The inspection visit at Hillcroft Caton Green took place on 15 December 2016 and was unannounced.

Hillcroft Caton Green is one of six services in the Hillcroft group. It is located in the village of Caton about five miles from Lancaster in a remote rural setting. Car parking facilities are available. It is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury.

The building is a large stone build house adapted for use as a nursing home. There are extensive well-kept grounds. There are two units, one catering for people living with dementia care needs and the other for people whose behaviours may challenge. Hillcroft Caton Green can support a maximum of 35 people. At the time of our inspection, 31 people were living at the home.

The service had 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.

At the last inspection on 08 July 2014, we found the provider was meeting the requirements of the regulations that were inspected.

During this inspection, we noted the provider had systems that ensured people who lived at the home were safe. Records we looked at indicated staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure and knew what to do should they witness any abusive actions at the nursing home.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who lived at the home. Staff told us they had experience of working in both units, this allowed them to get to know everyone living at the nursing home.

Staff responsible for administering medicines were trained to ensure they were competent and had the skills required. We investigated and noted medicines were kept safely and appropriate arrangements for storing medicines were in place.

Staff received training related to their role and were knowledgeable about their responsibilities. Staff told us they had a comprehensive induction when they started work. They had the skills, knowledge and experience required to support people with their care and support needs.

People and their relatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

Comments we received demonstrated people and their relatives were satisfied with the care provided. The provider and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

A complaints procedure was available and people and their relatives we spoke with said they knew how to complain. One person spoken with told us they had previously complained and were happy with the outcome. Staff spoken with felt the registered manager was accessible, supportive, approachable, and had listened and acted on concerns raised.

The registered manager had sought feedback from people w

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

This was an unannounced inspection carried out on the 8 July 2014.

The home is registered for 35 people to provide nursing care. The service provides care for people who exhibit behaviours that challenge the service or who live with dementia. The home has two separate units known as the ‘Manor’ and the ‘Croft’.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

During our visit we used a number of different methods to help us understand people’s experiences of the care and support they received. This was because some people were living with a dementia and were not able to tell us about their views and experiences of living at Caton Green.

During our visit we saw staff had developed a good relationship with the people they supported. We spoke with relatives, people who lived at the home, staff and management. Those people who were able to talk with us were positive about the home and the way care and support was delivered to them. Comments from people living at the home included, “The care is very good, I cannot fault anything here.” Also, “I ramble about, I can’t get far now, I can’t drive anymore, but the staff always speak as they go past.” A relative we spoke with who visited the home regularly said, “All the staff are good, I speak to them all. They work right round the home so I get to see them all. There are some who really get on with my husband well, but I have no complaints.”

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. One relative said, “I feel confident when I leave that he will be well looked and safe until I get back.” Safeguards were in place for people who may have been unable to make decisions about their care and support.

The registered manager and staff told us they had positive communication links with healthcare agencies, social workers and doctors in relation to peoples care and support needed.

Staff spoken with were positive about their work and confirmed they were supported by the manager. Staff received on-going training and development in the areas of care and support people required. Staff told us training in particular areas such as dementia and challenging behaviour was always available and supported by the manager. One staff member said, “We are constantly updating and attending courses around dementia and challenging behaviour, which is fantastic.” This helped to ensure staff had the knowledge and skills needed to meet the specific needs of people.

The service had policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We spoke with the manager and senior staff to check their understanding of MCA and DoLS. Staff demonstrated a good awareness of the code of practice and confirmed they had received training in these areas.

We undertook a responsive inspection in order to establish if the provider had safe measures in place to ensure windows in the home could not open beyond 100mm. This was to ensure that people who lived at the home were being protected against the risks of unsafe or unsuitable premises.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

During the inspection we spoke with the registered manager. She told us she had been made aware of the reported concerns the previous week and the handyperson had taken immediate action as we had requested. She told us he was currently in the building undertaking maintenance work on some of the windows he had identified required adjusting.

Is the service effective?

The handyperson showed us his checklist, identifying several windows for maintenance work to the restrictors. He told us he had ordered new window restrictors and was in the process of fitting them and making any adjustments.

Is the service caring?

During our inspection we spoke with a cleaner, a laundry assistant and the handyperson. Our discussions confirmed they were aware of the risks posed to people, and what action they should take if they observed any ongoing concerns regarding the windows being left wide open.

Is the service responsive?

We saw evidence to show us that the provider had taken immediate action to check all the windows in the home . On the day we contacted the provider, the handyperson had checked and adjusted a window opening at the front of the home to ensure it could not be opened any more than 100mm.

Is the service well-led?

The registered manager told us should members of the public have any concerns regarding the home, she would be very happy to speak with them directly. This would enable them the registered manager/provider to look into their concerns and provide reassurance that people living in the home are safe.

Many people living in Hillcroft - Caton Green had limited verbal communication and understanding and were not able to converse with us easily. We spoke with some people and observed staff interacting with people. We saw some good practice where people were supported sensitively and with respect. We also saw people left to unattended at mealtimes or left sitting unoccupied for long periods.

There were two separate units. One, The Manor was predominantly for people with behaviour that challenged. The other, The Croft was predominantly for people with nursing needs.

We spoke with some people living in the home and some relatives. Most people said they were satisfied with the care they received. One person said, "I like it here." A relative said she found the home excellent and nothing was too much trouble for the staff. Another relative said they cared for her relative very well and she had improved in the home. However these comments did not always reflect our observations. We found that people's views and experiences were not always taken into account when planning and carrying out care.

Most care records we looked at had all the necessary information to support people effectively. Most records showed effective strategies for managing behaviour that challenged.

We had concerns about the cleanliness of The Manor Unit.

There were not enough staff on duty, to support people safely and to provide meaningful activities.

Staff had received training and support to assist them in meeting the needs of people.

There were systems in place to check the quality of the service but senior staff did not always react in a timely manner.

This inspection was undertaken to review the improvements the provider made following our last inspection in June 2012. The inspection had identified concerns with the homes safeguarding procedures and supporting staff in their roles. On this inspection we found improvements had been made and they had addressed all the concerns from the previous inspection.

We spoke with a range of people about the home. They included the manager, staff, two residents, and a relative visiting the home. We also had responses from external agencies including social services. This helped us to gain a balanced overview of what people experienced living at the home.

Residents had difficulty communicating due to their dementia condition. However observations we made demonstrated people living there were comfortable. They also responded positively with staff members. We saw residents liked to move around the home, use their rooms and other communal areas. TThere were no restrictions noted and staff were seen to encourage people to make choices about what they wanted to do.

Staff we spoke with were all positive about the improvements made in respect of supporting them. Comments included,

“Now, we are much more supported by management.”

“More staff on duty has made a huge difference in the quality of care we provide.”

“Regular supervision sessions now take place with my senior."

We spoke with a number of residents, all of whom had some degree of dementia or challenging behaviour. We also spent time observing the interactions between staff and residents in both of the home's two units. We spoke with six people who were visiting friends or relatives on the day of the inspection.