This comprehensive inspection took place on 6 June and 11 July 2018. It was unannounced on the first day which was carried out by one adult social care inspector and an expert by experience. We arranged the second day of inspection which was completed by the inspector.

Following the last inspection in February 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Is the service well-led? This was because we found a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection we found people were not protected as quality monitoring systems were not fully effective and people’s care plans lacked up to date information about their care and treatment needs.

The provider submitted an improvement action plan on the 1 June 2017 to address these concerns, stating what they intended to do and when this would be achieved.

At this inspection we found improvements had been made so all the regulations had been met in respect to the breaches found at the previous inspection.

Hilldales Residential Care Home is a large three storey building, originally built as four houses around the turn of the twentieth century. Modifications have been made so that the properties are interconnected internally. There are communal areas on the ground floor and bedrooms on all floors of the building. Externally there is a paved area to the front of the houses and small courtyards to the side and rear which people have access to.

The home provides accommodation and personal care for up to 56 adults who have needs arising from alcohol problems or mental health issues. Some people are also living with a physical disability. At this inspection 33 people were living at the home when we visited.

There was a manager in post who had registered with the Care Quality Commission in May 2016. 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 registered manager was supported by a team of senior staff. Together they shared a vision of the service which was described in the home’s statement of purpose: “The aim of Hilldales Care Home is to offer men and women over the age of 25 who may have mental health problems and/or alcohol problems the opportunity to live in a caring environment with support from our care staff.”

To support these aims, the registered manager and senior team had worked with staff to ensure they had the necessary skills and knowledge necessary to meet people’s needs. Staff were well trained and knew people well. This enabled them to work with people confidently, showing care and compassion. Staff were alert to changes in people’s presentation and contacted health and social care professionals when necessary to support the person. Staff understood how to protect people and knew what to do if they thought someone was being abused.

People were really positive about living at Hilldales, many commented on the improvements that had been made over the last few years. They now described the home as comfortable, clean, well maintained and nice to live in. They were also positive about the meals they received. People were supported to do activities of their choice both in the home and in the local community.

People’s risks, needs and preferences had been assessed and, where possible, discussed with them to ensure that care plans were developed to meet these assessments. Medicines were stored, administered and recorded correctly.

Health professionals commented on how the service had improved and how they felt that staff were very responsive to people’s needs. Care plans were up to date and ha

This comprehensive inspection took place on 2 and 9 February 2017 and was unannounced.

Hilldales Residential Care Home is a large three storey building, originally built as four houses around the turn of the twentieth century. Modifications have been made so that the properties are interconnected internally. There are communal areas on the ground floor and bedrooms on all floors of the building. Externally there is a paved area to the front of the houses and small yards to the side and rear which people have access to.

The home provides accommodation and personal care for up to 56 adults who have needs arising from drug, alcohol or mental health problems. At this inspection 28 people were living at the home when we visited.

After an inspection in September 2015, the home was placed in special measures as there were ongoing breaches of regulations, which meant that some aspects of the service continued to be found inadequate.

The service was inspected again in July 2016 when the service was rated as requiring improvement overall. However, although improvements had been made, the Safe domain was still found inadequate. The home therefore continued to be in special measures. At the July 2016 inspection we found six breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the provider not having adequately trained staff to support people safely. This included staff being able to safely support people with moving and handling; a lack of systems to protect people from the risk of financial abuse; people’s needs and risks had not been fully assessed and conditions of people’s Deprivation of Liberty Safeguards (DoLS) authorisations had not been met. We also found people had not been adequately assessed for the risks when undertaking cleaning activities and there were moving and handling risks for staff in a laundry area. We found there was a lack of systems to assess and monitor the quality of the services provided. Although some aspects had improved, the home was rated as requiring improvement.

We reported that we would continue to keep the service in ‘special measures’ and consider what further action we would take. Following our inspection in July 2016, we met with the provider, the registered manager and senior staff in October 2016. At this meeting, they discussed the actions they had taken to address the breaches of regulations. After the meeting, we agreed to re-inspect the home in early 2017 before taking further action.

We found significant improvements at this inspection had been made which meant a number of the breaches had been addressed. However we found a continuing breach of regulation 17. Care plans and risk assessments were not updated to reflect people’s current needs and risks. There was still insufficient evidence to demonstrate that there were robust quality assurance systems in place. Although some systems were in place to monitor the service, there were still concerns and issues which they had not identified or addressed. For example, care record audits had not identified that care plans and risk assessments were not up to date. The system had also not identified that staff had not received regular supervision.

The registered manager was working on improvements with health and social care professionals including staff from the local authority’s quality assurance and improvement team. Senior local authority staff were providing mentorship to the registered manager. Both the registered manager and another senior member of staff had started to study for a Level 5 qualification in management.

People said they liked the registered manager and other senior staff and felt the home had been improved by them. People said they were treated with dignity and respect. People were able to have privacy and friends and family could visit when they wanted. People were supported to undertake activities of their choice both

This comprehensive inspection took place on 21 and 25 July 2016 and was unannounced.

Hilldales Residential Care Home is a large three storey building, originally built as four houses around the turn of the twentieth century. Modifications have been made so that the properties are interconnected internally. There are communal areas on the ground floor and bedrooms on all floors of the building. Externally there is a paved area to the front of the houses and small yards to the side and rear which people have access to.

The home provides accommodation and personal care for up to 56 adults who have needs arising from drug, alcohol or mental health problems.

The service was previously inspected in September and October 2015 when the service was rated as inadequate overall. At that inspection we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the provider not having adequately trained staff to protect people from the risk of fire; a lack of suitable systems in place to protect people from unsafe management and administration of medicines; a lack of systems to ensure people were protected from the risk of financial abuse; people’s needs and risks had not been fully assessed and care plans did not describe how to support people; people who lacked mental capacity to make particular decisions were not protected, people were being deprived of their liberty without appropriate Deprivation of Liberty Safeguards (DoLS) applications or authorisations in place. We also found some areas of the home and practices posed infection control risks and there were a lack of systems to assess and monitor the quality of the services provided. Although some improvements had been made, these were not sufficient to improve the overall rating of inadequate.

After the inspection, we reported that we were taking further action, which included placing the service in ‘special measures’.

Following our inspection in September 2015, we imposed a condition on the provider to have a registered manager for the service. 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.

Following the September 2015 inspection, we also issued a warning notice in respect of Regulation 11 of the Health and Social Care Act (2008) Regulations 2014. This was because people’s consent to care had not always been obtained before care was given. The warning notice required the provider to be compliant by 31 January 2016.

In March 2016, we undertook a focussed inspection to check whether the home was now compliant with Regulation 11. Although some improvements had been made, we found the home was still in breach of the regulation and therefore the warning notice remained in place.

A new manager had been appointed by the provider and had registered with the CQC on 6 May 2016. However this registered manager was inexperienced in the role. They said they met with the provider most weeks to discuss issues. However they also said did not have any support or mentoring from anyone such as a more experienced registered manager. They described how they were learning ‘on the job’ but were aware that they “didn’t know what they didn’t know.” This meant they did not have sufficient knowledge, skills and experience to carry out their role effectively and had not been supported to gain these as soon as they were appointed into post.

At this inspection 32 people were living at the home when we visited on the first day, but one person had moved to another home by the second day of inspection.

Staff and people said they liked the registered manager and other senior staff and felt supported by them. The regis

This focussed inspection took place on 9 March 2015 and was announced. We gave the provider short notice of our visit as we wanted to ensure they would be available to provide us with the information we required.

Hilldales Residential Care Home is a large three storey building, originally built as four houses around the turn of the twentieth century. Modifications have been made so that the properties are interconnected internally. There are communal areas on the ground floor and bedrooms on all floors of the building. Externally there is a paved area to the front of the houses and small yards to the side and rear which people have access to.

The home provides accommodation and personal care for up to 56 adults who have needs arising from drug, alcohol or mental health problems.

The service was previously inspected in September and October 2015 when the service was rated as inadequate overall. At that inspection we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the provider not having adequately trained staff place to protect people from the risk of fire; a lack of suitable systems in place to protect people from unsafe management and administration of medicines; a lack of systems to ensure people were protected from the risk of financial abuse; people’s needs and risks had not been fully assessed and care plans did not describe how to support people; people who lacked mental capacity to make particular decisions were not protected, people were being deprived of their liberty without appropriate Deprivation of Liberty Safeguards (DoLS) applications or authorisations in place, some areas of the home and practices posed infection control risks and there were a lack of systems to assess and monitor the quality of the services provided.

After the inspection, we reported that we were taking further action, which included placing the service in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the inspection in September and October 2015, we found best interests decision-making had not been undertaken to confirm the actions were in a person’s best interests. People had signed to give consent for staff to undertake action, for example where staff were managing people’s money. However there was no evidence that where there were concerns about the person’s capacity to understand what they were signing, this had been assessed.

At the inspection in Se

We carried out this responsive follow up inspection to check compliance in outcome 21-records. When we inspected as part of our planned schedule of inspections in July 2013, we found some records had not been accurately maintained. We asked the provider to send us an action plan to show us how they intended to be compliant. We received an action plan, which included new formats for audit tools in fire training, fire safety checks, cleaning audits and checking care plans were in place for all new people living at the home.

We spoke with the manager, who is not registered with CQC, with the office manager, senior carer and care staff member. We heard how the new forms had been developed to ensure compliance, and these were sent to the registered provider on a weekly basis for their assurance they were being completed.

We saw fortnightly audits had been completed on fire safety within the home. All staff had received updated training in fire safety in August and all names of staff who attended were recorded.

The senior care staff were completing monthly audit of cleaning work completed and each cleaner had a set routine of areas to be cleaned each day and what was needed weekly.

We carried out this planned inspection speaking with eight people who lived at the service and with six staff. We looked at key records including four care plans, daily records and audits and checks in respect of the environment.

People we spoke with gave a varied view of their experience of living at the service. One person told us they were most unhappy. We heard they had been drinking heavily outside of the home and this affected their mental well-being. Most people said they were treated well by staff. Comments included ''You couldn't get a better bunch, most caring and very good.'' Another person told us ''I don't want to be here, but the staff are very good. They are all kind and do their best.''

We saw care and support was well planned and delivered by a staff team who understood the needs of people they cared for. Additional training in mental health, diabetic care, wound care and preventing urinary tract infections had all helped to provide safe and effective care for people.

Systems were in place to review the quality of care provided, but we found some improvements were needed in record keeping.

At this inspection we spoke with nine people in detail about their experience of living at the home. We also spent time observing how staff interacted with people at the home and followed how medication was administered during the lunchtime period.

The expert by experience spent time asking people about how involved they felt in their care and support, as well as checking that people were happy with staffing arrangements, their rooms and the quality of the food they were offered.

We also looked at some key documents, including care plans, risk assessments, contracts and staff recruitment files. We found that most of these were up to date, although some had not been signed and dated.

We saw that people were consulted about the care and support they received and were able to be involved in making choices about how they spend their time and menu planning.

We found that there was a robust recruitment process that helped to protect vulnerable people.

During this unannounced inspection we spoke to eight people currently living at the service. They told us that they were generally happy with the care and support they received. Comments included

‘The staff are all very good, very nice and we all get on’

‘I have been here for a very long time, staff have come and gone, but they all do a good job.’

‘I am settling well, most people are friendly and I am getting to know the area’

People told us that they could choose when they got up and went to bed, and how they spent their day. One person told us that they went out most days with the manager and really enjoyed this. Another person told us they prefer to spend their time in their own room and staff respected this.

We saw that medication was well managed by staff that understood the need keep clear records.

Good clear audit trails were in place to ensure that where staff handled individuals personal monies, receipts were kept and regular checks were made on balances and records.

People told us that they enjoyed the meals provided and that there was always a good variety and choice. Most people we spoke to said they liked having a cooked breakfast. One person said that they were regularly asked what menu options they enjoyed and whether they wanted other choices included in the menu. We saw that this was also done more formally with menu meetings and questionnaires regarding food. People were able to help themselves to hot and cold drinks through the day as well as snacks. We saw that where individuals had dietary needs that staff recorded whether they had eaten each meal. We have asked that if people are at risk because of their lack of nutritional intake, that more detailed records of food and fluid be kept.

Staff had good opportunities for training and support and people who lived at the home were positive about the staff approach and felt safe and comfortable with the staff group who worked with them.

Good systems were in place to ensure that the views of people living at the home and staff were used to drive up any improvements.

This comprehensive inspection took place on 23 September, 1 and 7 October 2015 and was unannounced.

The service was previously inspected in December 2014 and January 2015 when the service was rated as Inadequate overall. At that inspection we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These breaches related to the provider not having suitable safeguards in place to protect people from the risk of fire; a lack of suitable systems in place to protect people from unsafe management and administration of medicines; a lack of systems to ensure people were protected from the risk of financial abuse; people’s dignity and privacy was not always respected; people’s needs and risks had not been fully assessed and care plans did not describe how to support people; people who lacked mental capacity to make particular decisions were not protected, people were being restricted without appropriate Deprivation of Liberty Safeguards authorisations and there were a lack of systems to assess and monitor the quality of the services provided.

After the previous inspection, the provider had submitted an action plan in July 2015 showing what improvements they had already made or intended to make to address the breaches that had been found. We reviewed the progress against this action plan as part of the inspection. All actions in the action plan were due to be completed by August 2015 although some were identified as on-going actions which implied they had been implemented but would continue forthwith, for example service user surveys.

At this inspection we found there had been some improvements in relation to protecting people in the event of fire. We also found people’s dignity and privacy was respected and there had been some systems introduced to protect people from the risk of financial abuse.

Since April 2015 new regulations have been introduced. These are called the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Therefore in this report we describe the Regulation 2010 breach and how that is translated into the Regulations 2014. At this inspection we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found breaches of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Hilldales Residential Care Home is a large three storey building, originally built as four houses around the turn of the twentieth century. Modifications have been made so that the properties are interconnected internally. There are communal areas on the ground floor and bedrooms on all floors of the building. Externally there is a paved area to the front of the houses and small yards to the side and rear which people have access to.

The home provides accommodation and personal care for up to 56 adults who have needs arising from drug, alcohol or mental health problems.

At this inspection, there were 40 people staying at the home, all of whom had lived at Hilldales Residential Care Home for a number of years. Staff support was provided at the home at all times; however some people did not require staff support when away from the home.

At the last inspection, we found Hilldales Residential Care Home did not have a registered manager. 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. Although the home was owned by a single provider, he did not manage the service on a day-to-day basis and had not appointed a registered manager to take charge as required by the CQC. At this inspection, we found that although an application by a senior member of staff for a registered manager had been received by the CQC, this had been rejected in June 2015 as it was incomplete and no further application had been submitted. Senior staff continued to manage the home in the absence of a registered manager. By the end of the inspection a recruitment process for a registered manager was underway.

There were still some areas of medicine administration which were not safe. Risk assessments carried out for people who self-administered their own medicines did not ensure that all risks had been considered, including harm to the person and to others.

We recommended that the provider should consider reviewing their medicines policy and procedures to ensure they are in line with national guidelines.

At the last inspection, we found the provider had not notified CQC about significant events that had occurred, including safeguarding concerns and incidents where the police had been involved. At this inspection we found evidence of events that had occurred since the last inspection, including incidents of abuse and incidents where the police had been involved. These had not been notified to the CQC. This meant that there was a continued breach of regulation.

There were a number of safety concerns about the home relating to the building and equipment used. These included the laundry facilities and the infection control risks posed by the maintenance of parts of the building.

There were sufficient numbers of care staff to support people. However we discussed with the provider that the night shifts were very long and some staff doing these shifts were not getting sufficient rest between shifts. We also raised concerns about the cleanliness of the home as there were only two cleaners on the first day of inspection. The provider recruited two additional cleaners by the end of the inspection.

People living at the home and health and social care professionals described the staff as very caring and committed. Staff worked with people in a very caring and professional way. People were able to access food and drink throughout the day and night. A balanced and varied menu was offered and people were involved in choosing what meal options were available. People were supported by staff to access health professionals including their GP, dentist and community nurses. Health and social care professionals described staff as proactive in contacting them when they had a concern.

People who had their money managed by the provider were not protected from the risk of financial abuse as the systems did not ensure they were given information about their income and expenditure.

Staff had completed some training but this had not always been effective. Staff were not able to describe how they would ensure that people’s capacity was assessed and where necessary, Deprivation of Liberty Safeguard applications submitted appropriately.

The provider had not complied with the regulation that requires providers to display their ratings from the last inspection.

There were 11 breaches of regulation. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We are taking further action in relation to this provider and will report on this when it is completed.