Hillcrest Care Home is a residential ‘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.

The service is registered to provide personal care and accommodation for up to 34 people, including older people, people living with a dementia and people living with a physical disability. The service provides care in one adapted building over three floors and has a garden area. At the time of our inspection there were 28 people living at the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

Care plans contained information about how people preferred to be supported and risks to people's safety. These had been assessed by staff and regularly reviewed. This enabled staff to have the guidance they needed to help people to remain safe and receive the care they chose.

Medicines were stored and administered safely and the premises were well maintained to keep people safe.

Staffing levels were sufficient to meet people's needs. We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff received the support and training they needed to give them the skills and knowledge to meet people's assessed needs.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

The care provided was person centred and we observed positive interactions between people and staff. Staff treated people with dignity and respect; they knew people well and could anticipate their needs. People told us they were happy and felt well cared for.

The provider had a system in place for responding to people's concerns and complaints. People were regularly asked for their views. There were effective systems in place to monitor and improve the quality of the service provided.

Further information is in the detailed findings below.

This inspection took place on 10 November 2015 and was unannounced. The service was last inspected on 18 August 2014, when the service was found to be compliant with the regulations assessed.

Hillcrest Care Home is registered to provide personal care and accommodation for up to 34 people, including older people, people living with a dementia and people living with a physical disability. The service is not registered to provide nursing care. The service is located in Catterick Garrison, and is close to local shops and amenities. At the time of our inspection there were 30 people living at the service.

The service had a registered manager, who had been registered with us since August 2011. 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 using the service, and their relatives, told us they felt safe at Hillcrest Care Home. Staff knew how to report any concerns about people’s welfare and had confidence in the registered manager responding appropriately to any concerns.

Staff were recruited safely and sufficient numbers of staff were available to meet people’s needs. Medicines were safely stored and people received the medicines they had been prescribed.

People had individual risk assessments in place, which ensured staff were aware of the risks relevant to each person’s care. The premises and equipment were maintained in safe working order. The service was homely and comfortable, although some areas looked worn and more adaptations could be made to support people living with a dementia.

Staff had the skills and knowledge they needed and felt supported by the registered manager. Staff supervision took place regularly to monitor staff performance.

The service was following the principles of the Mental Capacity Act 2005. At the time of the inspection no-one was subject to a Deprivation of Liberty Safeguards authorisation, although authorisations had been sought in the past. The assessment tools used to help staff make decisions about deprivation of liberty have been reviewed by the registered manager and provider to ensure that are implementing current best practice and protecting people’s legal rights.

People told us that the food was good. People’s dietary needs were assessed and monitored. Support had been requested from relevant professionals if there were concerns about people’s nutritional wellbeing. A range of foods, snacks and drinks were provided, to meet people’s individual needs.

Arrangements were in place so that people had access to a range of health and social care professionals. We received positive feedback from a health care professional, who told us the service worked well with them and provided a good standard of care to people.

People told us that they were well cared for and treated with dignity and respect by staff. We saw good examples of person centred care and a caring attitude by staff members during our visit.

Care staff knew people well and could describe people’s individual needs. People had their needs assessed and had detailed and individual care plans in place.

People had access to some activities and regular entertainers visited, although some people told us they wanted more involvement in their local community, such as walks out with staff. Visitors were made welcome and could visit when they wanted.

A complaints procedure was in place. People told us they felt able to raise any concerns or discuss anything they wanted to with the registered manager who encouraged feedback on an individual basis. There had been no recent formal complaints and people were happy with how any small issues had been responded to in the past.

People who used the service, relatives and staff were complimentary about the registered manager and their approach. The company director visited the service regularly to monitor the service and support the registered manager. Audits and checks were completed to monitor the service and identify any improvements that were needed.

The inspection was carried out by a single adult social care inspector. The focus of the inspection was People were cared for to answer five key questions; is the service safe, effective, caring, responsive and well led?

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

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of the people living in the home and a member of management was present.

Staff were recruited and supported to maintain standards through appropriate personnel processes and appraisal systems. Staff were well trained to undertake their duties and the management of medicines ensured any risks were minimised.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all care homes. We saw that proper policies and procedures were in place, and that relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People, and their relatives, told us they were happy with the care they receive and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. One person told us "The staff are all lovely and we've got a good manager".

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were kind, patient and encouraging. We saw that people were always asked for their preferences before any care was given and that people were always given time to respond.

Is the service responsive?

People's needs had been assessed and regularly reviewed. We were told that care plans were reviewed at least monthly. Records identified peoples likes and interests, and care plans reflected these preferences with due regard to previous lifestyles. People had access to activities and were supported to maintain relationships with friends and relatives.

Is the service well led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities. They told us that the manager kept them well informed and they felt their views were listened to and taken into consideration. Staff, relatives and visiting professionals all had very complimentary opinions about the manager of the home. The manager had good systems and processes in place to ensure the smooth running of the home.

We saw that people looked cared for they were clean and comfortable and they told us that they felt supported and "very well looked after". They said staff were very kind and helpful. One person said "The staff are fantastic, I am very very happy." Another person said "I like everything; it’s all really good for me living here". A visiting district nurse said "It is always a pleasure to come to Hillcrest; the staff are caring and know what they are doing. The people are very well looked after". A doctor said "I've always been able to speak to staff who know my patients, know what’s been happening and the reason for my visit, this is appreciated".

We saw that people had a choice of well cooked and nutritious food. Staff monitored people's weight and charted food and fluid intake of people who they had identified at being at risk of dehydration of malnutrition and took appropriate action promptly. People told us the food was "lovely". A relative said "Mothers put on weight and loves the food".

We looked at staff files and found that they had been recruited properly and checks had taken place to make sure that they were safe to work with vulnerable people. We also saw that staff are given an induction to home and to safe working practices.

The manager told us that she and the provider undertake quality audits and work to an action plan to resolve any outstanding matters promptly.

People we spoke with told us that they liked living at the home and staff were very kind. They said staff always knocked on doors and hesitated before they went in, they respected their wishes in everything and always asked what they wanted to wear when they were being helped to get dressed. They said staff responded quickly to call bells and they don’t feel rushed when being helped with their care needs.

People who use the service told us that they were very satisfied with the care that they were receiving. They also told us that they felt involved in the planning of their care. One person said "It's champion; I can do what I like, when I like". People liked the food that was provided; one person told us "The food is superb, the portions are just right and there is something for everyone."

People spoken with confirmed that they were very happy with the staff and the care and support that they provided for them. People told us they were happy with the service and were able to ask staff if they wanted anything. One person said "The staff are always around if I need anything, they are very obliging. Nothing is ever a problem, they are all smashing from top to bottom".

Staff spoken with said that they feel supported by the manager and the provider. One said "this is the best company I have worked for".