About the service:

¿ Hill Brow is a residential care home that was providing personal care to 28 people aged 65 and over at the time of the inspection.

¿ Hill Brow is purpose built over two floors, with secure entry and a lift. People have access to landscaped gardens.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

¿ People received a service that was safe, effective, caring, responsive and well led.

¿ The service had the characteristics of a good service in all areas.

¿ Overall people were happy and satisfied with the service they received. A person said, “Yes this is a good home and I think they run it very well. They try very hard - you can’t please everyone but for me this is a good place.”

¿ There was a visibly person-centred culture, underpinned by the provider’s principles, values and expectations of staff. People received kind, caring and compassionate care from staff.

¿ There was a strong learning culture. People received their care from staff who were well trained and well supported within their role.

¿ The service was responsive to people’s individual needs.

¿ 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.

¿ The service was well led. The recent change in manager of the service had been managed seamlessly for people.

¿ People’s views about their care were regularly sought and any feedback was acted upon.

¿ Working in partnership with other agencies and professionals, the service achieved positive outcomes for people in line with their needs and preferences.

Rating at last inspection:

¿ At the last inspection the service was rated good (08 March 2017).

Why we inspected:

¿ This was a planned inspection to check that this service remained good.

Follow up:

¿ We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated good. We will continue to monitor the service through the information we receive.

The inspection took place on 19 December 2016 and was unannounced. Hill Brow is registered to provide accommodation and support to 32 people. At the time of the inspection there were 30 people living there.

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 people were safe within the service. Staff had undertaken relevant safeguarding training and understood their role in keeping people safe. Risks to people in relation to all aspects of their care had been assessed and measures taken to reduce the likelihood of them occurring. Processes and procedures were in place to ensure people received their medicines from trained, competent staff.

People and their relatives told us there were enough staff to meet people’s needs in a timely manner. Records showed there were always enough competent staff on duty with the right mix of skills. People were safe because the provider had robust recruitment policies and procedures.

Staff underwent the industry recognised induction to their role and also received a variety of additional training. Staff had been regularly supported through supervision and were proactively encouraged with their professional development to ensure people received effective care.

Where people had capacity to do so they had signed their own care plans. Where people lacked the capacity to make a specific decision legal requirements had been met to ensure any decisions were made in their best interests.

People told us they were well supported with their nutritional needs. The food provided looked and smelt appetising. Risks to people associated with eating were assessed and managed safely.

People and their relatives told us people’s healthcare needs were well met.

People, their relatives and professionals told us people experienced positive caring relationships with staff. Peoples’ communication needs were understood well by staff. Staff ensured they communicated appropriately with people and involved them in decisions wherever possible. People and their relatives told us staff upheld their privacy and dignity in the provision of their care. People received a high standard of end of life care which was centred on their wishes.

People and their relatives told us staff had outstanding skills and an excellent understanding of people as individuals. They told us people experienced a more fulfilling and exceptional quality of life due to the quality of the care provided by skilled staff. There was a strong focus on providing person centred care which was both flexible and responsive to individual’s needs. People were supported to maintain and pursue their interests and to retain a sense of purpose and worth in their lives. The service created innovative ways for people to be provided with experiences which gave them stimulation and pleasure.

People and their relatives felt confident about how to make a complaint if they needed to. Where people had made complaints these had been appropriately responded to. The provider had sought individualised and meaningful feedback from people and their relatives which they then acted upon for peoples’ benefit.

The provider and manager had created and sustained a positive culture in the service based on clear values, which staff in all roles consistently applied in their work with people.

The service had a track record of being an excellent role model. There were very strong links with the community nursing team who often trialled new community projects with the service due to staff’s enthusiasm. These projects were of significant benefit both to people at Hill Brow and other local homes.

People their relatives, staff a

The inspection team who carried out this inspection consisted of an adult social care inspector and a specialist advisor. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

On the day of the inspection there were 26 people using the service. As part of this inspection we spoke with seven people who use the service, two people’s relatives, a visiting health professional, the registered manager, the general manager, the registered provider, five care staff, a kitchen assistant and the activities co-ordinator. We also reviewed records relating to the management of the home which included, six care plans, daily care records, incident records, staff rosters and records relating to the management of the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe. We spoke with people who told us they felt safe. One person’s relative told us “I feel complete assurance.”

Staff had received training in safeguarding and guidance was available to them. The registered manager had not recognised that all incidents where people had left the premises without staff being aware could have constituted neglect and should therefore have been referred to Social Services. However, they took appropriate action once this was brought to their attention. There was evidence that they had reported other incidents to Social Services as potential safeguarding issues.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Applications had been submitted to the relevant agency for one person because measures were in place to keep them safe which amounted to a deprivation of their liberty. Appropriate arrangements had been made for this person’s ongoing care.

There were sufficient staff to meet people’s needs and to ensure their safety. The registered manager kept the staffing level of the service under review and was able to increase staffing levels if required.

Clear records had been kept about what care people had received and when. People were safe as the service had recorded the care that had been provided. Records were kept securely.

Is the service effective?

The service was effective. People’s verbal and written consent had been sought in relation to the care provided. Where the service believed that the person lacked the capacity to consent to a decision they had completed an assessment and where required made a best interest decision on their behalf. Guidance and training were available for staff.

People had care plans and risk assessments in place that met their identified needs. The service was clear that they could not accommodate people who needed a secure environment. If people’s needs changed and it was identified that there was a risk of them leaving the premises then either risk assessments had been amended or the service had identified that they could no longer meet the person’s needs and alternative arrangements had been made.

Staff had received first aid training and were able to respond appropriately in a medical emergency. There was evidence that when people’s medical needs changed contact had been made with the relevant services.

Is the service caring?

The service was caring. People told us “Staff are excellent” and one relative said “It is a good place.” Staff were seen to be warm and genuine in their interactions. People were seen to be comfortable in the presence of staff.

Is the service responsive?

The service was responsive. One relative told us “I can ask the manager about any issues and they are resolved” and “I can go online and give written feedback.” One person told us that they could give their feedback on the service at the resident’s meetings.

Aspects of the service were audited to identify areas for improvement. The provider and the general manager reviewed the registered manager’s monthly audits and the results were discussed at the monthly managers meeting to identify any areas that required improvement.

The provider was aware that there was an increasing need for the service to be able to provide secure premises for people who required this level of provision. They were reviewing the situation in response to recent incidents and had a plan in place to increase the security of the premises which meant they would be able to accommodate people who were identified at the initial assessment as at increased risk of leaving the premises.

Is the service well-led?

The service was well led. We spoke with people and their relatives who told us that they felt the service was well led.

The staff were very satisfied with the leadership and the management of the service. Staff told us that they were able to call the registered manager if they had any concerns.

The provider had good oversight of the service as they visited most days.

The provider and the general manager were aware of the key issues facing the service for example, the security of the premises.

The registered manager had not notified the Care Quality Commission (CQC) of all incidents in relation to people leaving the service unnoticed. Once the issue was brought to their attention they took action to submit them and were able to demonstrate that they knew what CQC had to be notified of and how.

We spoke with people living at Hill Brow who told us the care and support provided at the home was excellent. They said the staff were caring and professional and knew their preferences and dislikes very well. Staff we spoke with had good knowledge of people’s care and support needs.

Three staff told us they enjoyed working at the home. They said they liked being able to provide support and care for people in ways that made a difference to the quality of people’s lives. The staff said they worked hard to provide the best possible care while ensuring Hill Brow remained a happy and homely place for people to live. One staff member told they loved coming to work and the team were supportive.

We saw the manager had a comprehensive quality review programme which focused on all aspects of care and organisation. This included the monitoring of accidents and incidents. In addition, care plans were reviewed on a monthly basis. These were evidenced in people’s records.

We spoke with two visiting relatives and five people who used the service. All the people we spoke with were very positive about the care at this home. People told us the staff were lovely, caring, kind and always treated them with respect.

Our observations throughout the inspection confirmed that staff treated people with respect and they demonstrated kindness and a caring attitude.

People told us that the staff provided the care they needed in a way that suited their preferences and routines. Relatives were equally positive about the care the staff provided to their family members.

One relative told us the staff had taken special care to ensure their relative was eating enough following their admission and as a result they were now eating independently and had gained weight.

We saw five care plans and each of these contained a full assessment of people's needs and a detailed plan of care for each individual. Our observations demonstrated that the staff knew people's needs and delivered suitable and appropriate care.

People said they felt safe and the records confirmed that staff had been trained to protect people from abuse or harm.

We observed that this home had a warm and pleasant atmosphere where people could pursue their interests and take part, if they chose, in the busy activities schedule.

People told us they knew how to complain if they needed to and the staff told us they understood how to report and manage any complaints.