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Inspection carried out on 16 April 2019

During a routine inspection

About the service: Hilderstone Hall is a care home that was providing personal and nursing care to 38 people at the time of the inspection.

People’s experience of using this service: People felt safe and happy living at Hilderstone Hall. People’s risks were assessed and planned for and there were enough staff to meet people’s needs and give people the time and reassurances they needed.

People were safeguarded from abuse and avoidable harm by well trained staff who cared about people’s wellbeing.

People had choices about what food to eat, how to spend their time and were involved in all aspects of their care. Staff knew them well including their likes, dislikes and preferences and provided support to people in the way they liked.

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.

People’s care records were accurate and up to date and provided staff with the information they needed to provide safe and personalised care.

People knew the management team and staff shared their vision of providing good quality support to people. People and staff were engaged and involved in the service and had opportunities to share feedback that was listened to by the management and provider.

The service had made improvements since the last inspection and now met the characteristics of Good in all areas; more information is in the full report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 28 April 2018)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this service. If we receive information of concern, we may bring planned inspections forward.

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

Inspection carried out on 16 March 2018

During a routine inspection

This inspection took place on 16 March 2018 and was unannounced. At the last inspection completed in September 2017, we rated the service as inadequate, as the provider was not meeting the regulations for safe care and treatment, by having sufficient staff, safeguarding people at risk and did not have effective management and governance arrangements in place.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following the last inspection, we met with the provider to confirm an action plan to show what they would do and by when to make improvements to meet the regulations.

At this inspection we found improvements had been made and the provider was meeting the regulations.

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

Hilderstone Hall accommodates up to 51 people in one adapted building. At the time of the inspection there were 25 people using the service.

There was a registered manager in post at the time of the 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. The registered manager was present during the inspection.

The systems in place to ensure people’s risks were managed were not consistently effective and we could not yet be assured the systems were sustainable. The provider had made significant improvements following the last inspection. However, further work was required to ensure this was sustainable.

Improvements had been made to the way in which people’s risks were managed; however, further work was required to ensure that risk management was consistently safe for all people who used the service.

People were protected from avoidable abuse and harm by trained staff. Most risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were managed safely and were kept clean and tidy. Staffing levels were sufficient to meet people's needs and staff had their suitability to work in a care setting checked before they began working with people. Medicines were now managed safely, following improvements to the systems in place. The registered manager had systems in place to learn when things went wrong.

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 support this practice. People were supported by trained staff and received effective care in line with their support needs. Staff received regular supervision and had access to continuous training. There was a good choice of food, which people enjoyed and they received support to meet their nutrition and hydration needs. The environment was designed to support people effectively. Healthcare professionals were consulted as needed and people had access to a range of healthcare services.

Staff were kind, caring and compassionate with people. People were supported to make their own choices and encouraged and supported to express their views. People were treated with dignity and respect by staff who knew them well.

Staff understood people and their needs and preferences. People had been invo

Inspection carried out on 12 September 2017

During a routine inspection

This inspection took place on 12 and 13 September 2017 and was unannounced.

Hilderstone Hall is a care home providing accommodation, personal and nursing care for up to 51 people. At the time of this inspection 35 people were using the service. At our last inspection we saw that there was a dedicated dementia care unit called Memory Lane but we were told during this inspection that this was no longer being utilised.

The provider did not have a registered manager in post. 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. The provider told us that a new manager had been recruited and that they would start their application to register with us once they were in post. An operations manager was temporarily managing the home until the new manager came into post.

At our previous inspection on 21 April 2015 the home was rated ‘Good’. At this inspection the home was rated ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Risks to people's safety, health and wellbeing were not always identified and managed safely and people did not always receive their planned care.

People were not always protected from the risks of avoidable harm and abuse because incidents of possible abuse were not identified and reported to the local authority as required. Action was not always taken to protect people from further occurrences.

There was not always enough suitably skilled staff to keep people safe or to meet their needs.

We found that medicines were not managed safely and people were at risk of not receiving their medicines as directed by the prescriber.

The provider did not have effective systems in place to consistently assess and monitor risks to people or the quality of care provided. This meant that issues with the quality of the care were not reliably identified and rectified.

The provider did not notify us of allegations of abuse which is a condition of their registration and required by law.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were not always followed to ensure people were supported to consent to their care. We identified one person who was potentially being un

Inspection carried out on 21 April 2015

During a routine inspection

This inspection took place on 21 April 2015 and was unannounced. At our previous inspection in August 2013 we did not have any concerns.

Hilderstone Hall is a social care home providing accommodation, personal and nursing care for up to 51 people. At the time of this inspection 43 people used the service. There was a dedicated dementia care unit called Memory Lane, seven people were accommodated in this unit.

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 told us they felt safe. Staff were aware of their responsibility to protect people from harm or abuse. They told us they were confident that any concerns they reported would be acted upon.

Risk assessments and care plans were completed to reduce the risk of harm to people. Staff had a good knowledge of people’s individual care needs but records were not always completed to reflect the care, support and treatment being provided.

Staffing levels were sufficient, people did not have to wait for help and support when it was needed. People’s medicines were managed safely; staff were knowledgeable and supported people with their medication as required.

Some people who used the service were unable to make certain decisions about their care. The legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were being followed. The MCA and the DoLS set out the requirements that ensure where applicable, decisions are made in people’s best interests when they are unable to do this for themselves. Arrangements were in place for best interest meetings and decisions to be made in accordance with the MCA when required.

People told us they enjoyed the food, had plenty to eat and drink and lots of choice. Where people needed help with eating, staff provided the level of support that each individual person required.

Health care professionals were contacted when additional support and help was required to ensure people’s health care needs were met.

People were treated with respect and approached in a kind and caring way. People told us they found the staff caring and compassionate. People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the home. All the visitors we spoke with told us they were made welcome by the staff in the home.

A variety of leisure and recreational activities were provided in house and in the community, these were either on a one to one basis or in groups. People could choose whether they wished to participate or not and staff respected their choices.

Staff, visitors and people who used the service told us they felt well supported by the management and worked well as a team. The safety and quality of the home was regularly checked and improvements made when necessary.

Inspection carried out on 20 August 2013

During a routine inspection

We carried out this inspection to check on the care and welfare of people using this service. The visit was unannounced which meant that the registered provider and the staff did not know we were coming.

At the time of our inspection 46 people were living in the home. We spoke with staff, visitors and people who used the service that were able to tell us about their experiences. One person who used the service told us: "The staff here are lovely; I have no complaints at all. I am very comfortable, nothing is too much trouble".

A visitor told us: "We were all very involved as a family in the care planning before my relative came in. We were able to come and look round beforehand even though my relative was in hospital. Staff visited the hospital ward twice to speak to my relative personally about what help was needed, what they liked and to tell them about the home. We are more than satisfied".

Some people were unable to speak with us either because of frailty or personal preference. We spoke with staff about the care and support they provided. They gave a detailed account of the specific individual needs of people. We saw that staff treated people compassionately; offering discreet assistance to those who required it.

We saw that systems were in place to ensure that medication was stored and administered in a safe way.

We saw staff were attentive and prompt when people required help and support.

We saw systems were in place for effective record keeping

Inspection carried out on 15 January 2013

During a routine inspection

At the time of our inspection 48 people were living in the home. We spoke with staff, visitors and people that used the service who were able to tell us about their experiences. Some people were unable to speak with us either because of frailty or personal preference. We saw that staff treated people compassionately; offering discreet assistance to those who required it.

We looked at the care planning documentation for three people who used the service to see how their care was provided and managed. We saw the plans were comprehensive and informative. We talked with staff who were aware of and able to discuss

people's care needs.

Staff told us their understanding of safeguarding vulnerable people and confirmed they had received training in this. People who used the service told us they did not have any concerns but if they did they would speak with the manager, senior staff or their family.

We saw staff were attentive and prompt when people required help and support. We did not see anyone waited for assistance when it was needed. Staff told us that they had received training to help them understand how to meet the needs of people in their care.

We saw that regular audits and checks were completed which ensured the service people received was maintained to the high standards they expected.

Inspection carried out on 29 September 2011

During an inspection looking at part of the service

Inspection carried out on 29 September 2011

During an inspection looking at part of the service

When we carried out an inspection visit at the service on 29 September 2011 we found that they were not compliant with outcomes four and sixteen. This means that they needed to make improvements to both of these outcomes.

Outcome four looks at the care and welfare of people who use the service. When we visited we found that people who were at the end of their lives did not always have their pain relief managed effectively. We identified that not all of the staff who were looking after people with these needs had received the appropriate training. Therefore it could not be guaranteed that people who were at the end of their lives would have their care, treatment and support needs met by the service.

Outcome sixteen looks at how the service assesses and monitors the quality of service provision. When we visited we found that the service could not demonstrate that it had taken action to make improvements where these were highlighted. The link between completions of quality audits, identification of improvements needed and actions taken to bring about these improvements was not clearly visible.

Following receipt of their inspection report the service sent us their action plan outlining how they would make the required improvements. They have also kept us updated of progress with this action plan.

Inspection carried out on 26 August 2011

During an inspection in response to concerns

We spoke with people living in the home,visitors, staff who work there and visiting professionals. We also held discussions with the newly appointed manager. This person had worked as the deputy manager at the home and was in the process of applying to become the registered manager of the service. People living in the home told us that they were happy with the care and support they received from the service. People felt that the staff who looked after them were very caring and supportive. People also felt that the service listened to their views and that they had a "voice". We spoke to two professional people who visit the service and they told us that they had no concerns and that they felt that the staff who work there were "very good". Prior to visiting the service two people had told us that they had concerns about the level of care and support given to a person with palliative care needs. They told us that they were concerned about this person's pain management in particular. We looked at this during our visit and have asked the service to make improvements in this area.