We carried out an unannounced comprehensive inspection on 20 and 21 and 22 February 2018.

Hillside Lodge 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 Lodge provides care and accommodation for up to 60 people separated into three separate units. Each unit provides care for 20 people, one providing nursing care, one residential care and one care for people living with dementia.

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. At the last inspection on the 25 November 2015 the service was rated Good overall. However it was Requires Improvements in Well-Led. At this inspection we found the service remained Good overall.

Why the service is rated good:

People told us they felt safe. Comments included; “I feel 100% safe here” and “Yes, I do feel safe here” also “Of course, I feel so safe.” A relative said; “Very safe- I have no concerns.”

The service was now well-led. At our inspection in November 2015 we recorded that the service was not consistently well led. The report for November 2015 highlighted that the records of people’s care were not all completed in full. For example, people who had records in place to record their food and fluid intake, and risks associated with their skin were not all completed consistency. It stated that; “The incomplete records detailed above are a beach of Regulation 17 of the Health and Social Care Act 2014.” At this inspection we found that the provider had followed their action plan and that steps had been taken to ensure the breach was met.

People lived in a service where the registered manager’s values and vision were embedded into the service, staff and culture. People, relatives and staff all agreed that the registered manager was approachable and had an “open door policy.” The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

The Provider Information Return (PIR) stated; “Manager and deputy complete monthly audits and the quality team visit twice yearly (unannounced) and complete a quality of life audit action plans which are a result of these audits.”

People remained safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. People, relatives and staff mostly said there were sufficient staff to keep people safe. However a few people and some staff commented that staffing levels were not always good. Comments from people included; “They are rushed off their feet’ and another said; “I would like staff to have more time to sit and talk to me.” While others said; “Staff numbers are fine” and “When I use my call bell the response is quick.” Another said; “When I call for help, it comes quickly generally.” Other staff said they were able to meet people’s needs and support them when needed. The registered manager said they monitored the staffing levels based on the needs of people currently living in the service.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People who required additional support to protect their skin integrity had input from either the qualified staff on duty or the district nurse team. Professionals said they believed people were safe and well cared for and had no concerns. People received their medicines safely by suitably trained staff.

Hillside Lodge is a modern three-storey home registered to accommodate up to 60 people. Accommodation is provided over three floors with each floor having 20 en-suite rooms. Each floor specialised in supporting people living with dementia or who required nursing or person care. The first and second floors are accessed by a shaft lift. At the time of our visit there were 60 people in residence.

The inspection took place on the 23 November 2015 and was unannounced. The last inspection of this service took place on the 19 August 2014 at which no concerns were identified.

The service had 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 registered manager was due to leave the service in early December 2015 and a new manager had started work at the service. The new manager was working alongside the registered manager for a three week period while the responsibilities for the day to day management of the home were handed over.

The majority of the records in relation to the management of the service and the delivery of people’s care were up to date, detailed and accurate, however some shortfalls and omissions were identified. Some people’s records relating to their food and fluid intake, repositioning charts and the application of topical creams had not been completed. Records of the inductions completed by some agency staff had not been maintained. There was not always a record that the legal documentation had been seen to support a named individual’s right to make a decision on another person’s behalf such as Power of Attorney documentation. The absence of accurate records can make the monitoring of people’s care, accountability for actions and reasons why decisions are made difficult to ascertain.

People and their relatives spoke positively of the service. They were complimentary about the caring, positive nature of the staff and the support they received. One person told us “They look after me ever so well”. Another person told us “They (the staff) pop in during the day to check I’m ok”.

People had access to and could choose from a range of social activities which they enjoyed. The activities organiser told us “People really perk up and are happier after activities”. People told us they enjoyed the food and were offered a choice each mealtime. One person told us “I have three choices (of meals) which I choose from”.

People were supported to remain independent and were encouraged to stand, walk, eat and drink themselves. One person told us “I can do most things for myself but they are always on hand to help me to do things I can’t quite manage on my own”. People’s privacy and dignity was maintained and people were treated with kindness and respect by staff. A staff member told us “We always make sure the doors are shut when we are delivering care and make sure people are covered”.

People felt safe and had access to the equipment they needed to move such as hoists to transfer and pressure relieving equipment. Each person had a call bell which they told us staff responded to quickly. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe from harm and abuse. There was enough staff on duty at all times to meet people’s needs. When the provider employed new staff they followed safe recruitment practices and new staff completed an induction that included shadowing experienced staff before they worked unsupervised.

There were clear lines of accountability. The home had good leadership and direction from the registered manager. People, their relatives and staff spoke positively about the registered manager and the management team. Without exception all staff felt one of the positive aspects of working at the service was the team work. One staff member stated “We have a really good team In here”. Another told us “There is such a good team. Everyone gets on and knows how each other works.” They commented that the management team and team leaders “Listen”, and said that team leaders understood the role of the care staff because they “Come on the floor and help”.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager and staff understood and worked within the principles of the mental capacity act and DoLS referrals had been made appropriately.

Staff received training to support them with their role on a continuous basis to ensure they could meet people’s needs effectively such as supporting people living with dementia. The training records demonstrated that staff had completed a range of training and learning to support them in their work and to keep them up to date with current practice and legislation.

We identified one area where the provider was not meeting the requirements of the law. You can read what action we have told the provider to take at the back of the full version of the report.

This inspection was carried out by an adult social care inspector and an expert-by-experience. The focus of the inspection was to check if the provider had taken sufficient action to meet the compliance action set at our visit in July 2013. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

This summary is based on our observations during the inspection, discussions with 19 people, six relatives, the manager, two team leaders, one agency nurse, six carers, two activities staff and a member of the maintenance team. We also reviewed records relating to the management of the service, six people's care and health records and five staff recruitment files. As some people could not talk with us about their experiences of living at the service we spent time observing how they were cared for and treated by staff. We observed interactions between staff and people who lived at the service for four hours during the morning and lunchtime period.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider had reviewed people’s dependencies and the staffing level. As a result there had been a temporary increase in the number of staff on duty in two parts of the service. During this period the provider and manager had considered ways to optimise the current staffing level, for example by involving activities and ancillary staff at peak times, such as mealtimes. People that we spoke with were complimentary about the staff. We observed that staff responded quickly to meet people’s needs and ensure their safety. One person told us, “I feel safer here than I would anywhere else”.

We looked at the recruitment processes and found them to be safe and thorough. The service had carried out relevant checks to ensure that staff had the necessary skills and aptitudes to work with people living at Hillside Lodge.

People were supported by staff who knew them well and who understood their needs and preferences. Staff told us that they received detailed handovers and were kept informed as to any changes in people’s care or treatment. We found that records relating to people’s care and treatment were generally up to date. In one part of the service there was a recent shortfall in some records. We discussed this with the manager on the day of our visit and received documentary evidence of changes that had been put in place. This helped to ensure that an accurate record about each person was maintained and that they received appropriate care and treatment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, the manager demonstrated knowledge of their responsibilities in respect of this.

Is the service effective?

We found that people’s care plans were detailed and that they had generally been reviewed on a monthly basis. This helped to ensure that the care provided was in line with their individual needs and preferences. The selection of care plans that we looked at demonstrated that people or their representatives had been consulted and that their personal needs and preferences were reflected.

As many of the people living at the service were unable to speak directly of their experience, we spent time observing the care and support that they received. Staff demonstrated skill and experience when supporting people. One person that we spoke with told us, “We are looked after very well”. Another said, “They go out of their way to help me”. A member of staff shared, “The care is very good. We are just like a family. It’s a nice place to work”.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We spoke with 19 people. They were all satisfied with the care that they received. They told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, “They (the staff) are very good”. A relative said, “I cannot put into words what I think about that place, they are fantastic”. In a recent card of appreciation a relative had written, ‘The love and care has been outstanding’.

Is the service responsive?

Activities were available that took account of people's capabilities and understanding. The service had a varied activity programme in place which included in-house activities as well as visiting entertainers. During our visit we observed people participating in a number of activities that stimulated and entertained them.

People were supported to access health related support in a timely manner. Relatives told us that they were kept informed and updated if there were any issues or concerns regarding the health of their family member. One relative said, “They contact me if there are any problems”.

People told us that they were able to raise concerns or make suggestions and that they were consulted about changes in the service. We found that the service listened and responded to questions and feedback received from people, their representatives and from staff.

Is the service well-led?

Since our last inspection we found that improvements had been made in relation to staffing. The manager was consulting on further changes and action in order to ensure that people’s needs were met and that staff received appropriate support.

We saw there were systems for monitoring the quality of services provided. The manager demonstrated a commitment to making improvements to the quality of service provided to people. One relative said, “I have had a good experience with them, and it (the service provided) has certainly improved”.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

We spoke with 11 people living at Hillside Lodge. They were all very positive about the care and support that they received. One said, “I think this is an excellent place”. Another told us, “It’s a home from home”. They told us that the staff were, “Good and helpful”.

We spoke with eight members of staff and the manager. Staff told us that they enjoyed working in the home. One said, “It is probably one of the best homes I’ve worked in. It has a personal touch”. Another told us, “We come into their home to care for them; I get a lot of job satisfaction”. They also told is that it was very busy and that sometimes they were really stretched.

We spoke with six relatives. They were delighted with the care. One said, “The care is first class or even better”. Another told us, “We had a lovely feeling about the place as soon as we went in”. They told us that the staff were, “Absolutely incredible” and that, “Their patience is abounding”.

We found that the home was bright and that people looked well cared for. People were provided with a good choice of food and drink. Staff were welcoming and we saw that they supported people with kindness and respect. People told us that they could approach staff or the manager if they were unhappy or had ideas to discuss. We found, however, that there were not always enough staff on duty to ensure that people were supported in a timely way.

We spoke with nine people living in the home, We were told that people were very happy with the care in the home, that the staff were kind and polite and that they were happy with the food. One person told us “the staff put up with a lot, they are very patient”. Another person told us “they ask you what you want, they say ‘can you’ and ‘would you like’.

Three visitors were spoken to and they did not express any concerns about the care in the home.

A relative we telephoned told us that the care was “good enough” but that, in relation to staffing,

“you never see anyone about”

We spoke to one professional from west Sussex County Council on the telephone and were told that they were happy with the care in the home but that sometimes staff were “few and far between”.

We spoke to the community psychiatric nurse who was very happy with the support her client received in the home.

We spoke to one general practitioner who told us that they were called in to the home appropriately

People spoken to stated that they were happy with the care and support offered to them. They stated that staff treat them as individuals and that they have choice. One person stated "They know when I like to go to bed and get up. I go to bed when I feel like it".

They stated that staff were kind and that they did not have to wait long when they rang their bell.

A relative spoken to stated that staff were exceptional and that the home was very good at communicating with her.