This inspection was carried out on 09, 14, 16 and 19 November 2018 and was unannounced on each of the four days. Prior to our inspection CQC received concerns regarding the safety of people and poor practice undertaken at the service. We inspected the service sooner than planned in response to the information we received.

This was the first inspection of the service since it was registered with CQC under the new provider Qualia Care Limited.

During this inspection we identified breaches of regulations 9, 10, 11, 12, 13, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Hillside is a care home. People 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. Hillside Care Home accommodates up to 119 people who require nursing and personal care. At the time of the inspection there were 66 people using the service.

The service provides accommodation in four separate units over two floors. At the time of the inspection three units were in use, the fourth unit was closed to admissions when the registered provider took over the service and they made the decision not to re-open it. Cedar unit is for people with nursing needs, Ash unit is for people living with dementia who also have nursing needs and Rowan unit is for young adults with a physical disability.

At the time of our inspection the service was not managed by a person registered with the Care Quality Commission (CQC). 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. There was a manager in post and they had applied to CQC to become the registered manager however their application remained pending at the time of this inspection.

The registered providers safeguarding processes and procedures were not followed to ensure people were protected from abuse. There was a delay in alerting the relevant safeguarding authority about an allegation of abuse made about a person using the service. A person was put at risk of harm because there was a failure to assess their mental capacity to consent in line with the Mental Capacity Act 2005.

Risks to people were not always identified and mitigated. We saw multiple examples on Cedar and Ash units were people were in bed and their call bells were out of reach. Risk assessments were completed for aspects of people’s care, however care plans lacked information about identified risks and how they were to be managed safely.

Some parts of the environment and equipment were unsafe and unhygienic. Rooms which were unlocked posed a risk to people’s health and safety. This included a sluice room on Rowan unit where there was access to hot water which had the potential to scald, and store rooms on Cedar unit which contained items which posed a trip hazard. Some items of equipment used by people were unclean including crash mats, and hoist slings were unhygienically stored.

The number of staff across the service were maintained in line with the calculations worked out using a dependency tool. However staffing levels and skill mix on Ash unit were insufficient to meet the needs of people and keep them safe. We observed multiple examples where peoples call and requests for assistance were not responded to in a timely way and where staff lacked the skills needed to support the needs of people living with dementia. The deployment of staff on Cedar unit was not always effective in meeting people’s needs at mealtimes.

A series of checks were carried out on applicants incl