Background to this inspection
Updated
7 April 2021
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.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
Hillingdon House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This gave the service five minutes notice of the inspection. This was because we needed to confirm the covid-19 status within the home and check what infection, prevention and control measures were in place.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback 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.
During the inspection-
We spoke with four people who use the service and three relatives about their experience of care provided. We spoke with six care staff, the registered manager and the provider, the local authority, consultancy team that the local authority had funded and the Care Home Intensive Support Team (CHIST) that had been deployed to support the home. We will refer to these professionals as supporting professionals throughout the report.
We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and supervision.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records
Updated
7 April 2021
About the service
Hillingdon House is a residential care home providing personal care for up to 22 people aged 65 and over. At the time of our inspection, the service was supporting 19 people, some of whom were living with dementia. The home is established over three floors and a separate annex building next door with seven bedrooms and a small communal area.
People’s experience of using this service and what we found
People did not always have the appropriate and correct equipment for staff to move them safely. People did not always have risk assessments and care plans in place that reflected their current needs. There was not always enough staff to meet people’s needs. This placed people at risk of harm
The heating system was not fit for purpose. There was no external fire risk assessment in place. Infection Prevention and Control (IPC) guidance was not always followed to ensure people were supported to reduce the risk of exposure and transmission of COVID-19.
Staff did not always follow isolation guidance that was in place for the COVID-19 pandemic.
The covid-19 contingency plan was not effective and there was no one to run the home in the absence of the registered manager. There was no oversight of the home during the COVID-19 outbreak. People’s care records were not reflective of current needs. The registered manager had audits in place. However, these were not always effective in identifying and addressing concerns.
Staff were aware of how and when to report abuse. People received their medication as prescribed. People told us they felt safe and were happy at Hillingdon House. Staff knew people well and had a good relationship with them.
People, staff and relatives told us they found the registered manager and provider approachable and they were encouraged to give feedback.
Rating at the last inspection
The last rating for this service was good (published 28 March 2019).
Why we inspected
We received concerns in relation to the management of medicines, infection control, and people’s safety. We also received further concerns from the local authority whilst the home was having a COVID-19 outbreak. Due to the COVID-19 outbreak, the registered manager required support from the local authority due to insufficient staff being available to support people. The local authority funded a consultancy company and the Care Home Intensive Support Team (CHIST) were deployed to support the home. These teams raised concerns including staffing levels, people’s safety and the management and oversight of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillingdon House on our website at www.cqc.org.uk.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We identified breaches in relation to people not receiving safe care and treatment and quality assurance systems not being completed to identify concerns and drive improvements.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.