The inspection visit at Hillcroft Nursing Home Lancaster was undertaken on 02 and 10 May 2017 and was unannounced on the first day.
Hillcroft Nursing Home is one of six nursing homes managed by Hillcroft Nursing Homes (Carnforth) Ltd. It is registered to provide care and accommodation for up to 20 people and is located in Lancaster. At the time of our inspection, 18 people lived at the home. The home caters predominantly for people living with dementia and who have complex behaviours.
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.
We last carried out a comprehensive inspection of the home on 22 March 2016. At this inspection, we rated the service as requires improvement as we identified two areas of concern. Documentation we looked at indicated people were not consistently supported to meet their care-planned requirements in relation to medicines. We noted administration of medicine forms contained missed signatures. We also made a recommendation about staff training on the subject of nutrition and hydration.
We carried out a focused inspection 18 November 2016 to ensure improvements had been made. We found the service had made all the required improvements.
During this inspection, we observed the administration of medicines at lunchtime. However, staff did not consistently record that moisturising creams had been administered.
We have made a recommendation about the introduction of a robust system to record and audit the application of prescribed creams.
Medicines were safely and appropriately stored and secured safely when not in use. We checked how staff stored and stock checked controlled drugs. We noted this followed current National Institute for Health and Care Excellence (NICE) guidelines.
We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who used the service were being met.
The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.
Staff received 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.
Staff had received safeguarding from abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.
Relatives told us they were involved in the care of their family member 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).
We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.
We found people had access to healthcare professionals and their healthcare needs were being met. We saw the management team had responded promptly when people had experienced health problems.
The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.
Care plans were organised and identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.
Relatives told us they were happy with the activities organised at Hillcroft Lancaster. The activities were arranged for individuals and for groups.
A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the management team were accessible, supportive and approachable.
During this inspection, we received comments from relatives that demonstrated people received personalised care. Staff spoke fondly of people they cared for. It was evident people mattered and staff had developed positive relationships with the people they supported.
The registered manager had consulted with relatives for input on how the service provided could continually improve. The provider had regularly completed a range of audits to maintain people’s safety and welfare.