This inspection took place on 21 and 22 and 26 November 2018 and was unannounced. Hillbrook Grange Residential Care Home was incorporated in 2010 as a private company and is overseen by a board of Trustees/Directors. Due to the home being a 'not-for-profit' charitable organisation all surplus funds are reinvested in the business for the benefit of the people who live there.

Hillbrook Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is in the Bramhall district of Stockport and is close to local shops and other amenities. Accommodation consists of single occupancy bedrooms located on the ground and first floors. There are two lounges, a quiet lounge/library and a dining room on the ground floor and extensive landscaped gardens adjoining the home. The service can accommodate up to 41 people; at the time of the inspection there were 32 people living at Hillbrook Grange.

At a previous inspection conducted in October 2017 the service was given an overall rating of requires improvement and there was one breach of Regulation 17 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014 in relation to good governance. At this inspection we found the service was now meeting the requirements of this regulation.

Audits, surveys and meetings helped the service maintain and improve their standards of support.

People thought the registered manager was approachable and supportive. There were now systems in place to audit the quality of service provision and additional audits were being developed to enhance the existing governance framework.

At the last inspection there was no registered manager in post. At this inspection we found there was a registered manager in post. 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 been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse. The service used the local authority safeguarding procedures to report any safeguarding concerns.

Recruitment procedures were robust which ensured new staff were safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was very clean, tidy and homely in character. Staff were trained in the prevention and control of infection to help protect the health and welfare of people who used the service.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business contingency plan in place in the event of any unforeseen emergencies.

New staff received induction training to provide them with the skills to care for people. Staff files and training records showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed many good interactions between staff and people who used the service; people and their relatives told us staff were kind and caring.

We saw from our observations of staff interactions with people and from records we saw, that people who used the service were given choices in all aspects of their lives and helped to remain independent where possible. Staff sought consent from people before assisting them.

We saw care plans gave staff sufficient information to

This inspection took place on 11 and 12 October 2017 and was unannounced. Hillbrook Grange Residential Care Home was incorporated in 2010 as a private company and is administered by a board of Trustees/Directors. Due to the home being a ‘not-for-profit’ charitable organisation all surplus funds are reinvested in the business for the benefit of the people who live there.

The service is located in the Bramhall district of Stockport and is close to local shops and other amenities. Accommodation consists of single occupancy bedrooms located on the ground and first floors. There are two lounges, a quiet lounge/library and a dining room on the ground floor and extensive landscaped gardens adjoining the home. The service can accommodate up to 41 people; at the time of the inspection there were 28 people living at Hillbrook Grange.

At a previous inspection conducted on 13 October 2016 the service was given an overall rating of requires improvement and there was one breach of regulation 11 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014 because the registered provider had not consistently acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This meant people had not always had their capacity assessed when decisions were made in their best interest and applications to lawfully deprive some people who met the criteria for DoLS had not been made. At this inspection we found the service was now meeting the requirements of this regulation; the service was adhering to the requirements of the MCA and staff had a good understanding of how to support people who lacked capacity

There was no registered manager in post. 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 living at Hillbrook Grange told us they felt safe and staff were kind and caring. The staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse.

There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm.

Equipment used by the home was maintained and serviced at regular intervals.

The service used a dependency tool that was updated every week to reflect changes in people’s needs.

We saw that there were risk assessments in individuals care plans to identify specific areas of concern. The care plans covered essential elements of people’s needs and preferences.

We looked at five staff personnel files and there was evidence of robust recruitment procedures.

Accidents and incidents were recorded and audited monthly to identify any trends or re-occurrences.

The home was clean and there were no malodours. Stockport council had conducted and infection control audit in May 2017 and the service had scored highly in all areas audited.

Staff sought consent from people before providing support

Staff received appropriate induction, training, supervision and appraisal and there was a staff training matrix in place. Staff told us they had sufficient induction and training and this enabled them to feel confident when supporting people.

Following the last inspection the service had identified the need for more person-centred care planning training and we found that this had been undertaken.

People told us the food at the home was good. There was a four week seasonal menu in use and this was displayed on the wall in the dining room. We found people's nutritional needs were monitored and met.

People’s health needs were managed effectively and there was evidence of professional involvement.

The environment was suitable for people's physical needs.

People who used the service told us

Hillbrook Grange Residential Care Home is registered as a charity and is administered by a Board of Directors. The service is located in the Bramhall district of Stockport and is close to local shops and other amenities. Stockport town centre, motorway network and public transport are easily accessible. Accommodation consists of single occupancy bedrooms located on the ground and first floors. There are two lounges, a quiet lounge/library and a dining room on the ground floor. The service can accommodate up to 41 people; at the time of the inspection there were 34 people living at Hillbrook Grange. Some of the vacancies had been planned to enable refurbishment of part of the service. Five of the bedrooms were allocated for people who require a ‘rapid response’ service which was a health-funded initiative to try to prevent people being admitted to hospital.

The service had a registered manager in post as required by a condition of registration. 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.

We undertook this unannounced inspection on the 13 October 2016. At the last inspection on 8 July 2014, the registered provider was compliant with all areas assessed.

We found there was inconsistency regarding the application of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered provider and registered manager had not always recorded when assessments of capacity and decisions made in their best interests had been made. We found there were people who may meet the criteria for DoLS but applications to deprive them of their liberty lawfully had not been made to the local authority. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found audit tools had been obtained and a plan was being developed to have a more systematic approach to quality monitoring. Currently the quality assurance checks were carried out in response to issues and needed development. We have made a recommendation that the registered provider and registered manager follow through with these plans and we will check them at the next inspection. We found there were systems for people to make suggestions and these were listened to and acted upon.

We found people who used the service were protected from the risk of harm and abuse. Staff had received safeguarding training and knew what to do if they witnessed abuse or if it was disclosed to them. People had risk assessments which helped to analyse any risk of harm, for example with moving and handling and falls and how it could be minimised. We found staff knew what to do in cases of emergencies and each person who used the service had a personal evacuation plan.

We found staff were recruited safely with all employment checks carried out prior to new staff starting work. New staff received an induction and shadowed more experienced staff until it was felt they were competent to work alone with people. We found there were sufficient care staff on duty to meet people’s current needs; there were ancillary staff for tasks such as activities, laundry, catering, domestic work, maintenance and administration so care staff could concentrate on looking after people.

We observed staff had a patient and caring approach. There were positive comments from relatives about the staff team. People who used the service and their relatives were provided with information on notice boards and in meetings. Staff treated people with respect and maintained confidentiality. Personal records were stored securely.

We found people received their medicines as prescribed and had access to a range of health care professionals in the community, when required to me

An adult social care inspector carried out this inspection. The focus of the inspection was

to answer five key questions; is the service safe, effective, caring, responsive and well led?

As part of this inspection we spoke with 4 people who use the service, 4 visitors, the

registered manager, the registered provider and 4 care staff. We also reviewed records

relating to the management of the home which included, 5 care plans, daily care records,

medical administration records and 4 staff records.

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 premises were clean, well maintained and had procedures in place for responding to foreseeable emergencies to reduce the risks to people at the home. We found systems were in place to reduce risks within the home, for example for the safe storage of medication.

We saw safe techniques were used by staff when helping people with mobility difficulties.

There was a staffing rota in place and everyone we spoke to including staff, visitors and people living in the home all felt there was enough staff on duty at any time. All staff felt they received plenty of training and felt competent to do their job. A person living at the home told us “There is always someone around and someone to help you.”

Is the service effective?

People's needs were being met at the home. We found that people's needs were assessed and care files included information about people's diagnosed health conditions and also their preferences. This meant they received care that protected their welfare and safety.

People and their relatives told us the food was good and there was a choice at meal times. One person said, "The food here is really good."

Is the service caring?

People told us they were happy with the care they received at the home. One person said, "Everyone here is so friendly, and so calm and kind." We observed that staff providing people's care were gentle and encouraging.

People appeared to be treated with dignity and the staff could tell us what they were able to do to maintain a person’s dignity. One told us, "They (the staff) always knock on the door before entering.”

Is the service responsive?

People’s needs had been assessed before they moved to the home. People’s records identified personal preferences and choices and the support that needed to be provided. The home worked with other services to ensure all care needs were met for the person such as a general practitioner or district nurse.

People who lived at the home, and relatives that we spoke to all felt that they could approach staff and the manager about anything and that they would be listened to and acted upon. Staff felt the manager was very supportive and her door was always open to them.

Is the service well-led?

The manager completed regular checks and audits of medication, infection control systems and other aspects of safety and care at the home. Records showed incidents and accidents, complaints and quality audits were reviewed by the manager.

Staff had an induction programme and appropriate checks were in place. Staff felt listened to and supported by their manager.

People using the service, their relatives and other people involved with the service had completed satisfaction surveys and records showed action was taken where any improvements were required such as the employment of an activities coordinator.

We visited Hillbrook Grange on the 11 May 2012. During our visit we spoke with three people who used the service and five members of staff. We also spoke with the Chairman of the Board of Directors which administers Hillbrook Grange.

None of the people we spoke with had any complaints about the way in which the home was managed. The three people we saw who used the service said that they felt safe living at Hillbrook Grange. One person who used the service said “I feel comfortable and when I am not happy they will listen.” Another said “I can tell staff if I am not happy, I have never complained there is nothing they could do better.” The third person we spoke with said “I have no complaints at all and if I did I could tell the managers.”

People told us that the meals were good and that they were given a choice at meal times. We were told by the head chef that he had a budget that enabled him to provide a balanced and nutritious diet for the people that lived at the home. We looked at the menus for the four week cycle and found them to include choices and were well balanced and nutritious.

We looked at four care files all of which were well organised and gave information that showed that peoples needs were being met. The three people we spoke with told us that their GP was called whenever necessary and would visit on the same day if required.

There was a small team of staff who were responsible for organising activities both ‘in house’ such as bingo, crafts and entertainers and trips out to places such as Llandudno and Blackpool.

Training for staff was an essential core value of the management and the staff team. This made sure that the staff group were up to date with current thinking and practice.

There were a number of different ways that the Board of Directors collected information to make sure that people were being looked after. They included meetings with the managers and staff who worked in the home; questionnaires given to both people who used the service and family members. Also individual board members, often during morning coffee, had discussions with people who lived at Hillbrook Grange in order to seek their views and opinions about the service offered.

We also contacted the Quality and Assurance team at Stockport Metropolitan Borough Council and Stockport Link. Both of the organisations told us that they had no information about the service which included any concerns.

We spoke with four people who lived at Hillbrook Grange, a family member, the Registered Manager and two members of the staff team. We also talked to Stockport Social Services Quality Assurance team as part of our inspection process.

No one we spoke with had any complaints. We observed that people were relaxed and that the staff team who were on duty at the time of our visit were polite at all times.

We were also able to talk with the Director/General Manager and one of the board members.

We were told “The home is excellent, couldn’t have anywhere better;” “I am asked what I like and don’t like, I can ask to see the doctor and can go to bed when I want and get up when I want;” “I can’t really say I have any complaints; my family are made very welcome;” and “I feel quite comfortable in talking to the staff if I had any concerns or complaints.”

One of the staff team told us; “The food is fantastic, the managers never skimps on the food. We can order anything that's required and there is a good budget to work with.” Another person told us that they felt well supported and had no complaints. They also said that they felt comfortable enough to say what they thought and could speak to board members if they wished to.

We looked at three care plans and other records such as staff rotas and personnel files. All were found to be up to date and well organised.