meetings with people and staff to gather their views about the service provided and to consult with them about various matters. People knew how to make a complaint if they were unhappy with the service. There were systems in place to monitor and assess the quality of service provided.

Hilton House is a residential home registered for up to 10 people of all ages who have learning disabilities and mental health needs.

There were eight people living in the service when we inspected on 31 January 2016. This was an unannounced inspection.

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.

Improvements were needed in how the staffing levels were assessed in the service to ensure people’s needs were met. Improvements were needed in the staff rota to show the actual times that staff worked. Appropriate recruitment checks were made to make sure that staff were of good character and able to work in the service. Staff were trained and supported to meet the needs of the people who used the service.

Improvements were needed in the service’s safe management of medicines to ensure that people were protected.

Improvements were needed in the application of the Deprivation of Liberty Safeguards (DoLS). People were provided with a choice of meals, improvements were needed in how staff were guided to meet people's specific dietary requirements. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service and were attentive to their needs. People, or their representatives, were involved in making decisions about their care and support.

Improvements were needed in how people’s care was planned and how staff were provided guidance on how people’s needs were met in care plans.

A complaints procedure was in place, however this was not displayed in the service and was not provided in an accessible format to support people to raise concerns. People’s views about the service were sought in meetings and satisfaction questionnaires.

The service did not have a robust quality assurance system to independently identify shortfalls and to continually improve. This includes shortfalls identified in the environment, records and governance.

Prior to our inspection visit we received information of concern from other professionals. When their investigations are complete we will make a decision on our regulatory action. If we do take further action we will report on this.

We found of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

We found people gave their consent to care and treatment and were supported by staff who understood their preferences gave them choices. One person we spoke with told us, "I like to walk to college and I go to church, it is close by." Another person told us "I can choose what courses I do at college. I like going out, everybody knows me in town." The same person told us "I have a good relationship with all the staff, I have 1 to 1 with my keyworker."

We found that care plans and risk assessments were in place and accurately reflected the needs of the people who used the service. We found that people were supported to attend college and pursue their interests in the community.

Medicines were received, stored and disposed of in line with current guidance. We saw that people received their medication in a timely way and were given information about the medicines they were taking.

The service was undergoing major building work when we conducted this inspection but appropriate health and safety measures were in place to ensure people's safety. The building and grounds were clean and well maintained and fit for purpose.

Staff received an induction on commencement of employment with the service and there were regular staff meetings and supervisions. We saw that staff were supported to undertake further training.

People living at Hilton House told us that they liked living there. The staff were supportive and helped people to be as independent as possible. They said they went out a lot doing activities in the community, used public transport, went to college and clubs and one person said "I have a very nice life."

Some people enjoyed spending their time with other people living at Hilton House and some spent time one to one with staff. People told us that the staff knew them very well. One person said "I like my room and I like going out to town with X." Another person told us "I have lived here a long while and know everyone, I can do so much for myself now."