About the service:

Hilton Residential Home is a residential care home that accommodates up to 21 people. At the time of the visit there were 14 people who lived there. There is no nursing care at this service.

People’s experiences of using this service

At the previous inspection the registered provider was in breach of regulation relating to the maintenance of the premises. Repairs and faults to the premises were not rectified and addressed promptly. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.We also made recommendations regarding the provision of activities because people were not always supported with meaningful day time activities. During this inspection, improvements had been made to the maintenance of the premises and some improvements had also been made to the provision of meaningful day time activities. Improvements to activities needed to be sustained. While there was a planner in place, the activities had not always been delivered as planned.

The registered manager and the registered provider had ensured the premises were maintained and any faults rectified. They had also completed audits to monitor the safety and quality of care provided.

People told us they received care in a safe way. Individual risks to people and the environment had been identified and assessed and measures put in place to manage them and minimise the risk of avoidable harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely by trained staff who ensured that people received medicines at the right time.

The management of risks associated with falls had improved however, improvements were required to ensure care staff consistently sought medical advice in instances where people had experienced head injuries. Care records for people living at the home temporarily needed to be robust. The registered manager rectified this immediately.

Sufficient numbers of suitably qualified and skilled staff were deployed to meet people’s individual needs. Staff had received a range of training and support to enable them to carry out their role safely. People told us they received the right care and support from staff who were well trained and competent at what they did.

Staff showed a genuine motivation to deliver care in a person-centred way based on people’s preferences and likes. They treated people with kindness, compassion and respect and ensured that people’s dignity was maintained at all times. People and their relatives spoke positively about the care and support provided.

People’s needs, and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People received support to maintain good nutrition and hydration and their healthcare needs were understood and met.

Records relating to consent for care were completed and people told us they were always offered choice and control over the care they received. Deprivation of liberties (DoLS) authorisations had been considered. However, we found the home had not applied for authorisation to ensure they could legally restrict people three people for their own safety. We asked the registered manager to take immediate action and they applied for authorisations after our inspection visit.

Care was delivered in a personalised way which was in line with information recorded in people's care plans. People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted person centred care and a positive culture within the staff team. People, family members and staff all described the registered manager as supportive and approachable. The registered manager showed they were committed to impr

This unannounced inspection took place on 16 January 2018.

Hilton Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 21 people. At the time of the visit there were 17 people who received support with personal care. There is no nursing care at this service.

The service was managed by 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.

At the last inspection in May 2017, we found shortfalls in a number of areas. This included shortfalls in the effective management of risks to receiving care and a failure to implement systems and processes for seeking consent and mental capacity assessments. We also found shortfalls in staff training, supervision and appraisals and lack of evidence to demonstrate the oversight provided to the registered manager to ensure compliance. These were breaches of Regulation 11, 12, 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we took enforcement action and issued the provider with a warning notice for the failure to maintain good governance. We also met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key question(s), ‘Is the service safe, Is the service effective, Is the service responsive and is the service well-led?’ to at least good.

During this inspection we reviewed actions the provider told us they had taken to gain compliance against the warning notice and breaches in regulations identified in May 2017. We found necessary improvements had been made in relation to the management of risks to receiving care, the safe recruitment of staff, staff training and supervision and seeking consent. We also found improvements had been made in relation to good governance and the provision of oversight at the service. However, we found further improvements were required in relation to the system for responding and rectifying faults and repairs within the premises.

During this inspection we found a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured that repairs and faults to the premises were rectified and addressed promptly. We have also made recommendations regarding the provision of activities, and staffing levels can see what action we told the registered provider to take at the back of the full version of the report.

This is the second consecutive time this service has been rated Requires Improvement.

Feedback from people and their relatives regarding the care quality was positive. Visiting professionals we spoke with gave positive feedback about the service. People who lived at the home told us that they felt safe. There was mixed feedback about the staffing levels in the home. We made a recommendation about monitoring and maintaining safe staffing levels in line with people’s needs. Visitors and people who lived at the home spoke highly of the registered manager and the care staff.

We found there had been improvements to the quality of care provided since our last inspection. The registered manager, the provider and their staff had made necessary improvements to address the shortfalls we found at found in May 2017 to ensure the service was compliant with regulations. Necessary improvements had been made to the management of risks to receiving care. Risk assessments had been develo

We carried out an inspection at Hilton Residential Home on 10 and 11 May 2017. The first day was unannounced.

Hilton Residential Home provides residential care to older people in nine single and five double rooms. Five rooms have en-suite toilet facilities. The home is located half a mile from Padiham town centre in Lancashire and is close to local shops and transport routes. Car parking is available at the front of the home. There are comfortable lounges, dining rooms and a conservatory. Various aids and adaptations are provided to support people maintain their independence in addition to assisted bathing facilities. There is a passenger lift to the lower ground floor bedrooms. At the time of our visit there were 15 people who lived in the home.

At the time of our inspection the service had a registered manager who had been in post since August 2016. 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.

We last inspected Hilton Residential Home on 14 and19 January 2015 and found the service was meeting regulations and was rated overall as good.

During this inspection we found the service to be in breach of five regulations under the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. The breaches were in respect of Regulation 11, seeking consent, Regulation 12, safe care and treatment, Regulation 17 good governance, Regulation 18, staffing, Regulation 19 employment of fit and proper persons. This included shortfalls in the effective management of risks of harm and abuse within the service and a failure to implement systems and processes for seeking consent and mental capacity assessments, shortfalls in staff training, supervision and appraisals and lack of evidence to demonstrate the oversight provided to the registered manager to ensure compliance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Before this inspection, we had received some concerning information in relation to the quality of the service, management of people’s money and good governance. We looked into these areas during the inspection.

Feedback from people and their relatives regarding the care quality was overwhelmingly positive. Views from professionals were also positive.

People who lived at Hilton Residential Home told us that they felt safe and there was sufficient staff available to meet their needs. Visitors and people who lived at the home spoke highly of the registered manager and the owner who is also the provider. They told us they were happy with the care and treatment.

There was deterioration in the quality of the service since the last inspection in January 2015.There had been a change in management and a high turnover of care staff. However, there was evidence of improvements that the registered manager had started to implement.

There were policies and procedures in use by staff. We noted that some of the policies were due for update and the registered manager had started to update them to ensure they reflected current practice, legislation and best practice.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found there were policies and procedures on safeguarding people. Although some staff had not received up to date training in safeguarding adults; they showed awareness of signs of abuse and what actions to take if they witnessed someone being ill-treated. Improvements were required in this area. The registered manager showed us evidence of the training and support that they had planned to implement to resolve this.

Safeguarding incidents had been reported to

Hilton Residential Home was registered with the Care Quality Commission to provide personal care and accommodation to 21 older people, and there were 17 people living there on the day of our inspection. As part of our inspection we spoke with three people who used the service, two members of staff, the registered manager, two district nurses and a visiting relative.

Overall, people told us they were happy living at Hilton Residential Home and felt well cared for by the staff. Comments from people who used the service included; “The home is goodness itself. I really can’t complain” and “ In their own way the staff are so kind and caring” and “If I can’t be at home then this is the best place for me” and “I feel treated like one of the family and as though I belong”.

During our inspection we looked at what methods were in place for people to provide consent to their care and support, and we found there were effective systems in place.

We looked at how people living at Hilton Residential Home received their medication and looked at the systems in place to ensure this was done safely.

We looked at three staff member files to ensure members of staff had been recruited safely and we found appropriate checks had been made before commencing employment.

We found there were systems in place to monitor the quality of service provision effectively which included the use of audits, surveys and staff meetings.

People using the service told us they liked living at Hilton Residential Home and were satisfied with the care provided. One person said, “It’s very homely.” Another person said, “The staff are very good.”

We saw that people were treated with respect and leisure activities were organised everyday.

We found that improvements have been made since our inspection of

2 March 2012. These included obtaining people’s views about the service provided and implementing a rolling programme of training for all members of staff.

We noted that appropriate and accurate records were kept for people using the service and the overall effective management of the home.

People told us they were happy living in the home and that the staff treated them well and

with respect. People said they enjoyed the food and felt that the staff really cared.

We were told that the staff worked well as a team and were well supported by the manager and the provider. Staff said they worked to provide a homely and family type environment.

We carried out an inspection of Hilton Residential Home on the 14 & 19 January 2015. The first day was unannounced.

We last inspected The Hilton Residential Home on 22 August 2013 and found the service was meeting the requirements of the current legislation in the outcomes assessed. These were, consent to care and treatment, care and welfare of people using the service, management of medicines, requirements relating to workers and assessing and monitoring the service provision.

Hilton Residential Home provides residential care to older people in nine single and five double rooms. Five rooms have en-suite toilet facilities. The home is located half a mile from Padiham town centre in Lancashire and is close to local shops and transport routes. Car parking is available at the front of the home. There are comfortable lounges, dining rooms and a conservatory. Various aids and adaptations are provided to support people maintain their independence in addition to assisted bathing facilities. There is a passenger lift to the lower ground floor bedrooms. At the time of our visit there were 21 people living in the home.

The home was managed by 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.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). We found the location to be meeting the requirements of DoLS. People using this service and their representatives were involved in decisions about how their care and support would be provided. The registered manager and support staff understood their responsibilities in promoting people's choice and decision-making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People told us they were cared for very well and they felt safe. They said they had never had any concerns about how they or other people were treated. One person said “I feel perfectly safe here. I couldn’t find one thing to complain about. Of course I can speak up for myself and maybe others can’t, but from my experience, and I’ve been here a while now, the staff are very good with everyone.” Routines were seen to be flexible to accommodate people’s varying needs and there were no institutional practices observed.

People were cared for by staff that had been recruited safely and were both trained and receiving training to support them in their duties. Staff were kept up to date with changes in people’s needs and circumstances on a daily basis. We found there were sufficient numbers of suitable staff to attend to people’s needs and keep them safe and we observed calls for assistance were responded to in a timely way. People told us there was enough staff working to attend to their needs as and when required.

Contractual arrangements were in place to make sure staff did not gain financially from people they cared for. For example, staff were not allowed to accept gifts, be involved in wills or bequests. This meant people could be confident they had some protection against financial abuse and this was closely monitored.

Individual risk assessments had been completed and were centred on the needs of the person. People’s rights to take risks were acknowledged and management strategies had been drawn up to guide staff and people using the service on how to manage identified risk.

People had their medicines when they needed it. Medicines were managed safely. We found accurate records and appropriate processes were in place for the ordering, receipt, storage, administration and disposal of medicines.

The home was warm, clean and hygienic. Cleaning schedules were followed and staff were provided with essential protective clothing. There were contractual arrangements for the disposal of clinical and sanitary waste and the water supply was monitored for the control of Legionella. Water temperatures at source were maintained at a safe temperature for bathing. People told us they were satisfied with their bedrooms and living arrangements and had their privacy respected by all staff.

Each person had an individual care plan. These were sufficiently detailed to ensure people’s care was personalised and they were kept under review. Staff followed ‘How I like to spend my day’ overview that placed people at the centre of their care. Staff discussed people’s needs on a daily basis and people were given additional support when they required this. Referrals had been made to the relevant health professionals for advice and support when people’s needs had changed. This meant people received safe and effective care.

We observed good interaction between staff and people using the service. There was much laughter and a friendly atmosphere throughout our visit. From our observations we found staff were respectful to people, attentive to their needs and treated people with kindness in their day to day care. Activities were varied and people had good community involvement.

People were provided with a nutritionally balanced diet. All of the people we spoke with said that the food served in the home was very good. One person told us, “The food is exceptionally good. I’ve never sent a meal back yet. We can have what we want for breakfast, cereal, porridge, and a cooked breakfast. We get a choice at tea but if I didn’t like what was on offer I would get something else I’m sure.”

People told us they were confident to raise any issue of concern and that it would be taken seriously. There were opportunities for people to give feedback about the service in quality assurance surveys. Recent surveys showed overall excellent satisfaction with the service.

People told us the management of the service was good. Staff, relatives and people using the service told us they had confidence in the registered manager.

There were informal and formal systems to assess and monitor the quality of the service which would help identify any improvements needed. There were opportunities for people to express their views about the service with evidence their views had been listened to and used to improve their quality of life experience.

During the inspection we found the service was meeting the required legal obligations and conditions of registrations.