2 Hill Close

2 Hill Close is a small residential care home providing support and care for up to 3 people at the time of the inspection. On the day of our inspection there were 3 people using the service. There are also 1 Hill Close and Hillcrest which are registered separately but form part of one complex with many elements such as staffing and policies shared across all three buildings. We inspected these services in a 2-week period because much of the evidence we needed to gather was common to all 3 services.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support

Systems were not robust enough to demonstrate people’s safety was always effectively managed. There were shortfalls in cleanliness and in the assessment and management of risk. There was a lack of clarity in relation to staff deployment. These shortfalls had not been picked up through the provider's governance arrangements.

The location of the service in an ordinary residential area provided good access to local amenities and services which helped support people’s independence and autonomy. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People told us they were happy living at 2 Hill Close and we observed that people were relaxed in the company of staff and others they lived with. Support was available when needed and people were able to join in with activities within their local community. People’s care was person-centred and enabled them to live independent lives.

Right Culture

Overall, there was a positive culture in the service and people were happy with the support they received. However, the terminology and definitions used by the provider were not always respectful or empowering. People told us they were happy in their home and with the support they received from staff. Staff knew their responsibilities and were confident to report concerns that might arise. Staff felt well supported by the management team who worked at the service. The management team was responsive to the inspection findings and keen to deliver a high-quality service.

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

Rating at last inspection

The last rating for this service was good (report published 8 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service, specifically, the time elapsed since the last full inspection.

We undertook a focused inspection to review the key questions of safe, caring and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We made recommendations about staffing and the use of respectful terminology and definitions.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in February 2015 we rated 2 Hill Close as ‘Good’, and did not identify any breaches of regulation. At this inspection the service remained good.

Why the service is rated ‘Good’.

Risks associated with care and the environment in and around the home were well assessed.

Staff were recruited safely, and understood how to recognise and report any safeguarding concerns they had. There were enough staff on duty.

People’s medicines were managed safely.

Staff had a thorough induction and had access to on-going training and support. The registered manager carried out checks to ensure training was effective.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. The provider asked for people’s consent to care and treatment. Some key information relating to this was in accessible formats.

People were asked what they wanted to be on menus. The provider supported people to access health and social care professionals when needed.

People had access to activities which reflected their interests. Staff understood how to respect people’s privacy and dignity.

There was person-centred information in people’s care plans. Accessible formats had been used effectively to enable people to write detailed plans for end of life care.

Staff told us they enjoyed working at the provider’s services within the complex, and said they had a good relationship with the registered manager. They told us the registered manager was supportive and approachable.

The provider was monitoring quality in the service. People were consulted and the registered manager undertook regular audits to ensure areas for improvement were identified and addressed. We received good feedback about care standards from a visiting health professional we spoke with.

We spoke with two people living in the home, staff and the registered manager. We found staff involved people in decisions about their care and daily lives. We saw staff supported people to maintain their independence. People told us they went out regularly and enjoyed the different activities that were available.

We saw staff gave people the support and assistance they needed. The care records we reviewed were person-centred, holistic and provided detailed information. People told us the staff were 'good'.

We found the home to be comfortable and it was due to be redecorated and refurbished in July. People told us they liked living there. There were sufficient staff to meet people's needs. There were systems in place to deal with complaints. People told us they would speak to staff if they were unhappy about anything.