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Inspection carried out on 16 April 2018

During a routine inspection

The inspection visit took place on 16 and 17 April 2018. The first day of the inspection was unannounced.

Hillcroft Slyne Nursing Home 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.

Hillcroft Slyne Nursing Home is situated in the parish of Slyne-with-Hest close to the city of Lancaster. It provides accommodation for up to 48 people in three ground floor units, supporting people with general nursing needs, dementia and complex behaviour that may be challenging. At the time of our inspection 46 people lived at Hillcroft Slyne Nursing Home.

There was a registered manager employed at Hillcroft Slyne Nursing Home. 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 17 April 2017 we asked the registered provider to take action to make improvements around the auditing of records related to the application of topical creams, and this action has been completed.

At the last inspection, there was a breach of Regulation 12 HSCA RA Regulations 2014 (Safe care and treatment). Staff did not always follow policies and procedures on the administration of medicines. We asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well – led to at least Good.

At this inspection we found the registered provider continued to provide a good standard of care to people who lived at the home.

We observed medicines administration and reviewed documentation around the administration and management of medicines. We looked at documentation related to the application and recording of topical creams. We found medicine protocols were followed correctly by staff trained to administer medicines. Documentation we viewed guided staff clearly on where to apply prescribed creams. We did not find any missed signatures within medicine and topical cream recording charts which indicated people had received appropriate treatment in accordance with their care plan and clinical guidance.

People who lived at Hillcroft Slyne Nursing Home had care plans that reflected their complex needs and these had been regularly reviewed to ensure they were up to date. The care plans had information related to all areas of a person’s care needs. Staff were knowledgeable of people’s needs and we observed them helping people as directed within their care plans.

Relatives told us staff treated their family members as individuals and delivered personalised care that was centred on them as an individual. Care plans seen and observations during our visit confirmed this.

Staff delivered end of life care that promoted people’s preferred priorities of care.

The registered provider had refurbished the home to ensure people living with dementia were living in an environment that promoted their safety, independence and positive wellbeing.

We saw staff were responsive to each person’s changing needs. They worked together to ensure people who became agitated were offered a selection of person centred interventions to meet their needs and soothe their agitation.

There were systems to record safeguarding concerns, accidents and incidents and corrective action took place as required. The service carefully monitored and analysed such events to learn from them and improve the service.

Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents as required.

People are supported to have maximum choice and con

Inspection carried out on 18 April 2017

During a routine inspection

The inspection visit at Hillcroft Slyne Nursing Home took place on 18 April 2017 and was unannounced.

Hillcroft Slyne Nursing Home is situated in the parish of Slyne-with-Hest close to the city of Lancaster. It is one of six nursing homes managed by Hillcroft Nursing Homes Limited.

It provides accommodation for up to 48 people in three ground floor units, supporting people

with general nursing needs, dementia and complex behaviour that may be challenging.

The service had a registered manager in place. 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 29 July 2014, we found the provider was meeting the requirements of the regulations that were inspected.

At this inspection, staff responsible for assisting people with their medicines had received training to ensure they were competent and had the skills required. People were supported to meet their care-planned requirements in relation to medicines. However, there had been several occasions when staff had failed to sign to document prescribed creams had been administered. The provider had not investigated further in a timely manner that medicines had been administered and it was a missed confirmation signature.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. You can see what action we told the provider to take at the back of the full version of the report.

During this inspection, we noted the provider had systems that ensured people who lived at the home were safe. We found staff were knowledgeable about the support needs of people in their care. They were aware of what help people needed to manage risks and remain safe.

Records we looked at indicated most staff had received safeguarding training related to the identification and prevention of abusive practices. They understood their responsibilities to report any unsafe care or abusive practices related to safeguarding of adults who could be vulnerable.

Staff received further training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. There was a training academy on site that inducted new staff and refreshed all staff on topics previously trained on. Staff members spoke positively about the training they had received.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with people who may be vulnerable. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff and records we looked at.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who lived at the home. The deployment of staff was organised directing staff with their allocated tasks. Staff we spoke with were very clear on their designated roles and responsibilities. We observed good communication by staff on meeting people’s needs safely and effectively.

Family members told us they were involved in their relatives care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Relatives told us and observations indicated people were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. People received person centred support with their meals that was respectful and responsive to their individual support needs.

Care plans were structur

Inspection carried out on 29th July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to provide a rating for the service under the Care Act 2014. 

Hillcroft Nursing Home (Throstle Grove) is one of six nursing homes managed by Hillcroft (Carnforth) Limited. The home provides accommodation for up to 48 people in three ground floor units, catering for people with general nursing needs, people living with dementia and people who exhibit behaviour that challenges the service.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

This was an unannounced inspection undertaken on the 29th July 2014.

Some people we spoke with who were able to express their views felt they received effective care and support to meet their needs. Care records we looked at showed people who lived at the home, or their representatives, were involved in the assessment of their needs. Records showed people had detailed care plans in place outlining the care and support they would like and agreed to.

We spent time in all areas of the home, including lounges and dining areas of all three units. This helped us to observe the daily routines and gain an insight into how people's care and support was managed.  During our visit we saw staff had developed a good relationship with the people they supported. We spoke with relatives, people who lived at the home, staff and management. Those people who were able to talk with us were positive about the home and the way care and support was delivered to them. Comments from relatives and people who lived at the home included, “The staff are good, there is nothing I dislike about the home.” Also a relative said, “The staff know exactly what they are talking about when I phone. I feel they know me as well.”

We observed people’s privacy and dignity was respected. We observed staff transferring people using hoists. We also saw they made sure drinks and snacks were within reach on small tables. People told us staff always knocked on the door before entering the room. One relative said, “Dignity is respected. The rooms are extremely pleasant and the staff knock before entering.”

Staff spoken with were positive about their work and confirmed they were supported by the manager. Staff received on-going training and development in the areas of care and support people required. Staff told us training in particular areas such as living with dementia and behaviour that challenged the service was always available and supported by the registered manager. Comments from staff about training opportunities included, “The manager encourages us to attend training courses and develop our careers.”

The management team within the organisation and the registered manager assessed and monitored the quality of care at the home. Audits were completed and checks carried out to monitor a number of areas, for example, medication, care plans and the building. This ensured the service was continually monitored so that the home continued to develop and provide quality care.

Inspection carried out on 27 February and 2 March 2014

During an inspection in response to concerns

We inspected Hillcroft Throstle Grove on 27th February 2014 and March 2nd 2014. These were unannounced responsive inspections because we had received information of concern regarding the staffing levels within the home the lack of activities available for people, training for staff and the care of people who exhibited behaviour that challenged the service. The home was previously found to be compliant when it was last inspected in September 2013.

The home has three Units, the Windermere Unit caring for elderly people with dementia type conditions. The Ullswater Unit is predominantly for people with nursing care needs. The Coniston Unit is for people who had behaviours that challenged the service. We spent time on each Unit observing care, talking with visitors and interviewing staff. We observed medication being administered.

Care plan records we looked at were found to be person centred and informative. Staff completed daily reports and these were updated frequently. The home worked in partnership with a range of professionals to meet people`s needs.

Although we saw that people were involved in some social and leisure activities in the home, the provider may like to note that these were limited. Meaningful activities stimulate and involve people and reduce anxieties and agitation.

Our discussions with staff showed us they were aware of their responsibilities regarding protecting people from the risks of abuse and how to report concerns. They were able to explain to us what to do in the event of any allegations or suspicion of abuse. This showed us the home had measures in place to protect people from the risks of abuse.

We observed staff giving people their medication. Medication was administered safely in the Ullswater and Windermere units but was not administered safely in the Coniston unit on both days we inspected.

We saw staff had enough time to meet people’s care needs and to provide some social interactions most of the time. However the provider may like to note that sometimes the deployment of staff could have been managed more effectively.

Staff we spoke with told us they felt supported by senior staff that they enjoyed their work and they received regular supervision.

The home had an effective system in place to identify, assess and manage risks to health, safety and welfare of people using the service and others.

Inspection carried out on 25 September 2013

During a routine inspection

We talked with residents and staff, looked at records and observed care at our visit. We looked at staff rotas and checked numbers of residents. We saw that most residents were health service funded under continuing health care provisions. This meant that most people had complex needs.

We checked whether people had given consent to their care and treatment. We found that the home was acting in accordance with legislation in ensuring people’s best interests.

We found that the atmosphere was generally calm, and that any incidents where residents became disturbed were well managed. Staff spoke nicely with people and used touch appropriately to reassure. Staff demonstrated a sound knowledge of individual needs. People who were able to express a view were happy with their care, except for sometimes feeling bored.

We found the home was clean, and properly equipped to maintain good levels of hygiene. Staff training was good, and there were sufficient, qualified staff on duty to ensure people were properly cared for.

The company had its own auditing systems in place with regular reviews of different aspects of the business on a rolling programme. This helped to ensure standards were maintained. The manager inspired confidence in staff and was leading by example, such as learning new ways of working with dementia. The company had a sound senior management team, of which the registered manager was a member. This supported change and improvement across the company. .

Inspection carried out on 12 December 2012

During an inspection to make sure that the improvements required had been made

This inspection was undertaken to review the improvements the provider made following the issue of a warning notice on 7th November 2012. The notice informed the provider they were required to ensure people in their care were protected from the risk of abuse or the potential for abuse. The provider was required to take all reasonable steps to identify the possibility of abuse and prevent abuse before it occurred.

We also assessed whether the provider had made improvements to the way staff were supported and also to the internal quality monitoring systems in place. Both these outcome areas were none complaint at the last inspection on 9th October 2012. Compliance Actions had been issued requiring the provider to make the necessary improvements.

On this occasion we did not speak directly with people living at the home however we did speak with members of staff. We were told that significant improvements had been made, internal quality monitoring systems had been strengthened, staff felt better supported and staff training and a change of staff culture within the home had helped to keep people safe.

Inspection carried out on 9 October 2012

During an inspection to make sure that the improvements required had been made

We last inspected Hillcroft Throstle Grove in May 2012. At that time we found the provider was not compliant in three outcome areas, and asked for an action plan. At that time there was no registered manager in post. This had now been put right.

We found that the provider had rectified the issue of non reporting of safeguarding incidents. However we found a high number of incidents between residents which had been insufficiently analysed or risk managed to minimise future problems. We were also concerned by the number of incidents of unsafe handling of residents by staff.

We found a new supervision system was in the process of being introduced but that nursing staff had yet to fully take on supervisory responsibility. Staffing levels had improved and rotas matched the staffing expected on each shift. However there was a shortfall of one staff member on the challenging behaviour unit meaning the deputy manager had to fill in and perform care duties.

On our last inspection, we found that cleaning staff were refusing to work on the challenging behaviour unit, and standards of cleanliness were unacceptable as a result. On this inspection, staff were working normally and most rooms were clean.

We found that the provider had invested in additional audit staff and reviews of quality, were now in place, including plans to make improvements. Insufficient action had been taken to analyse information about incidents which resulted in harm. You can see our judgements on the front page of this report.

Inspection carried out on 30 May 2012

During an inspection in response to concerns

We spoke with residents at Throstle Grove, and also with eight people who were visiting on the day of the inspection, across all three Units. Most residents at Throstle Grove were unable to directly express their opinions. Those who were able told us that they were happy with the care they received.

Most visitors told us they liked the home and felt welcome to visit there. They said the food was good, the rooms comfortable and the staff helpful. Most people had chosen the home because it wa located near to where they lived and provided accommodation for people with dementia. While people had looked around before admission, in practices choices had been made by relatives.

There were a number of concerns expressed. These concerned mixed up laundry, lack of willing ness to help a resident in his choice of where to have his meal, lack fo activities and the loss of someone's dentures meaning they needed to have soft food.

Inspection carried out on 5 July 2011

During a routine inspection

The relative of a user of the service said that she had been fully involved in the pre admission assessment process. The resulting care pathway had been shared with the relative including the outcome of subsequent reviews. This person considered the care and support offered was of a very high standard and that relatives were also very well supported. We were told, “They accept her illness and see through her illness with respect and calmness. The home is there for them, not just to give a service”.

A person living at the home said, “This is a lovely home to live in. I never thought I would settle but I did, staff are so kind”.

Without exception relatives and residents with mentally capacity, spoke very positively of the high quality care and support provided at Hillcroft (Slyne). A person living at the home told us, “The care here is very good and all the staff are very good. I am not just saying that I really mean it”. A relative said, “The facilities here are some of the best in the country, my wife is well taken care of. I feel highly that the staff are very competent”.

One person who was interviewed in her bedroom was very pleased with her personal space describing it as very comfortable, bright and “Right for me”. A relative said, “The cleanliness and food is fantastic. Its home from home as much as it can be. They are on the ball with everything”. Another relative said, “My wife is very comfortable living here, and well looked after”.

We were told that there is always a sufficient number and skill mix of staff on duty in each unit throughout the 24 hour period to meet individually assessed needs. A person living at the home stated that she never had to wait long for anything and that staff were, “Very good”. A relative commented, “I cannot say anything about anything, everything is really pretty good.” This same person, who visits often, said that in her experience the privacy and dignity of people living at the home was always very well respected by the staff group. Another relative told us, “They (the staff) listen and act upon what is said or any queries you may have. They always take on board what you are saying. My ***** is happy here, never unhappy, she loves the carers”. Another person said, “They ask if I think my ***** needs are being met or not or if there was anything else that they could do to make things better. There is a lot of humour in the unit, she is relaxed here, now content and happy, not distressed”. A member of staff told us, “We always try to do our best, I really enjoy working here”.