This unannounced comprehensive inspection took place on 10 and 11 January 2019 and was carried out by one adult social care inspector.

Hillgrove Residential Home is a ‘care home’ located in the Bidston area of the Wirral. The home accommodates up to 23 people over three floors in one large detached Edwardian building and has a patio/garden to the rear of the property. At the time of our inspection 18 people were living at the home.

People living 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.

The home had an experienced registered manager who was also the registered provider and had worked at the home for many 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we completed our previous inspection in October 2017 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as parts of the premises required repair and were unclean; fire safety provision and infection control standards were insufficient. We found a breach of Regulation 17, as the registered provider did not have effective systems in place to assess, monitor and mitigate the risks to the health, safety and welfare of people who used the service. We also found a breach of Regulation 18, as staff had not received appropriate training and appraisal in relation to their job role. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve in our key question areas of Safe, Effective and Well-led.

During this inspection we found that all the completed improvements recorded in the action plan had indeed been completed and this had led to improvements in our key question areas of Safe, Effective and Well-led. Overall, we found that the home had made sufficient improvements and was no longer in breach of the Regulations.

The registered manager explained that a number of environmental improvements had been made at the home since our last inspection. We found that the home was well-maintained, safe, clean and homely.

During this inspection we found that the registered manager had a variety of methods to assess and monitor the quality of the service provided at the home. These included regular audits of the home, staff and residents’ meetings and questionnaires to seek feedback about the home.

Records showed that staff received regular training relevant to their roles and were supported with regular supervision and appraisal meetings. Staff told us that they felt supported in their roles and all other staff, including the registered manager and deputy manager, were approachable and helpful.

We saw that there were policies and procedures in place to guide staff in relation to safeguarding vulnerable adults and whistleblowing. Staff had received training on this and information about how to raise safeguarding concerns was readily available in various places throughout the home. People living at the home and their relatives told us that they felt safe there. We noted that staff at the home took appropriate action when any such concerns arose. However, the home did not always notify CQC of these concerns as is required.

Registered providers are also required to display its most recent CQC inspection rating both at the premises and on its website, if applicable. We found that our last inspection rating and report was clearly displayed at the home. However, the provider’s website did not display this rating. Therefore, we have made a recommendation to address this.

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This was comprehensive inspection carried out on 24 and 26 October 2017. Hillgrove Residential Home provides accommodation with personal care for up to 23 people. Nursing care is not provided. At the time of our visit, 22 people lived at the home.

The home is a detached house set in its own grounds in the area of Bidston, Wirral. There is a small car park and garden with seating available within the grounds. Accommodation is provided on three floors with a passenger life enabling access to bedrooms on the first and second floor. All bedrooms are single occupancy and have a wash basin. There are communal bathroom facilities on each floor. There is a communal lounge, a lounge/dining room and a quiet lounge for people to use.

At the time of inspection there was a registered manager 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 home’s installations and lifting equipment had all been tested and certified as safe. For instance gas, electrics, hoists, fire alarm and the passenger lift. We found however that other parts of the home were in need of repair or were unclean. For instance, some of the home’s fire doors were faulty which meant they would not offer the required protection in the event of a fire. Some rooms did not have access to water sufficiently hot to enable good hand hygiene. Some of the home’s light fittings were broken and some of the plug holes in people’s hand basins were covered with limescale. This meant that the parts of the premises were unsafe and unclean.

Other improvements to the standards of infection control were also needed. We found some people who were sharing a bedroom also had shared hand towels or bars of soap. This was not good practice. People in shared accommodation should have their items clearly marked for their own personal use in order to prevent the spread of infection. We spoke with the manager about this. They assured us that all shared items would be removed. Systems were not in place to monitor and manage the risk of Legionella bacteria and the risk of this developing in the home’s water supply had not been assessed. We spoke with the manager about this and shortly after our inspection we received confirmation that a Legionella risk assessment had been organised.

Staff were recruited safely but some of the criminal conviction information relating to staff members may have been out of date. This was because some staff had been employed for over ten years without this information being renewed. Staff records showed that staff had adequate supervision in their job role but we found limited evidence that staff had received an appraisal of their skills and abilities or sufficient training to do their job role effectively. This meant the manager could not be confident that the skills and knowledge of staff members was sufficient or up to date.

We found that improvements to the way the home was managed were required. This was because the audits conducted by the manager in relation to health and safety, maintenance and infection control failed to identify and address the issues we found during our inspection. Similar issues in relation to health and safety, maintenance and infection control were also identified at the last inspection. This meant that the manager had been made aware previously that these areas required improvement but had failed to take sufficient action to address them. Other audits completed by the manager were either generic or not always accurate. This meant they were meaningless.

The home has been rated ‘requires improvement’ because of these issues. This is the second time the home has been rated requires improvement.

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This inspection took place on 14, 24 and 28 October. The inspection was unannounced.

Hillgrove Residential Home is in a large detached building in a residential area of Birkenhead. The building is of a Victorian style with well-kept gardens. The home is registered to provide care and accommodation for up to 23 people. At the time of our visit 19 people were staying at the home.

Accommodation is in 23 bedrooms over three floors, the upper floors are accessible by a staircase and a passenger lift. All of the bedrooms are single occupancy and have a wash basin. There are toilets and bathrooms on each floor.

The home required and 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.

The local authority had raised some concerns with the registered manager after a recent visit. The concerns related to the homes health and safety, including the use of supplies and equipment to prevent cross contamination and infection. The local authority also became aware during their visit of a safeguarding incident that had not been reported to the relevant organisations and some people living at the home required a Deprivation of Liberty Safeguard and no applications had been made. The local authority also made recommendations relating to making appropriate referrals for people to outside healthcare professionals.

We used this information to help plan our inspection. During our inspection we found that action had been taken and was on-going in relation to the concerns that had been raised.

During our inspection we found breaches of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was not an effective use of the systems and processes available at the home to assess, monitor and improve the quality and safety of the services provided to people. You can see what action we told the provider to take at the back of the full version of the report.

The registered manager regularly completed a number of checks and audits of the home. These were kept up to date. However the audits had been ineffective in identifying areas needing improvement. For example, improvements required to the equipment at the home, safety of the premises and planning people’s care. At the time of our inspection many of these issues had been rectified or works were in progress. However the systems at the home had not been effective as they had not highlighted the areas requiring improvement.

Due to some of the people who lived at the home having dementia, it was difficult for them to speak with us during our visit. People who spoke with us, told us they were well cared for and were happy living at the home. We observed the care of and interacted with people who didn’t speak with us. It was clear by how relaxed and comfortable they were with staff, that they felt safe at the home.

From the interactions between people staying at the home and staff members it was clear that they had warm, positive relationships. We saw people were treated with patience, kindness and with respect.

People’s friends and relatives spoke very highly of the home, the registered and deputy managers and the standard of care their relatives received. Visitors told us that they were always made to feel welcome at the home.

We saw that there was enough staff to safely meet people’s needs. At times staff were busy however we did not see people waiting for care or support. A senior staff member was on call 24 hours a day.

When we visited the service operated within the principles of the Mental Capacity Act 2005. Appropriate referrals had been made to the local authority for people who would benefit from a DoLS authorisation. This was done al

We spoke to different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for. We spoke to three people using the service, three relatives of people and three staff members. We spent time observing people using the service, to see how they were cared for and how staff interacted with them.

People said, “the staff are really helpful” and “it’s a comfort knowing (mum) is well cared for.” Most people using the service had a relative who had lasting power of attorney and they had discussed their preferences and care needs with staff when they had come to live in the home, and had signed care plans. A few people did not have any relatives and the Court of Protection had appointed a person to make decisions in their best interests.

We saw that plans for care were reviewed regularly and adapted as people’s needs changed.

We saw that the service had comprehensive policies and procedures documented for all aspects of services provided and for dealing with emergency situations.

People using the service said that there were always enough staff on duty to care for people and answer questions. Staff told us, and we saw evidence that confirmed they had received training to deliver care safely.

The premises were safe and suitable for the purpose of carrying on the regulated activity, accommodation for persons who require nursing or personal care.

We spoke with four people living in the home during our visit and two relatives who were available on the day. All the people told us that they were happy living in the home or that they were satisfied with their relatives care and support.

Two of the people spoken with told us that they felt safe living there and two relatives told us that they had no concerns regarding their relatives welfare in the home. One person living in the home who told us that the staff were smashing, that they were very helpful and that nothing was too much trouble.