24 and 26 February 2015
During a routine inspection
This inspection took place on 24 and 26 February 2015. Both days of inspection were unannounced. This means the provider did not know we would be visiting.
We last inspected the home on 28 January 2014 and found the provider was not meeting the legal requirements for care and welfare of service users and staffing. The provider submitted an action plan which stated how they would meet all legal requirements. During this inspection we found improvements had been made.
Hillside Grange is a residential care home with 45 bedrooms. Some bedrooms are located on the first floor and are accessible by both stairs and lift. At the time of the inspection there were 26 people living at Hillside Grange. Nine people lived on the first floor which is described as ‘memory lane’ and provides care for people who are living with dementia. 17 people were living on the ground floor which provides residential care.
Not all rooms at Hillside Grange are en-suite but they do all have a wash-basin. There are a selection of bathrooms and toilets available for people to use.
There was a registered manager in post at the time of the inspection but we had been previously notified that they would be absent from the service due to a secondment to manage a sister home. The deputy manager had taken over the running of the home on a full time basis with support from the Regional Director as needed. The registered manager was at Hillside Grange on the first day of inspection.
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.
Everyone we spoke with said they felt safe living at Hillside Grange. One person said, “We are in safe hands here, well looked after.” People and staff told us there were sufficient staff to care for people. We saw that staff were able to spend time chatting and engaging with people in a warm and unhurried manner.
There were thorough recruitment processes in place. This helps to safeguard people as it means thorough checks are completed before people are offered employment.
Potential risks to people had been identified and were being managed. Risk assessments documented background information, triggers to the risk occurring and how staff should respond to minimise and manage the risk. Emergency contingency plans were in place to ensure people were kept safe and well cared for should there be an emergency and people needed to temporarily leave the building.
Medicines were stored and managed safely. All staff administering medicines had been trained to do so and their competency levels were checked regularly. Protocols were in place for people who had been prescribed ‘as and when’ required medicines and information on why people had been prescribed certain medicines was readily available.
People were cared for by staff who were trained and knowledgeable and had the skills to meet their needs. Where refresher training was out of date courses had been booked for staff and they were due to attend within the next few weeks.
Staff said they felt well supported by the whole management team and we saw that supervisions and appraisals were up to date. Staff said they could approach management about ‘absolutely anything’.
We observed staff explaining things to people and seeking consent before support was offered. There was a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and relevant authorisations were in place.
Staff understood people’s nutritional needs and worked together to ensure specific dietary requirements were met. Relevant professionals had been contacted to offer assessments and guidance for people who had difficulty swallowing, had specific health needs or who had lost weight. Guidance was being followed appropriately and information on specific nutritional needs was understood by the kitchen staff.
Staff had warm and respectful relationships with people and could be observed treating people with kindness and compassion, offering reassurances and time for people to engage and respond. This meant people received care that was individualised and personal to them. Individual likes and dislikes, preferences, hopes and dreams were documented and were understood by staff who were observed having conversations with people about their family lives and history.
A variety of activities were on offer at the home and these included one to one time with people as well as group activities such as line dancing and days out. People were encouraged to share ideas and suggestions for the activities they wanted and they were involved in planning these with the activities coordinator. Only one person told us they were bored and wanted to go out more, everyone else we spoke with said they enjoyed the activities and we saw visitors and relatives getting involved as well.
People received information on how to complain in their welcome packs and told us they knew how to complain but had not had any reason to do so. Relatives and visitors told us they had no concerns about the care provided.
The service was managed well and even though the registered manager had been seconded to another home she was still maintaining contact with Hillside Grange and had a regular presence. It was obvious that the people who lived at Hillside Grange knew the registered manager and the deputy manager well and had formed warm and trusting relationships with them.
A variety of quality assurance systems and audits were completed which resulted in action plans which ensured a culture of continuous improvement and development.