Hillcroft is located in a residential area of Ormskirk. The home is on three floors, with passenger lift access. Accommodation is provided in single rooms for up to 34 adults, who need assistance with personal care. There are some amenities, such as shops, a post office, a church and a pub within a short distance and Ormskirk town centre is easily accessible by car or public transport. Some parking spaces are available at the home, but on road parking is also permitted.

The last inspection of this location was conducted on 19 January 2015. Although an overall rating of ‘Good’ was awarded at that time, we did find two breaches of the previous Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These were in relation to the management of medicines and the recruitment of staff. We asked the provider to tell us what they were going to do in order to address the shortfalls identified. The provider submitted an action plan, as requested.

This inspection was conducted on 31January 2017 and it was unannounced, which meant that people did not know we were going to visit the home.

The registered manager was on duty at the time of our inspection. 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 of the Health and Social Care Act and associated regulations about how the service is run.

At our last inspection on19 January 2015 we found that the registered person had not implemented robust procedures for the safe keeping of medicines. Therefore, this area was in need of improvement. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed by 20 March 2015.

During the course of this inspection we assessed the management of medicines. We found that on this occasion improvements had been made in this area, which helped to protect people from any risks associated with the unsafe use of medicines. Therefore, the previous breach of the Health and Social Care Act regulations had been met.

At our last inspection on 19 January 2015, we found that recruitment practices were not always sufficiently robust, in order to ensure that people employed were fit to work with this vulnerable client group. Therefore, this area was in need of improvement. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed by 20 March 2015.

At this inspection we looked at the personnel records of four staff members, who had been recruited since our last inspection on 19 January 2015. We found that on this occasion new staff had been appropriately appointed and therefore people who lived at Hillcroft were protected by the recruitment practices adopted by the home. Therefore, the previous breach of the Health and Social Care Act regulations had been met.

We found that a varied training programme had been provided for the staff team, which helped them to keep abreast of current practices and any changes in legislation. Regular supervision sessions for staff and annual appraisals were also being conducted.

At this inspection we found the environment to be warm and well maintained throughout. However, we did note an unpleasant smell in one area of the home. We observed staff members interacting well with those who lived at Hillcroft. People looked happy and comfortable in the presence of staff and were enjoying their company.

Records showed that although a wide range of risk assessments were established at the home, in relation to people’s health, safety and welfare, these had not always been fully completed and did not always accurately reflect people’s needs. Staff we spoke with were able to discuss people's needs well and it was quite clear that they were able to provide the care and support each person required in a kind and caring

During our inspection we were able to speak with a good percentage of people living at the home, who in general provided us with positive comments. They told us that they felt safe whilst care and support was being provided and that their needs were being met by a kind and caring staff team. They said independence was promoted and they were able to make decisions and choices about what they wanted to do, whilst living at the home.

Comments from those living at the home and a relative included:

"I have no complaints whatsoever. My husband is always clean and comfortable."

"I like living here. The staff are smashing and very caring."

"The only problem here is that there's not much going on. I do get bored sometimes."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how medicines were being managed and how people were supported to consent to care and treatment. Standards relating to complaints and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

During our inspection we were able to speak with eight people living at the home, who all provided us with positive comments. They told us that they felt safe living at Hillcroft, with their privacy and dignity always being respected and their needs being met by a kind and caring staff team. They said independence was promoted and they were able to make decisions and choices about what they wanted to do, whilst living at the home.

We found staff to be well supported and appropriately trained and those living at Hillcroft looked comfortable in their presence. We also spoke with several relatives who were all very complimentary about the staff team and the managers of the home.

Methods for monitoring the quality of service provided had been established and systems had been developed in order to protect the health and safety of those living at the home.

Comments from those living at the home and some relatives included:

"I am very content living here. I didn't like living on my own, so made the decision to move to Hillcroft many years ago and I haven't regretted it."

"I am more than happy with the care Mum receives. The staff are very kind."

"We had a lovely Christmas lunch with Turkey and all the trimmings."

"I had my Christmas lunch here with my husband. It was really nice."

During our inspection we spoke with residents about what life was like at

Hillcroft. We also spoke with some relatives, staff members and external professionals. Everyone provided us with positive feedback.

People told us they were able to make decisions about what they wanted to do and said their privacy and dignity was maintained at all times. They felt independence was always promoted and they had confidence in the staff team, who supported them in the way they wanted to be.

Comments from people living at the home included:

"I can always talk things over with the staff if I am anxious about anything."

"Even if I won the lottery I wouldn't move from here. I love it and to think I didn't want to come here or anywhere else in the first place."

"The staff are just great. They all go the extra mile."

Comments from relatives included:

"I visit regularly and as soon as I walk through the front door I am given a cup of tea, even without asking. The staff are so welcoming."

"I am always offered a meal if I am here when food is being served."

"The staff are excellent. They are very friendly and nothing at all is too much trouble."

Hillcroft is situated in a residential area of Ormskirk. The home is on three floors, with passenger lift access. Accommodation is provided in both single and shared rooms for up to 34 adults, who need assistance with personal care. En-suite facilities are installed in all bedrooms, 25 of which have wet rooms and 9 having bathrooms. Communal bathrooms and toilets are available throughout the home. There are some amenities, such as shops, a post office, church and pub within a short distance and Ormskirk town centre is easily accessible by car or public transport. Some car parking spaces are available at the home.

This unannounced inspection was conducted on 19th January 2015 and was carried out by two Adult Social Care inspectors from the Care Quality Commission. The registered manager was on duty when we visited Hillcroft. She had managed the day-to-day operation of the service for eight years. 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 of the Health and Social Care Act and associated regulations about how the service is run.

At the time of this inspection there were 32 people who lived at Hillcroft. We spoke with eight of them and two of their relatives. We asked people for their views about the services and facilities provided. We received positive comments from everyone. We spoke with nine staff members and the registered manager of the home. We looked at a wide range of records, including the care files of four people, whose care we ‘tracked’ and the personnel records of two staff members. We observed the activity within the home and looked at how staff interacted with people they supported.

Staff members were well trained and had good support from the management team. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at the home.

The recruitment practices adopted by the home did not consistently ensure that only suitable people were appointed to work with this vulnerable client group. Necessary checks had not always been conducted before people were employed and this created a potential risk for those who lived at Hillcroft.

This was a breach of Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

The home had been tastefully refurbished throughout since our last inspection and a new well-designed 11 bedded unit had been added. The premises were safe and maintained to a high standard. Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. This helped to promote people’s safety.

The planning of people’s care was based on an assessment of their needs, with information being gathered from a variety of sources. Regular reviews were conducted with any changes in circumstances being recorded well. A range of assessments had been conducted within a risk management framework and strategies had been implemented to promote people’s safety and well-being.

People were helped to maintain their independence. Staff were kind and caring towards those they supported and interacted well with the people who lived at Hillcroft. Assistance was provided for those who needed it in a dignified manner and people were enabled to complete activities of daily living in their own time, without being rushed.

Staff we spoke with told us they received a broad range of training programmes and provided us with some good examples of modules they had completed. They confirmed that regular supervision sessions were conducted, as well as annual appraisals.

Staff spoken with told us they felt exceptionally well supported by the registered manager of the home. They spoke in a complimentary way about her management style and described her as being, ‘approachable’, ‘lovely’ and ‘an excellent manager’.

The management of medications did not always promote people’s safety. Medication records were well maintained and detailed policies and procedures were in place. However, we noted the treatment room door was left unlocked whilst the room was vacant. The medicine storage cupboard was also unlocked, which created a potential risk for those who lived at the home.

This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.