The inspection took place on 26 and 27 September 2016 and was unannounced. East Hill House Residential Care Home is registered to provide residential care for up to 34 older people. At the time of the inspection there were 31 people living there.

The home has a dementia care unit 'The Willow's' on the third floor of the main house which provides care for up to eight people with dementia. There is a smaller unit opposite the main house 'The Court' which provides accommodation for up to 10 people.

The service had a 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 and their relatives told us the service was safe. Staff had undergone safeguarding training and had access to policies and guidance to enable them to safeguard people.

People and professionals told us risks to people were well managed. Risks to people had been assessed in relation to falls, choking, skin care and moving and handling. There were care plans in place to say how identified risks would be managed and staff understood how to manage risks to people. Risks to people from their environment were managed safely. Incidents were reviewed and measures taken to reduce the risk of repetition for people.

People and their relatives said there were enough staff on duty. The registered manager used a staffing dependency tool to determine the safe level of staffing for the service. There were enough staff rostered to meet people’s needs. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.

People and professionals told us medicines were well managed for people. People’s medicines were ordered, stored and disposed of safely. Where people lacked the capacity to consent to their medicines, legal requirements had been met. Staff had completed medicines training and updated their internal medicines training, but had not all updated their on-line medicines training within the past year, as required by the provider. There was no impact of this on people who received their medicines safely. The registered manager took immediate action once the issue was identified to ensure staff updated their training and implemented a process to ensure that in the future they would be made aware of upcoming expiry dates for staffs’ on-line medicines refresher training.

People told us the staff were well trained. People were cared for by staff who had received suitable training, on-going support and professional development to ensure they were competent to deliver peoples’ care effectively.

People reported that their consent was asked for when care was being given. Staff told us they had undertaken Mental Capacity Act (MCA) 2005 training, which records confirmed. They were able to demonstrate how it applied to their day to day work with people. The forthcoming introduction of new MCA paperwork by the provider will enable staff to more clearly document the outcome of best interest decisions for people in relation to Deprivation of Liberty Safeguards applications.

People were happy with the quality of the meals provided. People were appropriately supported by staff wherever they were eating within the service. People’s weights were monitored and appropriate action was taken if people were at risk from weight loss.

People and relatives reported there was good healthcare provision. Staff arranged for people to see a range of health care professionals as required.

People and relatives said the care delivered was very good. They thought staff were friendly, kind, caring, helpful and respectful. People experienced positive relationships with the staff who cared for them.

People’s communication needs were documented t

Our inspection team was made up of an inspector. They answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, their relatives, staff supporting them and from looking at records. We spoke with four people, one person’s relative, three staff, the registered manager and the regional manager during the course of the inspection. Not all people who lived on The Willows were able to communicate with us about their experiences of the care provided. Therefore we used our Short Observational Framework for Inspection (SOFI) to observe the care provided to people on this unit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Risks to people had been identified and there were plans in place to manage these risks. We saw evidence that the guidance for staff in relation to the management of risks to people had been followed.

Staff received training in safeguarding and they had updated this annually. Staff understood their roles and responsibilities in relation to safeguarding people. Relevant guidance was available for both staff and people.

Relevant checks had been made in relation to staff during their recruitment to ensure that they were suitable to work with vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. No-one was subject to DoLs however, we saw evidence that the service was aware of how to make referrals.

Is the service effective?

People’s needs had been assessed to ensure that the service was able to meet their needs. People had been involved in their care planning and asked about their preferences. One person told us “Yes, I was involved in planning my care.” The care delivered to people reflected what was recorded in their care plans.

There was evidence that staff had used evidence based practice to inform the care that people received. They used risk assessment tools to assess and monitor risks to people. Staff had received relevant training in caring for people with dementia.

People had been provided with relevant information in a range of formats in order to enable them to make decisions about their care.

There were a range of activities for people to engage with. Staff had ensured that people from the community came into the home and that people were supported to go out when they wished.

Is the service caring?

Staff were observed to treat people with dignity and respect when they communicated with people and provided their care. People told us that they were treated with dignity and respect. One person’s relative told us “Staff always treat X with dignity and respect.”

Staff were seen to be caring towards people, their communication was respectful and kind. They used appropriate communication methods if the person had dementia, for example, touch. People told us “The staff are very good” and another person said “Staff care about you.”

Is the service responsive?

People told us that the service had been responsive when their needs had changed. One person’s relative told us “They respond to issues.” Changes to people’s care were communicated to staff via the staff handover. People’s records were updated when there were changes to their care.

Is the service well-led?

People were encouraged to be actively involved in the running of the home. People contributed to staff training and interviewed staff. There was a regular resident’s meeting. People told us “The manager is responsive to suggestions.” Staff had been encouraged to contribute their ideas.

People and staff provided positive feedback on the management of the home. People told us “The manager is very good” and “X leads them well.” There was a clear management structure in place. There were a number of processes to ensure that the provider could monitor the quality of the service provided.