Hill View Care Home is a residential service which provides accommodation and support for up to 46 people who require nursing or personal care. At the time of our inspection there were 32 people living at the home.

At the last inspection, the service was rated Good. At this inspection we found that the service remained Good.

We found that staff had been recruited safely and were aware of how to safeguard vulnerable adults living at the home from abuse. There were safe processes and practices in place for the management and administration of medicines.

Most people were happy with staffing levels at the home. During our inspection we found that there were a suitable number of staff available to meet people’s needs in a timely way.

Staff received appropriate training. People who lived at the home and their relatives felt that staff had the knowledge and skills to meet people’s needs.

People received appropriate support with eating and drinking and their healthcare needs were met at the home.

People were encouraged to be independent and staff respected their privacy and dignity. We observed staff at the home communicating with people in a kind and caring way. People looked relaxed and comfortable in the home environment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. The service had taken appropriate action where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe.

We saw evidence that people received care that reflected their needs and preferences. We received positive feedback from people who lived at the home and relatives about the activities available.

People’s religious or spiritual needs were documented and they received appropriate support. However, people’s sexual orientation had not been documented. The registered manager advised that this would be discussed with people and documented in future.

The service had a registered manager in post. People who lived at the home, relatives and staff were happy with how the service was being managed. They found the registered manager and the deputy manager approachable.

The registered manager had sought feedback from people who lived at the home, their relatives and staff about the care and support provided. A high level of satisfaction had been expressed about many areas of the service. Where improvements had been suggested, we found evidence that action had been taken.

We found that audits and checks of the service had been completed regularly and were effective in ensuring that appropriate levels of quality and safety were maintained at the home.

Further information is in the detailed findings below.

We carried out this inspection because we had received concerns about the home. These concerns included a number of recent incidents investigated under safeguarding procedures.

During the inspection we spoke with five people who used the service and one visiting relative. People made the following comments, “It’s alright” and “Yes I feel safe, nothing bad has happened to me whilst I’ve been here”. People spoke positively about the staff team at Hill View one person told us, “The staff have been good to me, no qualms about them”.

Overall we found people were protected from abuse and the risks of abuse. However we found some issues in need of attention to provide more effective safeguards for people using the service. The providers were taking action in response to these matters.

We spoke with seven people using the service and two visitors. They were mostly satisfied with the care and support provided at Hill View. They told us: “They look after me very well”, “My father feels happy and safe here” and “Everything is okay”.

People were being involved as far as possible in planning and consenting to their support and were enabled to make decisions about matters which affected them.

Overall we found people experienced good care and treatment. They told us they were treated with respect. However, we found progress could be made in interacting with and occupying people.

People were getting support with their healthcare needs and they had ongoing support from health care professionals.

People were encouraged to maintain and develop their independence skills.

We found there were enough experienced and skilled staff available to provide care and treatment. However we found improvements could be made on providing clearer directions to make sure there are always enough staff on duty.

We found appropriate records were being kept to support good care practice and communication.

People had been consulted about their experience of the service. We found checks of the services’ various systems and practises had been carried out to reduce risks to people using the service.

People using the service told us they were satisfied with the care provided at Hill View. One person said, “I would recommend it to anybody, the staff are very good.” Another person told us she liked the home and members of staff were nice people.

We found that people felt confident to express any concerns. Members of staff had a good understanding of safeguarding procedures and knew the action they must take if abuse was suspected or witnessed.

We saw that suitable arrangements were in place for the safe keeping and handling of medicines.

We found that recruitment procedures were thorough and protected people from the employment of unsuitable staff.

We noted that systems were in place to monitor the quality of the service provided. We saw evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.

We saw that appropriate and accurate records were kept for people using the service and the overall effective management of the home.

We carried out an inspection of Hill View on 10 and 11 December 2014. The first day was unannounced. We last inspected Hill View to carry out a responsive review on 13 March 2014 to look at safeguarding issues and found the service was meeting the current regulations in the outcome assessed.

The home is a 46 people bedded care and nursing home registered to provide personal or nursing care to older people. Accommodation is provided in single rooms two of which have en-suite facilities. At time of the inspection there were 36 people accommodated in the home.

The home was managed by 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.

There was evidence that the rights of each person to take control over their own lives and make their own decisions and choices was at the heart of their care. People told us they felt safe. They said they had never had any concerns about how they or other people were treated. Staff were described as being ‘very good’. People identified as having some difficulty making choices were supported for example by a relative.

People told us they were cared for very well. They also considered their privacy and dignity was respected. There were two appointed ‘dignity champions’ in the staff group.

We found staff were attentive to people’s needs. They understood the varying needs of the different people we had discussed with them. Staff said they enjoyed their work and worked well together. There was a stable staff team who were clear about their responsibilities and duty of care.

People had their medication when they needed it. Medicines were managed safely. We found accurate records and appropriate processes were in place for the ordering, receipt, storage, administration and disposal of medicines.

The home was warm, clean and comfortable and people were satisfied with their bedrooms and living arrangements. Cleaning schedules were followed and staff were provided with essential protective clothing. There were contractual arrangements for the disposal of clinical and sanitary waste and the water supply was monitored for the control of Legionella. Water temperatures at source were maintained at a safe temperature to prevent accidental scalding.

A variety of activities were provided. The activity co-ordinator also engaged with people who preferred to or benefitted from having one to one activity sessions. Personal journals were being completed regarding activities and visiting arrangements were good.

People were cared for by staff that had been recruited safely. Staff had relevant training to support them in their role and in response to people’s changing needs. They were kept up to date with changes in people’s needs and circumstances. People were cared for by staff who were trained well and were supervised.

We saw that referrals had been made to the relevant health professionals for advice and support when people’s needs had changed. People who may be at risk of falling, developing pressure ulcers, or may not eat enough were identified and action had been taken to minimise the risk.

People’s lifestyle was centred on them and they did not have to conform to any institutional practice such as set times for getting up or going to bed. Meals provided met with their tastes, needs and choices. Routines were seen to be flexible to accommodate people’s varying needs.

People told us they were encouraged and supported to express their wishes and opinions. There were opportunities for people to give feedback about the service in quality assurance surveys. Recent surveys showed overall satisfaction with the service. People told us they knew how to make a complaint and felt confident any issue they raised would be dealt with promptly.

We were told by staff, visitors and people using the service the management of the service was good. There were processes in place to support the registered manager to account for the actions, behaviours and the performance of staff. The registered manager was also monitored by the regional manager who visited the service on a monthly basis as part of the provider’s quality monitoring. Checks were made to make sure the registered manager was meeting the required company standards in the day to day running of the home.

Senior staff had taken lead roles, for example in medication, fire safety, health and safety and infection control. This meant they kept up to date with best practice issues