This inspection took place on 28 September 2018. It was an unannounced visit to the service. We previously inspected the service on 2 May 2017. The service was not meeting all the requirements of the regulations at that time. We found a breach of one regulation where the service did not have effective quality assurance processes and the standard of record keeping was inconsistent. We rated the service ‘requires improvement’. Following the last inspection, we met with the provider to ask them to complete an action plan to show what they would do and by when, to improve the key question Well-led to at least ‘good.’ They sent us an improvement plan, which outlined the measures they would put in place. On this occasion, we have also found improvements are required, to ensure people receive safe, consistent and effective care.

Keep Hill Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The home is registered to provide care for up to nine older people and people with dementia. Nine people were living there at the time of our visit.

The service had 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.

Relatives were complimentary of the care provided. Their comments included “The staff are good, it is nice. There are no agency workers and most of the staff have been here for a long time, so they get to know the people.” Another relative said “(Name of person) has only been a resident here for a few weeks but they have settled really well. I am really pleased and it has made life so much better for me, too.”

People said they felt safe at the service. Staff had undertaken training on safe working practices, such as safeguarding and moving and handling. Risk assessments had been written, to reduce the likelihood of injury or harm to people during the provision of their care. Evacuation plans had been written for each person, to help support them safely in the event of an emergency, such as a fire. Equipment was serviced to make sure it was in safe working order. We have asked the registered manager to look at replacing the passenger lift, due to several breakdowns this year. We have made a further recommendation for the service to purchase its own equipment to maintain floors in a hygienic condition, rather than hire it.

People’s medicines were kept secure and records were maintained when staff had administered these. However, the home did not always ensure new prescriptions were obtained in time, to ensure people received regular courses of medicines.

We found there were sufficient staff on duty, to meet people’s needs. However, the home did not have a cook in post. Care workers were preparing meals as well as supporting people with their personal care. We have made a recommendation about this.

Staff were recruited using robust procedures, to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through induction, supervision and appraisal. There was an on-going training programme to make sure staff had the skills they needed to support people.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. People were supported with their healthcare needs.

People were not supported to take part in many activities or to have links with the local community. There was a vacant activity organiser post at the home, which had been advertised. Staff were providing activities, where they could, in

We undertook an unannounced inspection of Keep Hill Residential Home on 2 May 2017.

Keep Hill Residential Home is a care home providing personal care and accommodation for up to nine older people. At the time of our inspection there were six people living at the service. However, on the day of inspection there were four people in residence at Keep Hill Residential Home. One person was in hospital and the other person was on holiday with their family.

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 and the relative we spoke with felt people were safe at Keep Hill Residential Home. Staff understood their responsibilities in relation to safeguarding people. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. People and the relative were involved in their care and people’s independence was actively promoted. Relatives and staff told us people’s dignity was promoted.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where possible.

There were sufficient staff to meet people’s needs. The staff rota book confirmed planned staffing levels were maintained. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable to undertake their care role.

People told us and we saw they had enough to eat and drink. People were given a choice of meals and their preferences were respected. Where people had specific nutritional needs, staff were aware of these, and ensured these needs were met.

We saw the complaints procedure was accessible to people and the relative we spoke with told us they knew how to raise any concerns and were confident they would be listened to.

The relative we spoke with told us they were confident they would be listened to and action would be taken if they raised a concern. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

Staff spoke positively about the support they received from the deputy manager, the registered manager and all of the team at the home. Staff supervision and other meetings were scheduled and took place regularly. People, the relative we spoke with including staff told us all of the management team were approachable and there was a good level of communication within the service.

People told us the team at Keep Hill Residential Home was very friendly, responsive and well managed. The service sought people’s views and opinions and acted on them.

The deputy manager had commenced work at Keep Hill Residential Home in November 2016. They were in the process of looking at systems and enhancing the quality of these systems. They had introduced audits of medicines, but these were not always being completed. The registered manager did not have a system in place to monitor the quality of service delivery to people. The registered manager had failed to take appropriate action to correct this.

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

This inspection took place on 04 and 05 April 2016. It was an unannounced visit to the service.

We previously inspected the service on 05 and 06 March 2015. The service was not meeting all the requirements of the regulations at that time. We found deficiencies with how hazards were managed, in the recruitment of staff, cleanliness and infection control practice, recording of decisions made in people’s best interests and quality assurance systems. The provider sent us an action plan which outlined the improvements they would make. During this visit, we checked to see whether these improvements had been made.

Keep Hill Residential Home provides support for up to nine older people. The home was full at the time of our inspection with six permanent residents and three people who were staying for respite care.

The service had 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 received positive feedback about the service. Comments from people included “I’m very happy here,” “They’re very good” and “I’m certainly well looked after.” Healthcare professionals told us staff listened to and implemented any advice or recommendations they made about people’s care. One told us “I can’t praise them enough.”

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns.

We found there were sufficient staff to meet people’s needs. Improvements had been made to ensure staff received appropriate support through regular supervision and appraisal of their performance. There was an on-going training programme to provide and update staff on safe ways of working. Policies and procedures had been updated to make sure staff had up to date guidance to refer to.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. Improvement had been made to show how decisions were made on behalf of people who lacked capacity, in accordance with the Mental Capacity Act 2005.

Staff supported people with their healthcare needs to keep them healthy and well.

We found improvements had been made to infection control practice to help prevent the spread of infection at the home.

There had not been any complaints about the service. People knew how to raise any concerns and were relaxed when speaking with staff and the registered manager.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to assessing and mitigating risks to people’s health and safety, recruitment practice, monitoring and assessing the quality of people’s care and record keeping. We also found the provider had not fully implemented the actions they said they would take following our last inspection.

You can see what action we told the provider to take at the back of the full version of this report.

People we spoke with were all positive about their care and support and the conduct of the staff towards them. People told us staff treated them with respect, were polite and respected their privacy. One person told us “I am very happy…staff are very polite and caring.” Another person said “They (staff) take good care of us…they respect our likes and dislikes.”

People told us they felt they received good care and were happy living at the home. One person told us “I am very happy here, the home meets my needs.” A relative we spoke with told us “(X) is very happy here; when I come I see (X) looks very good.”

We found people's needs were assessed and care and support was planned and delivered in line with their individual care plan. Care records we reviewed were person-centred and informative.

We found people were cared for, or supported by, suitably qualified, skilled and experienced staff. People described staff as "Polite", "Caring" and "Understanding.

People were made aware of the complaints system. People we spoke with were confident about raising any complaints if they had a concern. One person told us “I have not had to make a complaint, because I have no reason do so.”

This inspection took place on 5 and 6 March 2015. It was an unannounced visit to the service.

We previously inspected the service on 2 October 2013. The service was meeting the requirements of the regulations at that time.

Keep Hill Residential Home provides support for up to 9 older people. It has 5 bedrooms on the ground floor and 4 upstairs. There is ramped access to the building and a passenger lift to help people up and down stairs. Eight people were living at the service at the time of our visit. One person was staying for a short break.

The service had a registered manager in post. They were also the registered provider of 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 received positive feedback about the service. Comments from people included “I’m quite happy here,” “I’ve no worries” and “It’s nice here – homely.” One person we met described a member of staff as their “Guardian angel.” Another told us a care worker who had supported them was “Very efficient.” Staff told us they had “Time to give people the care they need without rushing.” Relatives and visitors were happy with the standards of care. One said their relative “Seems happy enough here.” Another relative said they liked the fact that “Staff are always the same” so their family member was supported by care workers who knew them and understood their needs. They also told us “Staff are very kind and friendly.”

We found staff had completed training on abuse to provide them with the skills and knowledge to recognise and respond to safeguarding concerns.

Risk was not consistently managed well at the service. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care. However, there were hazards around the building which the provider had not noticed and which could cause harm to people. These included a loose radiator cover, a stair gate upstairs and lack of window restrictors to prevent people falling from upstairs windows.

There were sufficient staff to meet people’s needs. People were supported in an unrushed manner and staff were respectful and courteous when speaking with them. We heard conversations where staff were kind and compassionate towards people.

People were at risk of being supported by unsuitable care workers. Recruitment procedures were not consistently effective, as the full range of required information was not received before staff started work.

People were not supported by staff who had received effective supervision or appraisals to ensure they were performing to a satisfactory standard. However, staff told us they felt supported and regular team meetings were held. We have made a recommendation about supporting and developing staff through supervision and appraisals.

People’s views about how they wished to be supported and important background information was not always taken into account. Care plans had been written to document people’s needs. These did not always show that people and /or their relatives had been involved in what went into care plans. We have made a recommendation to involve people in their care planning. Decisions made on behalf of people had not followed the principles of the Mental Capacity Act 2005, to make sure actions were lawful and reasonable to protect people’s rights.

Staff supported people with their healthcare needs. We saw staff contacted people’s GPs when they had concerns and made a note of any advice given.

The building complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order. We found concerns with infection control practice in the kitchen. We have referred these to the Environmental Health Department.

People were at risk from receiving unsafe or inappropriate care. The service was not always managed well. The concerns we identified during our visit had not been picked up as part of the provider’s quality assurance processes. Records were not always maintained to an appropriate standard. We found policies and procedures were out of date and did not take into account current good practices.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.