Hill House Nursing Home is registered to provide accommodation, personal and nursing care for up to 44 older people who may be living with a dementia. At the time of our inspection there were 41 people living at the home. The home offers both long stay and short stay respite care.

This inspection took place on 4 and 5 April 2018 the first day was unannounced.

Hill House Nursing Home 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. Accommodation was provided over three floors.

The last inspection was carried out in January 2017 and the overall rating for the service was 'requires improvement.' The provider was in breach of two regulations. These related to 'safe care and treatment' (Regulation 12) and 'good governance' (Regulation 17). We issued requirement notices in relation to these breaches. We asked the provider for an action plan which they provided telling us how they were going to make the necessary improvements.

During this inspection we found improvements had been made.

A registered manager was in place. 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 told us staff treated them properly and they felt safe. One person said, “I feel safe and am happy here.” People were protected as staff had received training about safeguarding and knew how to respond to any concerns. There were systems in place to protect people from abuse. There was an up to date safeguarding policy in place and contact details for the local safeguarding adult’s team were displayed around the home.

Risk assessments were in place to help protect people from the risk of harm. People's risk assessments were reviewed regularly and provided guidance for staff in how to keep people safe and minimise the risks. Where people had been identified as at risk, records directed staff on the actions to take to reduce this risk. For example, some people were assessed as being at high risk of pressure damage to their skin and appropriate pressure relieving equipment was in place to minimise these risks.

People, relatives and health professionals were consistently positive about the caring approach of staff. Staff were kind, compassionate and caring toward the people they supported and spoke about people positively and with affection. The atmosphere in the home was calm and relaxed. People's privacy and dignity was respected by staff and people were encouraged to be as independent as possible, without compromising their safety.

People, relatives and staff told us they thought there was enough staff available to meet people's needs in a timely manner. One person said, “When I ring the call bell I never have to wait long.” People were supported by staff that had been safely recruited. Recruitment checks were in place and demonstrated that the staff employed had satisfactory skills and knowledge needed to care for people.

Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs.

Staff respected people's rights to make their own decisions and choices about their care and treatment. People's permission was sought by staff before they helped them with anything. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well. Where people may need restrictions on their liberty and freedom in order to

Hill House Nursing Home is registered to provide accommodation, personal and nursing care for up to 44 older people who may be living with a dementia. At the time of our inspection there were 38 people living at the home. The home offers both long stay and short stay respite care.

This inspection took place on 5, 12 & 13 January 2017, the first and second days of our inspection were unannounced. Two adult social care inspectors carried out this inspection. Hill House was previously inspected in November 2013, when it was found to be compliant with the regulations at that time.

Although Hill House did not have a registered manager at time of our inspection, a new manager had been appointed, and was being supported by the nominated individual. The previous manager had left in October 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People's medicines were not always managed safely. Medicine Administration Records (MARs) were not always completed accurately. This meant staff were unable to tell if people had received their medicines as prescribed. Where people were prescribed medicines to be given “when required” there was no guidance provided for staff as to when this should be used. Where people were prescribed topical medicines or creams, detailed guidance had not been provided and staff were not recording consistently within people’s records these had been applied. People received their prescribed medicines when they needed them and in a safe way. People were given time and encouragement to take their medicines at their own pace and staff always sought people’s consent. Staff had received training in the safe administration of medicines and records confirmed this.

People were not fully protected from the risks posed to them by environmental factors. Whilst some premises checks had been completed in a timely manner there were no recordings of water temperatures being carried out. Although the manager assured us taps were thermostatically controlled, these checks are important as they allow staff to monitor the temperature of the water to protect people from scalding when having a bath or shower. Whilst we did not find any taps where very hot water was being delivered, staff were not carrying out checks to ensure this was always the case.

There was insufficient oversight by the management team and nursing staff to ensure people's needs were being monitored on a day-to-day basis, as some records were either not maintained or were incomplete. Although people’s care plans had been regularly reviewed, we found nursing staff did not consistently review people’s daily notes as part of this process. This meant nursing staff were not reviewing all the information available to them and as such could not be sure that people were being adequately supported or receiving care appropriate to their needs.

We looked at the home’s quality assurance and governance systems and found the provider did not have effective systems to assess and monitor the quality and safety of the services provided at the home. Although some systems were working well others had not identified the concerns we found during this inspection.

We raised our concerns with the manager; who told us they were in the process of undertaking a complete review of the home. The manager had already identified many of the concerns we identified as part of this inspection and they were in the process of developing an action plan with time scales to address these concerns.

People said they felt safe and well cared for at Hill House, their comments included "I do feel safe” and "I love it here.” Relatives told us they did not have any concerns about people's safety. One relative said, "Peop

On the day we visited, there were 33 people living at the home. We spoke with 11 people and one relative and asked them about their experience of the home. We looked in detail at the care of four people who lived at the home. We spoke with 11 staff which included nursing and care staff and housekeeping. We also spoke with the registered manager and the provider.

People told us they were treated with respect and dignity by care workers and we also observed this to be the case. We found that care workers supported people to make choices in their everyday lives. People were encouraged to maintain independence and pursue their interests.One person said, "They are fabulous here, top notch”. Another person said, "They are so kind they help me with everything"

People's care needs were assessed and risk assessments and care plans we looked at showed how people were supported with their care and treatment. Staff we spoke with knew about people's care needs and how to meet them. We observed that staff interacted well with people, and were caring and compassionate. Staff responded to people's care needs and worked at a pace that suited them. There were enough staff on duty to meet people’s needs.

The home was clean and comfortable.

The home was well managed with a robust system of monitoring of the quality of care.