Hill House is registered to provide accommodation with nursing care for to up to 60 older people who may experience dementia. Nursing care is provided to people across three floors. People who experience dementia are accommodated on one of two ‘Safe’ units which are located on the ground and first floors. At the time of the inspection there were 55 people living at the service.

At the last inspection, the service was rated Good.

Rating at this inspection

At this inspection we found the service remained good.

Why the service is rated good.

The provider had robust policies, processes and staff training in place to protect people from avoidable risks to their safety and welfare, including the risk of abuse. Staffing levels were appropriate to meet people’s needs promptly and to support people safely. The provider ensured safe recruitment practices were followed. There were arrangements in place to ensure people received their medicines when they needed them, from trained staff.

There was a focus on staff development which created a desire for staff at all levels to continually improve; through: induction, training, professional development, supervision and appraisal. 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. People were supported to eat a range of healthy foods and their healthcare needs were met.

People and their relatives consistently told us the service was caring. The provider used creative ways for staff to build relationships with people. The provider’s creation of leaflets for relatives had enabled them to develop their knowledge and understanding so they could support their loved ones living with dementia and through end of life care. The regular involvement of a person in staff recruitment made them feel they mattered. Staff went out of their way to facilitate contact between a person and their relatives living abroad. People and their relatives consistently told us people’s privacy and dignity was upheld in the provision of their care. Relatives had derived great comfort from the provider’s ‘Life basket’ initiative for use at the end of their loved one’s life.

People continued to receive individualised care that was responsive to their needs. The needs of people living with dementia were well met by staff who were skilled in this area of care provision. People were provided with a range of activities to meet their needs for social stimulation. Peoples’ feedback on the service was: sought, listened to and acted upon to improve the service for people.

There was a positive and open culture, with an emphasis upon continual development and improvement. There was good, clear, visible and inspiring management at all levels. When issues were brought to the registered manager’s attention they took immediate action. Processes were in place to monitor and improve the quality of the service provided.

We spoke with 16 staff, seven people who used the service and one relative during the inspection.

People told us the staff were kind and caring and met their needs well. The people we spoke with said they usually enjoyed the food and they were offered plenty to eat and drink. One person said "The girls are lovely; I like the food and there's plenty to drink." Another person said "They are so kind; they help me."

We observed staff assisting people with their food and drink throughout the day. We observed that the environment was suited to the people who used the service and the home had been designed with their needs in mind.

We assessed whether there were enough staff on duty to meet people's assessed needs. We saw that there were enough staff who responded to people's needs without undue delays. Of the 16 staff we spoke with, all but two said there were enough staff to meet people's needs and there was always help available if this was required.

We found that there was an appropriate complaints system in place which had been used effectively to respond to and attempt to resolve any complaints.

We spoke with two people who used the service, four visiting relatives, a community optician and four members of staff. We also spoke with the acting manager, the general manager and the provider. We spent time observing the interactions between the staff and people who used the service because not everyone was able to verbally express their opinions about the service or to answer our questions, we also observed a residents meeting.

Everyone we spoke with expressed positive views about the staff and the care at this home. People's comments included: 'The staff are lovely, they go over and above to provide good care.'

'The staff are gentle and kind and they respect the choices my relative makes.'

People generally expressed the views that the staff always provided the care that was needed at people's preferred times. People told us that they felt safe at this home and that if they spoke to the staff about any concerns they were confident these were dealt with effectively.

People said they were always given choices and these were respected and they were consulted about their care.

We found that the provider assessed people's needs and ensured these needs were met. We saw that the staff treated people with respect and kindness and that they carried out care in a way that met people's needs.

During our visit the home was a lively and welcoming place and there were plenty of activities that people could choose to take part in.

During our visit we spoke with five people who use the service. We were also able to talk with the relatives of two people and a visiting health care professional.

People we spoke with all told us they were happy with the care they received at Hill House. One person told us that before they came to live at Hill House they had spent a day there. This had enabled them to decide if it was where they wanted to live. “The impression was good.”

One visitor said that they had noticed an improvement in their relative since moving to the home. They believed this was due to the stimulation they received through the activities that took place.

People told us that the home was kept very clean and one person told us about the cleaning regime for their room.

A visiting healthcare professional told us about visiting the home at various times of the day and night. They had always found sufficient skilled and experienced staff available.

During our visit relatives told us that they were very happy with the care provided by the staff at Hill House.

One visitor told us that their relative was “content and safe”.

One resident told us they were happy living at the home and the staff were good.

Another resident told us they enjoyed the food, but there was not much in the way of activities going on.

People told us the staff were lovely and that they knew what they were doing.

One person told us that they thought their relative's waking time in the morning was for the convenience of staff.

The inspection took place on 28 and 29 September 2015 and was unannounced. Hill House is registered to provide accommodation with nursing care for to up to 60 older people who may experience dementia. Nursing care is provided to people across three floors. People who experience dementia are accommodated on one of two ‘Safe’ units which are located on the ground and first floors. At the time of the inspection there were 54 people living at the service.

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.

Staff had not always fully completed people’s fluid charts as required, although they had identified when people were not sufficiently hydrated and referred them to the GP for further assessment. There were discrepancies between stocks of some medicines and the number there should have been if medicines had have been administered as prescribed. This created a potential risk people may not have received these medicines. We have made a recommendation that the provider refers to best practice guidance in relation to standards of record keeping.

People and their relatives told us the service was safe. Staff had undergone relevant training and understood their role in relation to safeguarding people. The provider had reported safeguarding incidents to the local authority and CQC as required.

Staff had completed a range of risk assessments in order to identify and manage risks to people in relation to areas such as mobility, falls and skin integrity. When people experienced a fall they had been monitored, the GP was informed and their care plans updated where required. Risks were discussed with people and their relatives so they could make informed decisions about how to manage them. Staff understood the risks to people and followed guidance to ensure their safety.

There were sufficient staff deployed to meet people’s care needs and arrangements were in place to meet any shortfalls. Staff were deployed according to people’s needs and the skill set of individual staff. Staff had undergone the required recruitment checks. The recruitment process had been effective at identifying unsuitable staff.

Medicines were safely ordered, stored and administered. Where people’s medicines were administered covertly legal requirements had been met. Staff had guidance in place for the administration of people’s ‘as required’ medicines. Nurses received regular updates on their medicines training. People received their medicines safely.

Staff underwent an induction to their role and received on-going training. Care staff were supported in their daily work by more senior staff and expected to undertake professional qualifications. Nurses received a range of training opportunities to enable them to evidence their on-going fitness to practice. In addition to the provider’s in-house training staff undertook training in collaboration with external agencies on topics such as hydration and falls. Staff received regular supervision and received an annual appraisal of their work. People were supported by staff who underwent a range of training to ensure people’s care was based on best practice.

Where people lacked the mental capacity to make specific decisions, staff were guided by the principles of the Mental Capacity Act 2005. This ensured any decisions made were in the person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLs applications had been submitted for people where required. People’s liberty was only restricted when this was legally authorised.

People were offered a range and choice of nourishing foods during the day. Risks to people from malnutrition had been identified and managed effectively. If people were at risk their foods were fortified to ensure they received sufficient calories. Staff understood people’s dietary requirements and preferences.

People were supported by staff to access a range of health care professionals as required in response to their identified health care needs. Staff had good working relationships with external health care professionals and ensured their guidance was incorporated into people’s care plans.

The provider had given consideration to people’s needs in the design of the building and in particular to the needs of people who experienced dementia to ensure the environment was suitable for them, for example, in the positioning of pictures to orientate people.

People and their relatives told us staff were caring. Nursing and care staff were encouraged to build relationships with people and their relatives. Staff encouraged the families of people who experienced dementia to complete life history books to enable them to understand more about the person’s life and their personal interests. Staff understood people’s care needs and preferences. They supported people to express their views and to make choices. Staff had undergone relevant training to ensure they understood how to uphold people’s privacy and dignity. People and their relatives told us staff applied this training in the provision of people’s care. Staff were observed to provide people’s care in private.

People’s care needs had been assessed on their admission to the service. They had a named nurse who was responsible for their care planning. They ensured the involvement of the person or their family in their care plans and regular reviews of people’s care were completed. People had care plans which detailed how their identified needs would be met. There were processes in place to ensure staff had up to date information about changes in people’s care needs and to ensure people were checked upon regularly. People were encouraged to participate in a range of activities across the week to ensure their social care needs were met.

The provider had a process in place to enable people to make both verbal and written complaints. Records demonstrated people’s complaints had been investigated, actions taken and feedback provided.

The provider audited a range of aspects of the service on a monthly basis. The results of the audits were then reviewed by the senior management team in order to identify any trends and to identify areas for improvement. The provider used a national safety tool to monitor the risk of people experiencing harm. They had also developed clinical pathways for staff to follow with an external professional to promote effective care for people based on evidence based practice. The views of people and their relatives were sought through meetings and feedback forms. People’s feedback about the quality of the service had been acted upon.

People, their relatives, staff and professionals all provided positive feedback about the quality of the management of the service. Management was visible at all levels of the service, the registered manager was readily available to people. The registered manager wished to step down from their role. During the handover period to the new manager, the provider had identified issues with the new manager and as a result they were in the process of replacing them. This had placed additional pressure on the registered manager which may have contributed to the issue we identified with the quality of some records.

There were processes in place to enable staff to have the opportunity to meet with the provider and to raise any issues as required. People’s care delivery was underpinned by a clear set of values which staff learnt about during their induction.