Hillside Lodge

Hillside Lodge 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.

Hillside Lodge provides care and accommodation for up to 60 people separated into three separate units. Each unit provides care for 20 people, one providing nursing care, one residential care and one care for people living with dementia.

There was 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. At the last inspection on the 25 November 2015 the service was rated Good overall. However it was Requires Improvements in Well-Led. At this inspection we found the service remained Good overall.

Why the service is rated good:

People told us they felt safe. Comments included; “I feel 100% safe here” and “Yes, I do feel safe here” also “Of course, I feel so safe.” A relative said; “Very safe- I have no concerns.”

The service was now well-led. At our inspection in November 2015 we recorded that the service was not consistently well led. The report for November 2015 highlighted that the records of people’s care were not all completed in full. For example, people who had records in place to record their food and fluid intake, and risks associated with their skin were not all completed consistency. It stated that; “The incomplete records detailed above are a beach of Regulation 17 of the Health and Social Care Act 2014.” At this inspection we found that the provider had followed their action plan and that steps had been taken to ensure the breach was met.

People lived in a service where the registered manager’s values and vision were embedded into the service, staff and culture. People, relatives and staff all agreed that the registered manager was approachable and had an “open door policy.” The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

The Provider Information Return (PIR) stated; “Manager and deputy complete monthly audits and the quality team visit twice yearly (unannounced) and complete a quality of life audit action plans which are a result of these audits.”

People remained safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. People, relatives and staff mostly said there were sufficient staff to keep people safe. However a few people and some staff commented that staffing levels were not always good. Comments from people included; “They are rushed off their feet’ and another said; “I would like staff to have more time to sit and talk to me.” While others said; “Staff numbers are fine” and “When I use my call bell the response is quick.” Another said; “When I call for help, it comes quickly generally.” Other staff said they were able to meet people’s needs and support them when needed. The registered manager said they monitored the staffing levels based on the needs of people currently living in the service.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People who required additional support to protect their skin integrity had input from either the qualified staff on duty or the district nurse team. Professionals said they believed people were safe and well cared for and had no concerns. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). Staff said the Care Certificate training looked at and discussed the Equality and Diversity policy of the company. People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People who required assistance were supported in a respectful and dignified way.

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. People’s end of life wishes were clearly documented. People's healthcare needs were monitored by either the qualified staff or the care staff and people had access to a variety of healthcare professionals.

People’s equality and diversity was respected and people were supported in the way they wanted to be. People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs. However care plans were seen to be repetitive and difficult to navigate. Many staff commented on the amount of paperwork needed to be completed with the same information needing to be recorded many times in different places. The registered manager and the company were currently reviewing the format of the care plans in place.

People were treated with kindness and compassion by the staff who valued them. The staff had built strong relationships with people. People's privacy and dignity was respected with staff knocking on people’s door. However we did note during our observations that some staff when walking pass people did not always acknowledge them, did not look at them or ask if they were all fine. The registered manager would raise this at the staff meeting arranged. People or their representatives, were involved in decisions about the care and support people received.

People lived in an environment that was clean and hygienic. The environment had been assessed to ensure it was safe and met people’s needs.

The service remained responsive to people's individual needs and provided personalised care and support. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the registered manager confirmed any complaints received would be fully investigated and responded to.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the registered manager and provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service.

This summary is based on our observations during the inspection, discussions with 19 people, six relatives, the manager, two team leaders, one agency nurse, six carers, two activities staff and a member of the maintenance team. We also reviewed records relating to the management of the service, six people's care and health records and five staff recruitment files. As some people could not talk with us about their experiences of living at the service we spent time observing how they were cared for and treated by staff. We observed interactions between staff and people who lived at the service for four hours during the morning and lunchtime period.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider had reviewed people's dependencies and the staffing level. As a result there had been a temporary increase in the number of staff on duty in two parts of the service. During this period the provider and manager had considered ways to optimise the current staffing level, for example by involving activities and ancillary staff at peak times, such as mealtimes. People that we spoke with were complimentary about the staff. We observed that staff responded quickly to meet people's needs and ensure their safety. One person told us, 'I feel safer here than I would anywhere else'.

We looked at the recruitment processes and found them to be safe and thorough. The service had carried out relevant checks to ensure that staff had the necessary skills and aptitudes to work with people living at Hillside Lodge.

People were supported by staff who knew them well and who understood their needs and preferences. Staff told us that they received detailed handovers and were kept informed as to any changes in people's care or treatment. We found that records relating to people's care and treatment were generally up to date. In one part of the service there was a recent shortfall in some records. We discussed this with the manager on the day of our visit and received documentary evidence of changes that had been put in place. This helped to ensure that an accurate record about each person was maintained and that they received appropriate care and treatment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, the manager demonstrated knowledge of their responsibilities in respect of this.

Is the service effective?

We found that people's care plans were detailed and that they had generally been reviewed on a monthly basis. This helped to ensure that the care provided was in line with their individual needs and preferences. The selection of care plans that we looked at demonstrated that people or their representatives had been consulted and that their personal needs and preferences were reflected.

As many of the people living at the service were unable to speak directly of their experience, we spent time observing the care and support that they received. Staff demonstrated skill and experience when supporting people. One person that we spoke with told us, 'We are looked after very well'. Another said, 'They go out of their way to help me'. A member of staff shared, 'The care is very good. We are just like a family. It's a nice place to work'.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We spoke with 19 people. They were all satisfied with the care that they received. They told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, 'They (the staff) are very good'. A relative said, 'I cannot put into words what I think about that place, they are fantastic'. In a recent card of appreciation a relative had written, 'The love and care has been outstanding'.

Is the service responsive?

Activities were available that took account of people's capabilities and understanding. The service had a varied activity programme in place which included in-house activities as well as visiting entertainers. During our visit we observed people participating in a number of activities that stimulated and entertained them.

People were supported to access health related support in a timely manner. Relatives told us that they were kept informed and updated if there were any issues or concerns regarding the health of their family member. One relative said, 'They contact me if there are any problems'.

People told us that they were able to raise concerns or make suggestions and that they were consulted about changes in the service. We found that the service listened and responded to questions and feedback received from people, their representatives and from staff.

Is the service well-led?

Since our last inspection we found that improvements had been made in relation to staffing. The manager was consulting on further changes and action in order to ensure that people's needs were met and that staff received appropriate support.

We saw there were systems for monitoring the quality of services provided. The manager demonstrated a commitment to making improvements to the quality of service provided to people. One relative said, 'I have had a good experience with them, and it (the service provided) has certainly improved'.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

We spoke with eight members of staff and the manager. Staff told us that they enjoyed working in the home. One said, 'It is probably one of the best homes I've worked in. It has a personal touch'. Another told us, 'We come into their home to care for them; I get a lot of job satisfaction'. They also told is that it was very busy and that sometimes they were really stretched.

We spoke with six relatives. They were delighted with the care. One said, 'The care is first class or even better'. Another told us, 'We had a lovely feeling about the place as soon as we went in'. They told us that the staff were, 'Absolutely incredible' and that, 'Their patience is abounding'.

We found that the home was bright and that people looked well cared for. People were provided with a good choice of food and drink. Staff were welcoming and we saw that they supported people with kindness and respect. People told us that they could approach staff or the manager if they were unhappy or had ideas to discuss. We found, however, that there were not always enough staff on duty to ensure that people were supported in a timely way.