Hilton Rose 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.

Hilton Rose accommodates 27 people in one adapted building. Hilton Rose is a care home that has previously been in Special Measures. It has been inspected since and a number of improvements were noted and Hilton Rose was rated as Good overall although we identified improvements in how people could be involved in activities. At this inspection, we found improvements had been made overall.

The nominated individual was also the registered manager. 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 felt safe and at ease around staff that understood how to support people. Staff had received updated training and guidance about how best to support people to remain safe. The registered provider had also improved safety for people living in the home following a recent incident. People’s risks to their health and wellbeing were also known and understood by staff. Staffing had recently been increased at the home and staff were appointed following a recruitment checks into their background. People received support with their medicines and staff helped to reduce the spread of infection within the home by using aprons and gloves where appropriate.

Staff were supported through guidance and training. Regular staff and supervision meetings ensured staff were kept up to date about people’s care. 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 that practice. People were involved in making decisions about their care and their consent was appropriately obtained by staff when caring for them. People who could not make decisions for themselves were supported to have a decision made about their care and support which was in their best interest. People accessed help from a number of different healthcare professionals and were supported to maintain a healthy lifestyle. People were offered choices in their meals and could make day to day decisions affecting their care.

People liked and valued the staff supporting them. People’s needs were understood by staff who knew about people’s histories and preferences. People’s families were involved in planning their care where this was appropriate. People’s preferences for end of life care planning had also been discussed, where people chose to talk about this.

People’s choice of hobbies and interests were known by staff supporting them. People were encouraged to do things they enjoyed and play music that reflected their taste. People’s changing needs were reviewed and documented for staff to refer to. People understood they could complain if they needed to and the process for doing so.

The registered manager had been at the home for a number of years and was supported by staff who had also there for some period of time. The registered manager had incorporated improvements identified in previous inspections and had worked with staff to share learning. The registered manager undertook regular checks of the quality of care being offered and worked with stakeholders to improve learning about best practice in caring and supporting people.

Our inspection took place on 2 November 2016 and was unannounced. We last inspected the service on 20 and 21 October 2015 and the service was rated requires improvement overall. We found the provider was not meeting the legal requirements regarding safe recruitment practices and we asked the provider to make improvements. During this inspection we looked to see if improvements had been made and found they had been.

Hilton Rose Retirement Home provides accommodation for people requiring personal care for up to 25 people. At the time of the inspection there were 22 older people who were living with dementia at the service.

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 felt safe. People were supported by a staff team who knew how to keep people safe from the risk of harm and abuse. People were kept safe as potential risks had been assessed and staff were working in ways to reduce these risks. People were supported by sufficient numbers of staff who had been recruited safely. People received their medicines as prescribed from suitably trained staff.

People received care and support from a suitably trained staff team who had access to ongoing training and support to enable them to carry out effective care and support.

People were asked for their consent to care and support and the principles of the Mental Capacity Act 2005 were being followed. People’s capacity was being assessed where appropriate and where required decisions were being made in the best interests of people.

People were supported to have sufficient quantities to eat and drink. People told us they felt they were not always offered a choice of food. People’s specific dietary needs were catered for and specialist professional advice was being followed.

People were supported to access healthcare services when they needed to. People were supported by a staff team who were able to recognise changes in people’s health and well-being and knew how to report and respond to any changes.

People were supported by a staff team who were kind and treated them with dignity and respect.

People were encouraged to maintain their independence and were supported to maintain relationships that were important to them.

People had opportunities to engage in activities and events, however people were not always supported to follow their personal interests or hobbies. People were supported by staff who knew their care needs well and were supporting them appropriately. People and their relatives were involved in the planning and review of their care where possible.

People and their relatives knew who the registered manager was and felt confident to approach them with concerns or complaints. Complaints were being investigated and action taken.

People, relatives and staff were provided with opportunities to give feedback on the service. The registered manager had systems and processes in place to monitor and analyse the quality of the service, and they used information from quality checks to drive improvement.

This inspection was completed by one inspector. On the day of our inspection we found that 25 people lived at Hilton Rose Care Home. Due to their complex needs or health conditions, we were not able to speak with all of the people who used the service. We observed their experiences of care to inform our inspection. We spoke with three people who used the service, one relative, the registered manager, deputy manager, three care staff and a visiting GP.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. We used the evidence we collected during our inspection to answer five questions. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. One person told us, "I feel safe here." Staff we spoke with understood their role in safeguarding the people they supported. However, we found that the provider had not responded appropriately to one allegation of abuse and had not made the necessary alert to the local safeguarding team. We found people were not protected against the risk of unlawful control of their liberty because the provider had not acted in accordance with legal requirements.

Staff knew about people's risk management plans and we saw they were supported in line with those plans. This meant people were cared for in a way that protected them from harm.

People were not always protected from the risks associated with the recording of medicines.

Systems were not in place to make sure the registered manager learned from events such as accidents and incidents, complaints and checks made on the service. This increased the risk to people.

We found records in relation to the storage of medicines, health and safety and incidents were inaccurate. This increased the risk to people.

Is the service effective?

People told us their care needs were assessed with them. We saw evidence that people were involved in their care planning and reviews. We saw care plans were regularly reviewed and updated.

People had their medicines at the dose, time and frequency they were prescribed to ensure medicines were effective. Staff monitored the effect of medicines and reported these to people's health care professionals.

Is the service caring?

People were supported by kind and caring staff. We saw staff were patient and encouraged people to be independent. One relative told us, "The staff are kind."

People’s preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People had the opportunity to engage in a different activity each day.

People were asked their views about the service and the provider acted on comments that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. We found staff discussed people's care needs with them.

Is the service well led?

The provider had some risk management systems in place. We found the provider did not check that risks were managed effectively.

We found record keeping was poor in relation to the recording of medicines, incidents and checks on equipment.

We spoke with three people who lived at the home and two relatives.

People we spoke with were positive about the care and support that they or their relative received. One person told us: "They are all very good here". Another person said: "We are here to be looked after and I can say we are".

We saw that people could choose how they spent their day. Visitors told us that they were able to visit when they wished and were always made to feel welcome.

People told us that they enjoyed the food which was varied. People said that they were offered a choice.

We found the home was clean. There were appropriate systems in place to reduce the risk of cross infection. People who lived at or visited the home told us they found the home to be clean.

People told us that staff were caring. They told us that staff assisted them when they needed it. One person said: "I can't fault the staff". A relative said: "They all seem very good, I cannot fault them".

The home had appropriate systems in place to enable people to raise concerns and be confident that their concerns would be investigated and addressed.

This inspection was a follow up inspection to the previous inspection undertaken on 13 August 2012 to check that the service was compliant with the regulations.

We found that systems now in place provided greater assurance that people's privacy and dignity were more fully promoted.

Improvements made to the home since our last inspection made it a more pleasant and safer place to live.

People who lived at Hilton Rose and their relatives told us during this and the previous inspection that they were very happy with the care provided at the service. One person said, "We are well looked after". Care records had been improved and provided staff with more information about people's needs and how they should be met.

We found that improvements to the management and storage of medicines gave greater protection for people against the risks associated with medicines.

It was positive to see the improvements that had been made since our previous inspection and that the service was now compliant with the regulations. We saw that there were improved systems in place to monitor the quality of care, management of medicines and the safety and comfort of the environment of the home. This will provide greater assurance that any issues will be more proactively identified and responded to.

People told us that they were respected. We found that staff did not always fully respect people's bedrooms as their personal and private space. People had their independence promoted and were encouraged by staff to walk and feed themselves but staff also provided assistance when needed.

People we spoke to were positive about the care they or their relative received, Staff were seen to be kind and usually provided the care and reassurance people needed. Improvements were needed in relation to the care that people who were diabetic received and liaison with other health professionals who should support them. There was also a need to ensure that staff addressed care instructions from other health professionals to ensure that people consistently received the care and treatment they needed.

The service had made some improvements to ensure that medicines were administered safely, However further improvement was needed to the storage and management of medicines to promote people's health and wellbeing.

Improvements were needed to the environment of the home to ensure it was a safe and comfortable place to live.

The availability and use of some equipment within the home was not appropriate and may put people who were living at the home at risk.

We carried out this review to check on the care and welfare of people using this service. We spoke to nine people, two relatives, the manager, and three staff.

On the day of the review, we saw that the tables in the dining room had been set nicely with red and white flowers to create a nice environment for Valentines Day. Staff wore red coloured tops and we saw that people using the service were encouraged to wear red clothes as a way of celebrating Valentines Day. This means people had an opportunity to celebrate special occasions.

We saw that staff were not proactive at reassuring people and engaging with people. People were reassured when they directly approached staff. One person said, “Sometimes staff tell me to get back to bed if I get up during the night.”

We saw that there were limited activities for people to take part in. One person told us, “There are no activities here; I walk around to get some exercise.”

We saw that the home has not followed recommendations made by the pharmacist following a medicines audit. Improvements are required to ensure staff are consistently recording administration of medicines to decrease the risk of medicines error.

The inspection took place on 20 and 21 October 2015 and was unannounced. At the last inspection on 2 to 4 June 2015 the provider was not meeting the legal requirements. We asked them to make improvements regarding respecting people’s privacy and dignity, obtaining consent to care, providing care to people safely, ensuring that there were sufficient numbers of staff to support people, how care staff are recruited for their roles and the overall management of the service. At this inspection we found the provider had made some improvements but there were still areas that require further improvement.

Hilton Rose Retirement Home is a residential home that provides accommodation for up to 25 people. At the time of the inspection there were 19 older people who were living with dementia at the service. 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.

We found there had been improvements in medicines management, however, people didn’t consistently receive their medicines as prescribed.

People were not always protected by robust recruitment practices that ensured care staff were suitable to work in care settings before they commenced work.

The provider was developing quality assurance and governance systems in the service, however, the systems were not always identifying and managing potential risks to people. Policies and procedures were not always up to date and followed.

People told us that they felt safe living at the service. Staff and managers could identify the signs of potential abuse and were able to describe what action they would take if they felt someone was at risk of harm. People were supported by staffing levels that kept them safe.

Risks to people were mostly being assessed by staff and managers and actions put in place to mitigate risks. A key worker system was in place to check that care plans and risk assessments were up to date and any changes in risk were reviewed.

People told us staff obtained their consent before they were supported. Staff and managers knew how to obtain people’s consent if they lacked capacity to make decisions around their own care.

People were supported by staff who told us that they received good training and were supported to be effective in their roles.

People told us they were happy with the food and drink that they received. Staff and managers were aware of people’s special dietary needs and ensured these needs were met. People told us that they felt their day to day health care needs were met by the provider. We saw evidence of regular intervention by external healthcare professionals to ensure the risks to people’s health were managed.

People living at the service told us that staff and managers were caring. We observed positive, caring interactions between staff and people living at the service. We saw staff offered people choices when providing support and took time to listen and respect people’s decisions. People told us that their privacy, dignity and independence was respected and promoted by staff at the service.

People told us there were not enough leisure opportunities available to them at the service. People and their relatives told us they were involved in the planning of their care. Changes in people’s care needs were identified, recorded and communicated to staff members.

People and their relatives told us they felt their complaints were listened to and that action was taken by the managers. People living at the service and staff had been involved in the development of the service. People, staff and relatives gave positive feedback about management within the service and acknowledged the improvements made since the last inspection.

We found there were some areas in which the provider was not meeting the requirements of the law.  You can see what action we told the provider to take at the back of the full version of the report.