Hill Brow

We found the following examples of good practice.

The provider had acted to make sure people could have visitors safely. There was a hand washing facility prior to entering the home with instructions on good hand hygiene. Temperature and symptom checks were made prior to entry.

Family visits had been facilitated through a separate room with its own access from outside using screens. This room included a microphone and speaker system to support people who have difficulty hearing. In addition, there was a visitor lounge with entrance away from the main part of the home. When unable to have visits, the provider supported people with video or telephone calls to keep in touch with family. The provider had bought iPads and upgraded their WiFi to ensure this worked well.

Personal protective equipment (PPE) guidance and practice followed government guidance. The manager had put detailed processes in place around infection prevention and control (IPC) and PPE for staff to follow. Some staff were part of the provider’s “Infection Control Army” and were trained to a higher level to be able to support their colleagues with good practise.

The provider had a thorough policy for admissions including COVID-19 testing and a zoned area to isolate people on admission from other residents in the home.

Hill Brow is a residential care home that was providing personal care to 28 people aged 65 and over at the time of the inspection. Hill Brow is purpose built over two floors, with secure entry and a lift. People have access to landscaped gardens.

People’s experience of using this service:

Overall people were happy and satisfied with the service they received. A person said, “Yes this is a good home and I think they run it very well. They try very hard - you can’t please everyone but for me this is a good place.”

Since the last inspection the provider had introduced new initiatives to effectively meet people’s mental health needs and monitor their frailty levels. They had participated in local and national initiatives to improve people’s care. They had trialled a clinical development lead for people. There was a strong learning culture. People received their care from staff who were well trained and well supported within their role.

The service was exceptionally responsive when identifying and meeting people’s individual needs, as staff underwent graduated training to understand the needs of people living with dementia. Staff were responsive to people’s suggestions and supported people to achieve their goals such as holidays. The provider ensured relatives were well supported at the end of people’s lives through the introduction of a ‘scrap book’ and the end of life basket.

There was a visibly person-centred culture, underpinned by the provider’s principles, values and expectations of staff. People received kind, caring and compassionate care from permanent staff, there was zero use of agency staff.

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

The service was well led. The recent change in manager of the service had been managed seamlessly for people. People’s views about their care were regularly sought and any feedback was acted upon. Working in partnership with other agencies and professionals, the service achieved positive outcomes for people in line with their needs and preferences.

The home has been rated Outstanding overall as it met the characteristics for this rating in two of the five key questions. More information is in the full report, which is on the CQC website at: www.cqc.org.uk

Rating at last inspection:

At the last inspection the service was rated good (08 March 2017).

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated outstanding. We will continue to monitor the service through the information we receive.

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 2008 and associated Regulations about how the service is run.

People and their relatives told us people were safe within the service. Staff had undertaken relevant safeguarding training and understood their role in keeping people safe. Risks to people in relation to all aspects of their care had been assessed and measures taken to reduce the likelihood of them occurring. Processes and procedures were in place to ensure people received their medicines from trained, competent staff.

People and their relatives told us there were enough staff to meet people’s needs in a timely manner. Records showed there were always enough competent staff on duty with the right mix of skills. People were safe because the provider had robust recruitment policies and procedures.

Staff underwent the industry recognised induction to their role and also received a variety of additional training. Staff had been regularly supported through supervision and were proactively encouraged with their professional development to ensure people received effective care.

Where people had capacity to do so they had signed their own care plans. Where people lacked the capacity to make a specific decision legal requirements had been met to ensure any decisions were made in their best interests.

People told us they were well supported with their nutritional needs. The food provided looked and smelt appetising. Risks to people associated with eating were assessed and managed safely.

People and their relatives told us people’s healthcare needs were well met.

People, their relatives and professionals told us people experienced positive caring relationships with staff. Peoples’ communication needs were understood well by staff. Staff ensured they communicated appropriately with people and involved them in decisions wherever possible. People and their relatives told us staff upheld their privacy and dignity in the provision of their care. People received a high standard of end of life care which was centred on their wishes.

People and their relatives told us staff had outstanding skills and an excellent understanding of people as individuals. They told us people experienced a more fulfilling and exceptional quality of life due to the quality of the care provided by skilled staff. There was a strong focus on providing person centred care which was both flexible and responsive to individual’s needs. People were supported to maintain and pursue their interests and to retain a sense of purpose and worth in their lives. The service created innovative ways for people to be provided with experiences which gave them stimulation and pleasure.

People and their relatives felt confident about how to make a complaint if they needed to. Where people had made complaints these had been appropriately responded to. The provider had sought individualised and meaningful feedback from people and their relatives which they then acted upon for peoples’ benefit.

The provider and manager had created and sustained a positive culture in the service based on clear values, which staff in all roles consistently applied in their work with people.

The service had a track record of being an excellent role model. There were very strong links with the community nursing team who often trialled new community projects with the service due to staff’s enthusiasm. These projects were of significant benefit both to people at Hill Brow and other local homes.

People their relatives, staff and professionals told us the service was very well run. At all levels of the service management was highly visible, accessible, supportive and responsive to ideas to improve people’s experience of the service.

The service strove for excellence through consultation, research and reflective practice. Their involvement with university research projects and local initiatives had led to a range of improvements in the welfare of people and their experience of the care provided. Robust processes were in place to audit the standards of people’s care and to drive service improvement.

On the day of the inspection there were 26 people using the service. As part of this inspection we spoke with seven people who use the service, two people's relatives, a visiting health professional, the registered manager, the general manager, the registered provider, five care staff, a kitchen assistant and the activities co-ordinator. We also reviewed records relating to the management of the home which included, six care plans, daily care records, incident records, staff rosters and records relating to the management of the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe. We spoke with people who told us they felt safe. One person's relative told us 'I feel complete assurance.'

Staff had received training in safeguarding and guidance was available to them. The registered manager had not recognised that all incidents where people had left the premises without staff being aware could have constituted neglect and should therefore have been referred to Social Services. However, they took appropriate action once this was brought to their attention. There was evidence that they had reported other incidents to Social Services as potential safeguarding issues.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Applications had been submitted to the relevant agency for one person because measures were in place to keep them safe which amounted to a deprivation of their liberty. Appropriate arrangements had been made for this person's ongoing care.

There were sufficient staff to meet people's needs and to ensure their safety. The registered manager kept the staffing level of the service under review and was able to increase staffing levels if required.

Clear records had been kept about what care people had received and when. People were safe as the service had recorded the care that had been provided. Records were kept securely.

Is the service effective?

The service was effective. People's verbal and written consent had been sought in relation to the care provided. Where the service believed that the person lacked the capacity to consent to a decision they had completed an assessment and where required made a best interest decision on their behalf. Guidance and training were available for staff.

People had care plans and risk assessments in place that met their identified needs. The service was clear that they could not accommodate people who needed a secure environment. If people's needs changed and it was identified that there was a risk of them leaving the premises then either risk assessments had been amended or the service had identified that they could no longer meet the person's needs and alternative arrangements had been made.

Staff had received first aid training and were able to respond appropriately in a medical emergency. There was evidence that when people's medical needs changed contact had been made with the relevant services.

Is the service caring?

The service was caring. People told us 'Staff are excellent' and one relative said 'It is a good place.' Staff were seen to be warm and genuine in their interactions. People were seen to be comfortable in the presence of staff.

Is the service responsive?

The service was responsive. One relative told us 'I can ask the manager about any issues and they are resolved' and 'I can go online and give written feedback.' One person told us that they could give their feedback on the service at the resident's meetings.

Aspects of the service were audited to identify areas for improvement. The provider and the general manager reviewed the registered manager's monthly audits and the results were discussed at the monthly managers meeting to identify any areas that required improvement.

The provider was aware that there was an increasing need for the service to be able to provide secure premises for people who required this level of provision. They were reviewing the situation in response to recent incidents and had a plan in place to increase the security of the premises which meant they would be able to accommodate people who were identified at the initial assessment as at increased risk of leaving the premises.

Is the service well-led?

The service was well led. We spoke with people and their relatives who told us that they felt the service was well led.

The staff were very satisfied with the leadership and the management of the service. Staff told us that they were able to call the registered manager if they had any concerns.

The provider had good oversight of the service as they visited most days.

The provider and the general manager were aware of the key issues facing the service for example, the security of the premises.

The registered manager had not notified the Care Quality Commission (CQC) of all incidents in relation to people leaving the service unnoticed. Once the issue was brought to their attention they took action to submit them and were able to demonstrate that they knew what CQC had to be notified of and how.

Three staff told us they enjoyed working at the home. They said they liked being able to provide support and care for people in ways that made a difference to the quality of people's lives. The staff said they worked hard to provide the best possible care while ensuring Hill Brow remained a happy and homely place for people to live. One staff member told they loved coming to work and the team were supportive.

We saw the manager had a comprehensive quality review programme which focused on all aspects of care and organisation. This included the monitoring of accidents and incidents. In addition, care plans were reviewed on a monthly basis. These were evidenced in people's records.

Our observations throughout the inspection confirmed that staff treated people with respect and they demonstrated kindness and a caring attitude.

People told us that the staff provided the care they needed in a way that suited their preferences and routines. Relatives were equally positive about the care the staff provided to their family members.

One relative told us the staff had taken special care to ensure their relative was eating enough following their admission and as a result they were now eating independently and had gained weight.

We saw five care plans and each of these contained a full assessment of people's needs and a detailed plan of care for each individual. Our observations demonstrated that the staff knew people's needs and delivered suitable and appropriate care.

People said they felt safe and the records confirmed that staff had been trained to protect people from abuse or harm.

We observed that this home had a warm and pleasant atmosphere where people could pursue their interests and take part, if they chose, in the busy activities schedule.

People told us they knew how to complain if they needed to and the staff told us they understood how to report and manage any complaints.