We inspected this service on 13 November 2018. The inspection was unannounced. Hilton Lodge is a care home registered for a maximum of 13 people some of whom have had long term mental health needs. At the time of our inspection there were 11 people living at the service.

Hilton Lodge is a ‘care home’. People in care homes receive accommodation and 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.

Hilton Lodge had a registered manager at the service. 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 our last inspection on 22 February 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

We found the service provided a homely atmosphere and people told us they enjoyed living at the service and the staff were kind and caring and treated them with dignity and respect.

We found care records contained information regarding people’s preferences and care needs. Documents also gave guidance to staff on how to manage risks safely.

The registered manager recruited staff safely by ensuring all the relevant checks and references were in place prior to staff starting work. Staff received suitable training and supervision to be effective in their role. There were enough staff to meet people’s needs.

Medicines were stored and managed safely.

There were systems in place to ensure people were protected from infection through effective cleaning processes and the safe storage of food.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

There was a complaints process in place and we could see the registered manager learnt from any incidents that took place. The registered manager was well regarded by the people living at the service, staff and relatives. They ensured the quality of the service was maintained through a mixture of quality audits and by being present and involved in the day to day running of the service.

Further information is in the detailed findings below.

We inspected this service on 22 February 2016. The inspection was unannounced. Hilton Lodge is a care home registered for a maximum of 13 people some of whom have had long term mental health needs.

At the time of our inspection there were 13 people living at the service. The service is located in two adjoining terraced houses with access to a back garden. We previously inspected the service on 15 November 2013 and the service was found to be meeting the regulations inspected.

Hilton Lodge had a registered manager at the service. 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 warm and friendly atmosphere at the service. Staff talked positively about their jobs telling us they enjoyed their work and felt valued. The staff we met were caring, kind and compassionate and treated people with dignity and respect. People using the service informed us that they were happy with the care and services provided.

We saw staff were aware of people’s needs, their likes and dislikes and their needs were carefully documented within detailed care plans. We saw from records that staff responded quickly to people’s change in needs if they were physically or mentally unwell.

Care records were individualised, contained people’s personal histories and reflected their choices, and arrangements were in place to ensure that these were responded to. Care plans provided detailed information on people’s health needs which were closely monitored. Risk assessments had been carried out and updated regularly. These contained guidance for staff on protecting people.

People were supported to maintain good health through regular access to healthcare professionals, such as GPs and the local general hospital. People spoke highly of the food, and we saw there was a plentiful and varied range of food available. People’s cultural and religious needs were facilitated by staff.

People had their medicines managed safely and received their medicines as prescribed. Medicines were stored in a locked cupboard and the documentation was accurate and checked daily by the registered manager.

Staff had been carefully recruited and there were enough staff to meet people's needs. Staff felt supported and there was evidence of regular supervision taking place in the last 12 months. Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

We found the premises were clean and tidy, and measures were in place for infection control. The communal areas had been recently decorated and there was a record of essential services being checked. There was clear documentation relating to complaints and incidents.

The registered manager was visible within the home, and we could tell from staff meeting records and from talking with staff and people living at the service that he was passionate about providing good quality care to people within his care.

There was a lift to access upstairs and there was an accessible bathing facility for people with mobility problems. The garden which people looked out onto from the lounge and dining area was well kept, and in the good weather was well used by people who lived at the service.

People told us that they liked the service provided. One person described the home as, “exceptionally good.” A second person said, “it’s very pleasant and staff are nice.” Relatives we spoke with were also positive. One told us, “it’s a really good home.”

Staff were bright and enthusiastic and had created a warm and friendly atmosphere. Staff were knowledgeable about people’s needs and we observed them working kindly and calmly with people.

Care plans were detailed and included a range of risk assessments. The provider and staff were able to describe people’s needs and how they provided care including providing care in people’s best interests. Meal provision was efficiently organised with staff assisting where needed and monitoring people’s individual nutritional needs. There were suitable arrangements for people’s medication needs including guidance for staff and checks to make sure medication administration was carried out safely.

Comfortable, well maintained premises were provided and there had been recent improvements such as two new bathrooms in which an adapted bath and new level access shower had been installed. The home was clean throughout.

Staff told us they liked working at the home and felt supported. We saw records of the provision of relevant staff training including dementia care and manual handling. We were shown records confirming that staff had been provided with regular supervision. There were a range of quality monitoring initiatives including surveys of people using the service, internal auditing and external advice and support for the provider.

Hilton Lodge had twelve residents at the time of our inspection. They all suffered from dementia or had other mental health conditions. The majority of them were unable to give us feedback on the quality of the service. Those who were able to express their views told us that ‘The service is alright, they look after you well’ and that ‘It couldn’t be any better, (staff are) very nice people’. Others told that they were satisfied with the service, the meals and the staff.

One person’s close friend, who visited the home, told us that they had never had any problems with the quality of the service or with the way people were treated. We were told that the staff and the manager were always approachable and it was apparent that the well-being of the residents was important to them.

We found that people’s needs were assessed and that their care plans were available and were reviewed on a regular basis. People’s health was monitored and received medical attention when it was needed. The manager monitored the quality of the service and involved people and their families in the development of the service.

People told us that members of staff were “respectful”, “patient” and “kind” and that when they received assistance with personal care the member of staff respected their privacy and dignity. When we asked people if they thought that staffing levels were sufficient everyone agreed that there were enough members of staff on duty and that staff responded to requests for assistance “quickly”. Although most people were not aware of their care plan they all told us that “I get enough support”. They said that there were activities taking place both inside and outside the home but one person said that “no activities interest me”.

When asked about the food served in the home people said that the manager asks them about the menu and if the person does not like the main dish, alternatives are offered. Some people required a purred diet and when served, the different items in the meal had been pureed together, producing a brown mixture. This detracted from the appearance of the meal.

They said that if they had any concerns they would speak to the manager and referred to him by name. They told us “he would listen. You can talk to him. He’s around every day”. When we asked if they had any complaints they said “nothing yet” and “everything is alright”. They told us that they felt safe and comfortable with the people that they lived with and the members of staff supporting them.

When asked whether there were ways that the home could improve the service provided a person said “no improvements, continue the way they are”. They said that “they want the best for everyone”. People told us that they could comment on the quality of care at residents’ meetings or when they saw the manager.