About the service:

Hillcrest is a residential care home that is registered to provide personal care for up to five adults with learning disabilities and autism.

The service worked within the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people could live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control over their own lives, choice, and independence.

People’s experience of using this service:

• People received safe care and were protected against avoidable harm, neglect and discrimination.

• Risks to people’s safety were assessed and strategies were put in place to reduce the risks.

• The recruitment practices ensured suitable staff were employed to work at the service and staff were employed in sufficient numbers to meet people’s needs.

• Peoples medicines were safely managed.

• Systems were in place to control and prevent the spread of infection.

• People’s needs were assessed to ensure the service could meet their needs.

• Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care.

• People were supported to maintain good nutrition and hydration.

• Staff supported people to live healthier lives and access to healthcare services.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

• Staff treated people with kindness, compassion and respect.

• People were supported to express their views and be involved in making decisions about their care.

• People were involved in planning their care and in on-going reviews of their care.

• Systems were in place to continuously monitor the quality of the service.

• The service worked in partnership with outside agencies.

Last Inspection Rating:

Requires Improvement (report published on 27/04/2018).

The service met the characteristics for a rating of ‘good’ in all five key questions we inspected. Therefore, our overall rating for the service after this inspection was ‘Good’.

Why we inspected:

This was a planned inspection.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Hillcrest 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.

Hillcrest provides support to five adults with autism. At the time of our inspection, four people were receiving long term support from the service and one person regularly stayed in the home for respite care.

At our last inspection on the 4 January 2016, we rated the service “Good.” At this inspection we found that the service ‘Required Improvement’.

There was a registered manager in post at the time of the inspection, they were also the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were not always protected against the risks associated with the appointment of new staff as the provider had not consistently followed safe recruitment practices and recruitment records were incomplete. The registered manager took prompt appropriate action in response to our feedback and needs to ensure that these processes are followed going forward.

The quality assurance processes in place to monitor the quality and safety of the service and drive improvement required strengthening. Audits had not resulted in sufficient action to mitigate risks to people’s health and safety .There was insufficient oversight of staff training records, which did not provide up to date information regarding the training staff had received.

Staff induction training and on-going training was provided to ensure that staff had the skills, knowledge and support they needed to perform their roles. Staff were well supported by the registered manager and senior team, and had regular one to one supervisions.

Staff understood their responsibilities to keep people safe from harm. Safeguarding procedures were in place and staff understood their duty to report potential risks to people’s safety. Staffing levels ensured that people's care and support needs were safely met.

People received their medicines as prescribed and risk assessments were in place to manage risks within people’s lives. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

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. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care.

People’s diverse needs were met by the adaptation, design and decoration of premises and people were involved in decisions about the environment.

People were encouraged to make decisions about how their care was provided and staff had a good understanding of people's needs and preferences. Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes.

Staff supported people to access support from healthcare professionals, and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

The service had an open culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive continuous improvement. The provider had a process in place which ensured people could raise any complaints or concerns.

The inspection took place on 4 January 2016 and was unannounced. At the last inspection the service was meeting the essential standards of quality and safety and no concerns were identified.

The service is registered to care for up to five people with autistic spectrum disorder. At the time of our inspection five people were using the service.

A registered manager was 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.

The staff had a good understanding of what constituted abuse and of the safeguarding procedures to be followed to report abuse and we found that appropriate systems were in place to safeguard people from the risk of harm and abuse.

Risk assessments and accident management systems were in place and used to identify and manage risks to peoples’ health and welfare. The staff were aware of the risks, specific to people using the service and followed the risk management plans to promote people’s safety and independence.

Appropriate systems were in place to protect people from risks associated with medicines and ensured people received their medicines safely.

The staffing arrangements ensured there was enough staff available to continually meet people’s needs. The staff recruitment systems ensured that staff were suitable to work with people using the service.

Staff were provided with comprehensive induction training and on-going training. A programme of staff supervision and annual appraisals enabled them to reflect on their work practice and plan their learning and development needs.

Staff treated people with dignity and respect and ensured their rights were upheld. Consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards codes of practice were met.

People had varied and nutritious meals and healthy eating was promoted. People were supported to acquire the skills of home cooking and meal preparation within their capabilities.

Staff cared for people with kindness and compassionate. Partnerships were forged and the staff and relatives who worked in collaboration to care for people using the service. The views of people living at the service and their representatives were sought and areas identified for improvement were acted upon to make positive changes. Information was made available to people and their representatives on how to raise any concerns or complaints.

People and their families were fully involved and in control of their care. The care plans were detailed and reflected people’s needs and choices on how they wanted their care and support to be provided.

The service was led by a registered manager, who continually strived to provide a quality service. Staff met regularly with the registered manager to receive information and to discuss plans for the service.

Regular audits were carried out to assess and monitor the quality of the service. The vision and values of the service were person-centred and made sure people were at the heart of the service.

We found that people lived in a comfortable and homely atmosphere. One person we spoke with told us, "I like it here a lot. I am going out to see my mum today". Another person we spoke with said, ‘’They are absolutely superb. Staff are well motivated and committed to look after my relative and they get it right all the time.’’

We found that care plans were person centred and had included the individual or their representative in the planning of their care.

Staff told us that they received regular support and training to enable them to carry out their role.

The provider carried out effective checks to make sure people that lived at the home received a good standard of care.

We used a number of different methods to help us understand the experiences of people using the service. People who used the service had complex needs which meant they were limited in what they could tell us about their experiences. We spoke to a relative, who told us that they were very pleased with the care and support provided at Hillcrest. They told us that their family member was always happy to return to Hillcrest. They said they were pleased with the encouragement and opportunities that had been provided for her.

We watched and listened to interactions between staff and people who used the service. We saw that people had individual routines that were familiar and important to them. People were relaxed in the presence of staff and staff spoke quietly and calmly to people. One person who used the service told us about visiting the gym and doing a paper round. Records showed that others also took part in activities within and outside Hillcrest.