Hill House Care Home

Hill House Care Home is a care home registered to provider accommodation and personal and/or nursing care to up to 75 people. The service provides support to older people, some of whom may be living with dementia. The service is a three-storey building, divided into six units, with extensive gardens that people can access.

At the time of our inspection there were 54 people living at the service, with four additional people having been admitted to hospital.

People’s experience of using this service and what we found

People received safe care and support. Staff understood their safeguarding responsibilities and the procedures to follow should they have any concerns.

Risks to people's health, safety and wellbeing were assessed and managed. People's care plans detailed current risks and included guidance for staff.

There were enough members of staff. Staff were visible and able to respond promptly to people. Safe recruitment processes were followed.

Medicines were managed safely, with people receiving their medicines as directed by the prescriber. Infection control measures were followed, and staff had access to sufficient Personal Protective Equipment (PPE).

The service was well-led. There were robust assurance systems in place to monitor quality across the service. Actions were taken and improvements were made, when identified.

The registered manager used a number of forums to seek feedback from people, their relatives and staff. The outcomes of audits, checks and feedback received were used to drive improvements at the service. The registered manager and provider had effective oversight of the service and used a ‘Quality Improvement Plan’ to ensure action was taken in response to the findings of assurance processes. The service worked in partnership with outside agencies.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was rated good (published 19 December 2017).

At the last inspection, the service was not rated (published 14 April 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Visitors entered the service into the reception area where they were provided with guidance, had their temperature checked, completed a health screening questionnaire and then undertook a rapid COVID -19 test. They were then provided with personal protective equipment (PPE). This was in line with government guidance

People had a designated person who was able to visit them in their room, a visitor’s pod was available for other family members. A booking system was in place.

The service was clean and there was cleaning in progress throughout our visit.

When people tested positive for COVID-19, returned from hospital or those new to the service, they were supported to isolate for 14 days.

Staff had received training in, putting on and taking off personal protective equipment (PPE), infection control and COVID-19.

The provider had developed policies, procedures and risks assessments for managing the service in relation to COVID-19.

When we last inspected the service on 09 November 2016 we found that the provider was in breach of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to ensure that people were always protected from risks and avoidable harm. Staff had not always operated safe moving and handling practices and had not always identified concerns and reported them appropriately. The provider did not have effective governance systems and procedures in place and had failed to identify some of the concerns we found during our inspection.

Following the inspection, the provider wrote to us to tell us how they would make the improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements to help ensure that staff operated safe moving and handling practices and had put additional measures in place to monitor and audit the quality and safety of the service which helped identify any shortfalls which were then addressed in a timely way.

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.’

People told us that they felt safe living at Hill House. Staff demonstrated they understood how to keep people safe and we noted that risks to people's safety and well-being were managed through a risk management process. We observed people's needs were met in a timely way by sufficient numbers of skilled and experienced staff. However people told us they would like staff to be able to spend more time chatting with them. The provider had a robust recruitment process in place which helped to ensure that staff employed were of good character and suited to the roles they were employed for. People's medicines were managed safely and kept under regular review. Infection control measures were in place to help reduce the risks of cross infection.

Staff received regular support through team meetings, one to one supervision and an annual appraisal from a member of the management team which they told us made them feel supported. People received support they needed to eat and drink sufficient amounts to help maintain their health and well-being. People’s health care needs were taken care of with access to a range of healthcare professionals and where required appropriate referrals were made to external health professionals such as dieticians or physiotherapists.

People and their relatives were very complimentary about the staff and management at the home. They told us staff were kind, caring and compassionate. Staff members, including the management team, were knowledgeable about individuals' care and support needs and preferences and people and where appropriate their relatives had been involved in the planning of their care where they were able. Visitors were welcomed at all times and people were supported to maintain family relationships.

The provider had systems in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were encouraged and supported to raise any concerns with staff or management and were confident they would be listened to and things would be addressed.

There was an open and inclusive culture in the home and people, their relatives and staff felt they could approach the management team and were comfortable to speak with the registered manager if they had a concern. The provider had systems and processes in place to regularly monitor the quality and safety of the care and support provided to people who used the service.

Hill house is registered to provide accommodation and personal and nursing care for up to 76 people who live with dementia, age related fragility, physical and or learning disabilities. There were sixty four people living at Hill house at the time of this inspection.

The home had a manager who had applied to CQC to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

When we last inspected the service on 21/1/2016. We found the provider was meeting all the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

However during this inspection we found that the provider had failed to provide safe care and treatment that protected people from harm. Staff did not always have the necessary skills, experience and competencies to meet people’s needs safely. There had not been an effective system in place to assess, monitor and update people’s care plans and risk assessments and staff did not always have the opportunity to read and follow the instructions contained within the care records. Quality monitoring systems and process were not effective in identifying some of the shortfalls we found during our inspection.

Some of the people we spoke with told us they felt safe living at Hill house. Although we found that staff did not always understood how to keep people safe and risks to people's safety and well-being were not always identified and managed effectively to reduce risks. People's needs were met in a timely way by sufficient numbers of staff, however staff did not always have the right skills and experience to provide safe and effective care. There was a heavy reliance on the use of agency and bank staff to cover shifts and recruitment was on-going at the time of our inspection. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were suitable to work in a care home environment. However in the case of agency staff pre-working profiles were not always assessed in advance of staff working. People's medicines were managed safely. People told us they received their medicines regularly from staff who had been trained in the safe administration of medicines.

Staff received individual supervision from their line manager, for care staff this was the nurse who led the shift. Staff told us they felt supported and gave them an opportunity to discuss any training and development needs. People received appropriate support to have a healthy diet and their health needs were met with appropriate referrals made to health professionals when required.

People and their relatives were complimentary about the staff telling us they were very caring. Staff knew about people’s basic care needs. Some of the staff were able to tell us about people’s care and support needs and their daily routines. People were sometimes involved in the planning of their care as much as they were able. People's relatives and other visitors to the home were encouraged and supported to visit at any time they wished.

The provider had systems and processes in place to receive feedback from people who used the service and their relatives about the quality of services provided. People and their relatives were confident to raise any issues or concerns with the management team and felt they would be listened to.

The provider had arrangements in place to monitor the quality of the care and support provided for people who used the service. The systems were not always effective in identifying areas where improvements were required There was an open and transparent culture in the home and people and their relatives and staff were confident to speak with the management team if they had any concerns they wanted to discuss.

At this inspection we found the service to be in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

Hill House Care Centre is registered to provide accommodation and nursing care for up to 76 people, with age related frailty, physical disabilities and people who live with a dementia. There were 69 people living at the service on the day of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

At the last inspection on 20 and 23 November 2013, the service was found to be meeting the standards. At this inspection we found that the provider had continued to meet the standards.

People were protected from the risk of potential abuse. Staff had received training and demonstrated a good understanding of how to recognise and report concerns. Risks were assessed and reviewed and actions were in place to reduce risk where possible without restricting people’s right to make informed decisions.

People were supported by appropriate levels of staff who had the right skills and experience. There was a robust recruitment process in place and staff received regular training and supervision.

People were supported to eat and drink sufficient amounts to keep them healthy, and had regular access to various health care professionals when required including their GP.

The leadership in the home was strong and staff were valued. Staff had been given individual areas of responsibility to ensure the smooth running of the home. There were systems and processes in place to monitor the quality of the service and actions in place to address any issues.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted DoLS applications which were pending an outcome.

People told us that they enjoyed their meals and were offered choices. Suitable arrangements were in place to assess people's nutritional needs and ensure they received the food and fluids they needed.

We identified that there were appropriate arrangements in place to manage people's medicines safely and ensure that suitable staff were employed.

We observed that people were living in a fresh, clean environment.