Hillside Lodge

Updated 30 March 2018

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

This was a comprehensive inspection completed on the 20 and 21 and 22 February 2018. This inspection was unannounced on day one.

The inspection team was made up of one inspector, one specialist nurse advisor and two experts by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we looked at other information we held about the service such as notifications and previous reports. The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with 23 people, seven relatives and two healthcare professionals. Some people had complex needs that limited their ability to communicate and tell us about their experience of being supported at Hillside Lodge. Therefore we observed how staff interacted and looked after people and we looked around the premises. As some people were not able to comment specifically about their care experiences, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people living in the service.

We looked at records relating to the individual’s care and the running of the home. These included care and support plans and records relating to medication administration for people living in the home. We also looked at quality monitoring of the service.

Updated 30 March 2018

We carried out an unannounced comprehensive inspection on 20 and 21 and 22 February 2018.

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.