The inspection visit at Hillcroft Nursing Home Lancaster was undertaken on 02 and 10 May 2017 and was unannounced on the first day.

Hillcroft Nursing Home is one of six nursing homes managed by Hillcroft Nursing Homes (Carnforth) Ltd. It is registered to provide care and accommodation for up to 20 people and is located in Lancaster. At the time of our inspection, 18 people lived at the home. The home caters predominantly for people living with dementia and who have complex behaviours.

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.

We last carried out a comprehensive inspection of the home on 22 March 2016. At this inspection, we rated the service as requires improvement as we identified two areas of concern. Documentation we looked at indicated people were not consistently supported to meet their care-planned requirements in relation to medicines. We noted administration of medicine forms contained missed signatures. We also made a recommendation about staff training on the subject of nutrition and hydration.

We carried out a focused inspection 18 November 2016 to ensure improvements had been made. We found the service had made all the required improvements.

During this inspection, we observed the administration of medicines at lunchtime. However, staff did not consistently record that moisturising creams had been administered.

We have made a recommendation about the introduction of a robust system to record and audit the application of prescribed creams.

Medicines were safely and appropriately stored and secured safely when not in use. We checked how staff stored and stock checked controlled drugs. We noted this followed current National Institute for Health and Care Excellence (NICE) guidelines.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who used the service were being met.

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.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received safeguarding from 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.

Relatives told us they were involved in the care of their family member 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).

We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were being met. We saw the management team had responded promptly when people had experienced health problems.

The management 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.

Care plans were organised and identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Relatives told us they were happy

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We carried out this unannounced focused inspection on the 18 November 2016 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Hillcroft Nursing Home Lancaster' on our website at www.cqc.org.uk'.

Hillcroft Nursing Home Lancaster is one of six nursing homes managed by Hillcroft Nursing Homes (Carnforth) Ltd. It is registered to provide care and accommodation for up to 20 people and is located in Lancaster. The home caters predominantly for people living with dementia and who have complex behaviours.

The service had a registered manager in place. 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.

At our focused inspection on the 18 November 2016, we found improvements had been made. We found the provider had introduced an electronic system to monitor the administration and recording of medicines effectively.

To keep people safe we saw the provider had introduced an amended application form that allowed candidates to document any gaps in their employment.

The inspection visit at Hillcroft Nursing Home Lancaster took place on 22 March 2016 and was unannounced.

Hillcroft Nursing Home is one of five nursing homes managed by Hillcroft Nursing Homes (Carnforth) Ltd. It is registered to provide care and accommodation for up to 20 people and is located in Lancaster. The home caters predominantly for people living with dementia and who have complex behaviours.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the last inspection on 28 January 2014, we found the provider was meeting the requirements of the regulations that were inspected.

During this inspection, we noted staff responsible for the administration of medicines had received regular training to ensure they maintained their competency and skills. Medicines were safely and appropriately stored. Documentation looked at indicated people were not always supported to meet their care planned requirements in relation to medicines. We noted administration of medicine forms contained missed signatures.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. You can see what action we told the provider to take at the back of the full version of the report.

The provider had recruitment and selection procedures to minimise the risk of unsuitable employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the home, which was confirmed through discussions with staff. Gaps in employment were not documented as being explored.

This was a breach of Regulation 19 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report.

People did not always receive the appropriate support at mealtimes. Staff members did not fully engage with people who required support with their meals.

Staff had received abuse training. They understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the home.

People and their representatives 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).

The registered manager 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 relatives we spoke with said they knew how to complain. Staff spoken with felt the registered manager was accessible, supportive and approachable and would listen to and act on concerns raised.

The registered manager had sought feedback from people and their relatives for input on how the home could continually improve.

The registered manager had regularly completed a range of audits to maintain people’s safety and welfare.

We looked at care plan records, staff training records, staff supervision arrangements, the services safeguarding procedures and quality monitoring arrangements. We also spoke with a number of relatives visiting the home and with staff throughout the inspection. We observed the quality of care and support provided by staff during the inspection. We did this to confirm people were having their care needs met. We also wanted to identify staff had been trained and appropriate support arrangements were in place for them.

We observed staff to be very attentive and caring when meeting the needs of people who lived in the home. There was a homely and welcoming atmosphere the home. There was a choice of three different lounge areas for people to spend time in. One of the lounges had a sensory area, and this was used to help people to feel calm and relaxed.

Staff told us they felt supported and attended training courses and refresher training to meet the needs of people. Staff had attended safeguarding training and were aware of what action they were required to take to protect people from the risks of abuse.

We looked at the staffing levels within the home. The rotas showed us there was sufficient staff on duty with a range of skills and experience to meet the needs of the people who lived at the home. However staff told us they did not feel they always had sufficient staff to meet the changing needs of people. The registered manager told us they had some vacancies and she was interviewing for new staff the following week. In the meantime staff were working additional shifts to cover for the shortfalls. The registered manager had a range of audits and systems in place to monitor the quality of the service they were providing.

We spoke with many relatives, and these were some of their comments:

“I am really happy; they seem to have his medication spot on. He is happy there and everything is top notch.”

“I think the staff are a great bunch. They are genuinely fond of my mother. I can`t speak highly enough of them.”

“ I am absolutely involved in planning my mother`s care. The staff work very hard and I see the difference in my mum. They must be meeting her needs.”

During our last inspection in June 2012 we found the homes safeguarding procedures were not being followed. We identified a number of 'resident on resident' incidents which should have been referred to local authority safeguarding team. We found these concerns had been addressed by the manager. We saw a number of incidents had been referred to the local authority safeguarding team. The manager had also informed the Care Quality Commission (CQC) as required by regulation.

During this inspection we looked at staff training records. These confirmed safeguarding training of vulnerable adults had been completed and formed part of their continuing professional development.

The staff members we spoke with showed a good understanding of safeguarding procedures. They were clear about their responsibilities to report any incidents or suspicion of abuse or neglect. They said they wouldn't hesitate to report any concerns they had about care practices.

The people visiting the home told us their relatives were being well looked after. They said they had no concerns about the care being provided or their relatives safety. Comments received included:

“I have no concerns about my husbands care. I know he is in safe hands”.

“The staff cope with the difficult residents very well. I have never heard a single member of staff raise their voice or show impatience with people. I cannot praise them high enough”.

All twenty places in the home were occupied when we visited. Most people were unable to have a detailed conversation about the care and support they received. However we talked with people in a general way and we observed how people were supported by staff. People able to talk with us told us that staff were kind and nice. We observed staff supporting people in a respectful and sensitive way. One person was unable to use the words to make understandable conversation but staff still listened and responded appropriately. Another person became upset and was gently and sensitively supported.

We spoke with two relatives who said they were fully involved in making decisions about their care. Relatives said they were kept informed and involved in what was happening with their family member and in the home generally. A relative said, “The staff are great, they couldn’t be better. They always involve me in decisions. They are fantastic.” Another relative told us, “The staff here are always so kind and encourage people to do what they can. They always let me know what is happening and keep me up to date.”

We observed staff interacting with people. We talked with four people although we were unable to ask detailed questions. People living in the home were praising about the care and support they received. One person said "I like her” (pointing to a member of staff). Another person said, “I like it here."

As well as talking with people we used the short observational framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who have communication difficulties or difficulties in understanding. We found that staff interacted well with people. They assisted people sensitively, chatting as they carried out tasks and activities with people. We observed staff reducing one person’s agitation when they gently discouraged the person from taking someone else’s drink. They distracted the person by chatting while taking them to get a drink of their own.

We saw staff encourage people who had limited communication to be involved in conversations and activities. Staff assisted one person who had taken long walks when they were younger, to walk around the home whenever they wanted to. This improved their wellbeing and made sure they were safe, as they were unsteady if walking alone. We also saw staff assist people with personal care promptly and sensitively when they needed help.

We spoke with two relatives. One relative said, "The staff are excellent, they are so good to the people here and to their families." Another relative said "I am glad that we came here. We looked at lots of homes and liked here straight away.”

Relatives said the staff were caring, patient and helpful and they felt their family members were safe at the home. They told us that they would tell staff if they were concerned about anything and they would deal with the problem. A relative told us that on the rare occasion that a member of staff did not support people well, it was immediately dealt with.

We spoke with three staff about safeguarding. They told us what they would do in the event of any allegations or suspicion of abuse. Relatives and staff said they would talk to senior staff if they had any concerns about care in the home.

Relatives spoken with were complimentary about staff skills. A relative told us, “Staff are well trained here and know what they were doing.” Staff spoken with told us that the training they received was good and helped them work well with people.

The relatives of people living in the home said their family members were well supported by the staff team. They felt that they could tell them if they wanted their care provided in a different way or if they were unhappy about anything. Staff said they had good support from the manager and were able to discuss ideas or concerns with her.

During the course of the visit we spoke with the home’s manager, a recently recruited member of the care staff team, a long serving trained member of staff and the relative of a person living at the home. We also spent a period of time observing staff and residents in a communal area and talking with a small number of people living at the home. However the conversation with residents was limited because of mental incapacity. Following the visit further information was also obtained from the training coordinator and another relative of somebody living at Hillcroft Care Home Lancaster.

Without exception, people spoke very positively about Hillcroft Lancaster and the care and support provided. One relative told us that written information about the home and the services and facilities had been provided, she had been involved in discussing her relative’s needs and requirements, the resulting care pathway had been explained to her and that she was very happy with “Everything”. Another relative said, “I cannot fault it, I have never heard a staff voice raised and they talk to me all the time about **** (Wife)”.

We spoke with a small number of people living in the home in various communal areas; however discussion was limited because of mental impairment. Relatives spoken with spoke very highly of the care and support provided at Hillcroft Care Home Lancaster and the qualities of the staff team. One person told us, “They do everything well. They look after him well; give him a lot of attention, a great place”.

A member of staff confirmed that the organisation was very committed to ensuring a well trained staff team. As part of the staff training programme, adult safeguarding training is a mandatory topic for all staff in order to protect people living at the home.

Staff spoke very positively about the training provided. One member of staff said, “We all get on well together and there is a really high standard of care. Everything is done properly. Training is excellent”.

Relatives spoken with confirmed that they were encouraged to voice their opinions and any suggestions for improvement.