About the service:

Hillside Nursing Home is a residential care home providing accommodation, personal and nursing care to 53 people at the time of the inspection.

People’s experience of using this service:

• People and relatives told us that people received safe care.

• Risks associated with people’s needs had been assessed. However, further improvements were needed with risk assessments associated with behaviour which may challenge the service. We made a recommendation in this area.

• There were sufficient staff to meet people’s needs.

• Medicines were being managed safely.

• Staff had the knowledge and received the support they required to meet people’s individual needs.

• People were supported with their nutritional needs and had choices with meals.

• The staff worked well with external health care professionals and people were supported with their needs and accessed health services when required.

• People received care from staff who were kind and compassionate.

• Staff understood people’s needs, preferences, and what was important to them.

• People’s independence was promoted and their privacy and dignity was respected.

• Care plans were person centred and detailed people’s support needs.

• People and staff were positive about the management and the service. There was an effective quality assurance system in place to identify shortfalls and take action to ensure people were safe.

• The service met the characteristics for a rating of ‘Good’. Therefore, our overall rating for the service after this inspection was ‘Good’.

• For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

• At the last inspection on 24 January 2018 the service was rated ‘Requires Improvement’. The home was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing, person centred care and good governance.

• This had been addressed at this inspection.

• The last inspection report was published on 12 April 2018.

Why we inspected:

• This was a planned inspection based on the rating of the last inspection.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This unannounced inspection took place on 24, 26 and 31 January 2018.

Hillside is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Hillside is a purpose built 55 bed service providing accommodation and nursing care for older people, including those living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those that need it. For example, hoists and adapted baths are available. 47 people were using the service when we visited.

The service did not have a registered manager but a new manager has been in post since November 2017 and had started the process to register with 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.

At the last inspection on 17 and 18 May 2017, we found three breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The lack of consistent and specific information about people's needs placed them at risk of not receiving the care they required and wanted. Systems in place did not always ensure safe equipment and staff competency. People were not consistently safeguarded from the risk of abuse. After the inspection the provider sent us an action plan detailing the action they were taking to meet these requirements.

At this inspection, we found action had been taken and the breaches with regard to safe equipment, staff competency and safeguarding were met. Systems were in place to check equipment and staff competencies. Staff were aware of their responsibilities to ensure people were safe and action was taken if there were any concerns or possible abuse.

People’s care plans were not sufficiently personalised or detailed and did not contain the necessary information to ensure their needs were effectively met.

Staffing levels and deployment were not sufficient to meet people’s needs and to enable them to be supported in a way that they wished. Staff received the support and training they needed to give them the necessary skills and knowledge to meet people’s assessed needs.

Systems to monitor the service provided had been changed and strengthened. However, further work was needed to ensure people received a good quality of service and legal requirements met.

People were encouraged to do things for themselves and staff provided care in a way that respected people's privacy but their dignity was not always maintained.

People were supported to receive the healthcare they needed.

Systems were in place to ensure that decisions made in people’s best interest protected their human and legal rights.

People received their prescribed medicines safely. Medicines were administered by staff who were trained and assessed as being competent to do this.

Staff supported people to make choices about their care and systems were in place to ensure they were not unlawfully deprived of their liberty.

Staff and relatives were positive about the changes implemented by the new registered manager.

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. People told us they felt safe at Hillside and were supported by kind and caring staff.

Systems were in place to minimise risk and to ensure that people were supported as safely as possible.

People’s nutritional needs were met but we have recommended the lunchtime arrangements be reviewed to ensure people were fully supported and that mealtimes were a pleasurable experience.

People were protected by the provider’s recruitment

This unannounced inspection took place over two days on 17 and 18 May 2017.

Hillside Nursing Home is a purpose built 55 bed care home providing accommodation and nursing and personal care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those that need it. 41 people were using the service when we visited.

The service 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 and associated Regulations about how the service is run.

The registered provider of the service recently changed from GCH (Hillside) Ltd to GCH (South) Ltd. Whilst this change is a technically a new registration it is however just a change in legal entity for a continuing service.

At our last inspection on 7 and 8 December 2016 we found breaches of five regulations. Medicines were not safely managed, there were not enough staff deployed to safely meet people’s needs, services and equipment were not always properly maintained, people’s healthcare needs were not fully met, care plans were not sufficiently detailed or personalised and the service had not been adequately monitored. Action had been taken and improvements made. Systems in place to monitor the service provided were more robust than at the last inspection. However, further work was needed to ensure that people received a good quality of service.

Staff received appropriate training to enable them to meet people’s needs. Further training was scheduled to ensure that staff training was up to date. However, systems were not in place to check that staff had the necessary competence to carry out specific invasive procedures.

Systems were in place to safeguard people from abuse and staff were aware of how to report any concerns about people’s safety and welfare. However, this process was not always followed and unexplained injuries were not always followed up.

People’s care plans were not personalised or detailed and they and their relatives were not routinely involved in their development and review.

Internal checks on equipment had not been consistently undertaken to ensure they were safe for use.

We found medicines were safely managed and people received their medicines in line with the prescriber’s directions. People only received their medicines without their knowledge (covertly) when this had been assessed as being in their best interest.

There were sufficient staff deployed to safely provide people with the care and support they needed.

People had access to healthcare professionals and were supported to remain as healthy as possible.

Staff supported people to make choices about their care and systems were in place to ensure they were not unlawfully deprived of their liberty.

Activities were provided and we saw that staff also spent time with people talking to them and reminiscing.

Staff and relatives were positive about the changes implemented by the new registered manager.

People told us they felt safe at Hillside and were supported by kind and caring staff.

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff provided care in a respectful way that promoted people’s dignity.

Recruitment checks were carried out on staff before they started to work with people who need support.

People’s nutritional needs were met and they and we saw that staff supported people to eat their meals in a relaxed and unhurried manner.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.