Background to this inspection
Updated
2 October 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection visit was carried out by one inspector.
Service and service type
Hillside Farm Care 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.
There was no requirement for the service to have a registered manager. The provider was the manager and oversaw the day-to-day running of the service. We have referred to the provider as ‘the manager’ throughout this report.
Notice of inspection
The first day of inspection, on 16 July 2019, was unannounced. The second day, on 22 July 2019, was announced.
What we did before the inspection
Our inspection was informed by evidence we already held about the service. We sought the views of commissioners from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
During the inspection visit we spoke with five people who used the service. We spoke with one relative and two care staff. We spoke with the responsible person for the service. We looked at a range of records related to how the service was managed. These included four people’s care records and how medicines were managed for six people. We also looked at two staff recruitment and training files, and the manager’s quality auditing system. During the inspection visit we asked the responsible person to send us additional evidence about how the service was managed, and they did this.
After the inspection
We continued to seek clarification from the responsible person to validate evidence found. We looked at training data and quality assurance records. We also spoke with four relatives by telephone to seek their views.
Updated
2 October 2019
About the service
Hillside Farm Care Home is a residential care home providing accommodation with personal and nursing care to eight people aged 65 and over at the time of the inspection. The majority of people living at the home are older people living with dementia. The service accommodates up to 10 people in one adapted building and is in a rural setting outside the village of Bunny in Nottinghamshire.
People’s experience of using this service and what we found
People did not always receive their prescribed medicines safely. Risks associated with the service environment were not always assessed and mitigated.
We recommend that the manager ensures that risks relating to people’s health and safety are reviewed. We also recommend that the manager ensures that their management system identifies and manages risks.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Although the manager understood the principles of the Mental Capacity Act, they had not ensured that they had consistently followed these principles.
The manager understood their role and responsibilities in relation to managing a registered care home. The manager undertook audits of all aspects of the service to review the quality of care, and identify areas where improvements were needed. However, these audits and checks did not always identify areas for improvement.
People and their relatives felt the service was safe. Staff understood how to recognise and report concerns or abuse. People were protected from risks associated with their assessed health needs. There were enough staff to keep people safe, and people were protected from the risk of infections. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences.
People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. People and relatives felt staff got the right training to meet their needs. People were supported and encouraged to have a varied diet that gave them enough to eat and drink. People were supported by staff to access healthcare services when required. The manager had taken steps to ensure the environment was accessible for people.
People and relatives spoke positively about the staff who supported them. People and relatives were involved in making decisions about care. People said staff always treated them with respect. Staff had a good understanding of dignity in care and had training in this. Staff respected people's right to confidentiality.
People were regularly asked for their views about their care. Relatives were also involved in reviewing family members’ care with them. Staff were proactive in responding to people’s individual needs and encouraged them to do things which were meaningful to them and made them happy. The manager had a system in place to respond to complaints and concerns. People and their relatives were encouraged to talk about their wishes regarding care towards the end of their lives.
People and relatives felt the service was well-led. Staff felt supported in their work, and there was a positive team attitude.
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 (published 31 January 2019).
Why we inspected
The inspection was prompted in part due to concerns received about how medicines were managed. A decision was made for us to inspect and examine those risks. We found evidence during this inspection that people were at risk of harm from this concern. Please see the Safe section of this full report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.