We carried out a review of the data available to us about Hill House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hill House, you can give feedback on this service.
Hill House is a residential care home providing accommodation and personal care for up to 13 people. At the time of the inspection eight people were receiving support. The home supports adults including people over the age of 65, with various needs including learning disabilities and autistic spectrum disorder and a mental health diagnosis.
People’s experience of using this service and what we found
People felt safe and staff had good knowledge of safeguarding processes. There were enough staff to support people safely. Care plan and risk assessments were up to date and reviewed regularly. People received their medicines safely.
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.
People were treated with kindness and compassion. People’s privacy and dignity was maintained. People were encouraged to be independent.
Systems were effective for monitoring the quality and safety of the services provided. There was good involvement with community professionals. Staff knew how to raise concerns.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. The service maximises people’s choice, control and independence. Care is person-centred and promotes people’s dignity, privacy and human Rights. Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
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 requires improvement (21 April 2020).
Why we inspected
The inspection was prompted in part due to whistleblowing and safeguarding concerns received. The concerns highlighted possible neglect, poor medicine management, environmental issues and allegation of abuse. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and effective sections of this full report.
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.
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.
Hill House is a residential care home providing accommodation and personal care for up to 13 people. At the time of the inspection 10 people were receiving support. One of the 10 people was in the process of finding a new home so was not living at Hill House but did still have a bedroom there. The home supports people with various needs including learning disabilities, autistic spectrum disorder and a mental health diagnosis.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service is a large home, bigger than most domestic style properties. It is registered to support up to 13 people. This is larger than current best practice guidance. However, the manager was in the process of adapting the service to ensure the size of the building did not have a negative impact on people living there.
People’s experience of using this service and what we found
Improvements had been made since the last inspection in October 2019 where Hill House was rated as inadequate. Some people using the service had left since the last inspection, this has enabled the service to work on improving quality and safety. There had been improvements in the governance systems and processes but there remained some areas for further improvement and development whilst embedding and sustaining the progress made so far.
Care plans and risk assessments had been reviewed and updated. Risks to people had been assessed and mitigated. Safeguarding processes were in place to protect people from the risk of abuse. There were enough staff to keep people safe.
There were positive interactions between staff and people living at Hill House. People’s privacy and dignity was maintained. People felt well supported and listened too.
People’s communication needs were met. People were supported to take part in activities. People’s personal preferences were identified in their care plans. People were supported and encouraged to be part of the community.
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.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The manager was working to ensure the outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 12 February 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since 12 February 2020 During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
The inspection was prompted in part by a notification of a specific incident and an allegation of abuse. Following which one person using the service sustained a serious injury. One incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of this incident. The information CQC received about the incident indicated concerns about people’s safety. This inspection examined those risks.
We found no evidence during this inspection people were at risk of harm from these concerns. 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.
Hill House is a residential care home, providing personal care and accommodation for up to 13 people with learning disabilities and/or autistic spectrum disorder. There were 12 people living at the home at the time of our inspection. The home was divided into three separate floors for people who used the service, with lounges, sensory rooms, activities rooms, gardens and dining room areas.
The service had been registered since October 2010, however, the provider was not taking into consideration the principles and values that underpin Registering the Right Support and other best practice guidance for the accommodation of people with learning disabilities. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
People’s experience of using this service and what we found
Since our last inspection visit, we had received concerning information that indicated people did not always receive personalised care, specifically around the lack of skilled staffing levels and risk management.
People and staff did not always feel safe at Hill House. Staff did not always understand how to keep people safe and reduce potential risks to people. Risks associated with some people’s care were not managed safely. People’s individual needs, health conditions and complex behaviours, had not always prompted risk management plans to be in place.
People did not receive person-centred care from staff, as staff lacked the skills and training they needed, and the guidance they needed to ensure people were supported according to their personal needs.
People were not always involved in choosing their care and support, from pre-admission to living in the home. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.
The staff team did not always prevent people from becoming socially isolated within the home. People did not always have their privacy and dignity respected. People were not always encouraged to be independent and make everyday decisions about how they wanted to live their lives.
People and their relatives knew how to raise concerns and provide feedback about the service, and there was evidence that concerns had been raised with the manager of the home. However, concerns were not documented in a complaints log, which did not promote an understanding of how concerns were being addressed and learned from.
The previous registered manager had left the provider’s organisation several weeks before our inspection visit. The service was led by a manager who had been in post for five weeks, and a deputy manager. The provider was not offering the support and guidance needed at the home, to the staffing team and the new manager. There was a lack of effective auditing procedures in place to identify issues and areas for improvement at the service.
Although some risks to people, and the need to update care records, had been identified by the new manager and the provider before our inspection visit, action to mitigate risks to people’s safety had not been resolved in a timely way, and whilst problems continued, additional measures to reduce risks had not been taken by the provider. Following our inspection, measures were put in place and a review of the service commenced.
Rating at last inspection
The last comprehensive inspection report for Hill House (published April 2019) we gave a rating of good in all areas. At this inspection we found the service had deteriorated and have rated the service as inadequate.
During this inspection visit, we found the safety and quality of the service had deteriorated and some people’s care outcomes were not of a good standard. The service is now rated Inadequate. We identified breaches of the Health and Social Care Act 2014 (Regulated Activities):
Regulation 10 Privacy and Dignity
Regulation 11 Need for Consent
Regulation 12 Safe care and treatment
Regulation 13 Safeguarding
Regulation 17 Good governance
Regulation 18 Staffing
Why we inspected
This inspection was a responsive inspection prompted in part due to concerns received about safeguarding alerts and investigations that were notified to CQC. This included incidents of challenging and violent behaviours. We were also notified of the findings of a recent compliance inspection by the local authority where the service was rated as Inadequate. A decision was made for us to inspect and examine those risks.
We found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.
People’s experience of using this service:
•People told us that they were happy living at Hill House.
•Staff were kind and caring and encouraged people to be as independent as possible.
•People were protected from the risk of harm and abuse by a team of trained staff who knew people’s needs well.
•Risks were planned for and managed well. The service encouraged positive risk taking.
•People received their medication on time and in a safe way.
•People had access to healthcare.
•Assessments and care plans were personalised and detailed. Staff used People’s care records to guide them to care for people in an person-centred way.
•Staff had a good working knowledge of the Mental capacity Act and it’s principles.
•The service worked well with other agencies and organisations to ensure people received the right level of care and support.
•People and relatives knew how to make a complaint.
•The registered manager had made significant improvements throughout the home to provide effective outcomes for people.
Rating at last inspection: At the last inspection, the service was rated as Requires Improvement. (Last inspection report published 31 October 2017) At this inspection we found that improvements had been made and the service now meets the characteristics of Good in all areas.
Why we inspected: This was a planned inspection based on the date and the rating of the last inspection.
Follow up: We will continue to monitor the service through information we receive.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Following our last inspection, we met with the registered provider and they assured us that the identified concerns would be addressed. The registered provider sent us a written action plan outlining how they intended to address and meet the breaches of regulations. A new manager joined the service in January 2017 and had registered in May 2017. At this inspection, we identified improved practice at the home and found that the previous breaches had been met, although further improvements were required. These improvements had been identified and were being addressed through systems in place at the home.
At the time of our inspection, Hill House was registered as a care home with nursing for up to 13 people who have a learning disability or autism and eight people were living at the home.
The registered manager of the home was present throughout our inspection. 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, staff and healthcare professionals we spoke with described the home and impact of the new registered manager positively.
People showed that they felt safe at the home and in the company of staff. Staff showed awareness of types of abuse that people could experience. Staff were confident they could approach the registered manager with any safeguarding concerns and that their concerns would be addressed. There were enough staff available who had been suitably recruited to help protect people living at the home.
Incidents were investigated and people’s support needs reviewed to help reduce risks. Risk assessments and staff knowledge required further development in some areas to further promote people’s safety. Health and safety audits were in place and routine maintenance checks had been introduced. Medicines management was safe and further identified areas of improvement were being addressed.
People were supported by staff who showed understanding of their needs and wishes and how to help meet these. Further guidance and training was planned to develop staff knowledge of people’s needs and to help build on the improved practice we observed.
People were supported to make choices and their consent sought and improvements had been made to ensure adherence with the requirements of the MCA. Further progress was required around staff understanding of the MCA to help build on the improved practice we observed.
People were offered choices around their meals and told us they enjoyed food at the home. Further improvements were required to help ensure all people’s dietary and hydration needs were always met. People were supported to have their care needs and health monitored with the support of additional health and social care professionals.
Improvements had been made in ensuring people were treated with respect and dignity. People often had a positive rapport with staff and showed they were comfortable and at ease at the home. People were being supported to make decisions about their care and we saw that plans were ongoing to always understand and meet the communication needs of people living at the home.
People often responded positively to their care and activity at the home. Improvements had been made and were ongoing to ensure care always met and reflected all people’s preferences and individual needs. People received information about how to make a complaint and told us they would feel able to raise issues. Complaints were handled openly and used to drive improvements.
Systems were in place to support the running of the home and ongoing improvements to the quality of care provided. Leadership and staff guidance had improved and progress was ongoing to help involve all people in their care and development of the home. Further progress was required to ensure improved practice was fully embedded and records were not always robust.
This service has been in special measures. Services that are in special measures are kept under review and are normally inspected again within 6 months. We expect services to make significant improvements within this timeframe.
Following our last inspection of 15 November 2016, the provider immediately supplied their own action plan outlining how they would address the concerns we had identified. We also met with the provider in January 2017 to receive further assurance about action taken to comply with the regulations. After our report was published, we received a written action plan from the provider outlining how they had met, and would continue to meet the regulations.
During this inspection the service demonstrated to us that improvements had been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore this service is now out of special measures.
The home is registered to provide personal care and accommodation for up to 13 people who have a learning disability or autism. At the time of our inspection, ten people were living at the home.
The registered manager had left the service in October 2016 and a new manager had joined the service and was in the process of completing their application to register. 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 could not be confident that they would always be kept safe at the home. People were not always protected by safe practices or effective risk management at the home. Appropriate action was not taken to prevent future incidents occurring at the home where people and staff had been put at risk of harm. People could not be confident that they would be supported to use safe equipment or that they would be protected by safe infection control practices.
People were not always supported to receive their medicines as prescribed or to ensure that the correct amounts of medicines were available to keep them well. People were not always supported by staff with the right mix of skills and knowledge to meet their needs.
People were not supported in line with the principles of the Mental Capacity Act (2005). People’s consent was not always sought and some people were stopped from moving freely or as they wished around the home. Concerns were not resolved by the manager and some staff had not received training or guidance in relation to the Mental Capacity Act (2005).
Some staff we spoke with demonstrated an understanding of people’s needs, however we saw that this knowledge was not always applied in practice. Staff had not been equipped with specific training by the registered provider in relation to people’s needs. Staff practice was not led or overseen by the manager or informed by clear guidance.
People were not always supported to eat enough or to maintain a balanced diet to stay healthy. Care had not been taken to plan people’s mealtimes so that people’s preferences were met in terms of how they were offered choices and ensuring that mealtimes were a positive experience. People could not be confident that they would always be supported to access healthcare support or monitor their ongoing health needs as required to stay well.
Whilst we observed some positive interactions from staff towards people living at the home, this was not consistent practice. Planned action was not taken to meet people’s communication needs and staff failed to always address people directly or involve people in their care. Care had not been taken to ensure that people resided in a safe and comfortable environment, we were informed that this was being addressed. Staff failed to promote people’s dignity at all times.
People did not always receive care that was responsive to their needs or in line with their care plans. People were not always supported to participate in activities of interest to them. An activity coordinator had recently been recruited and provided examples of how they had supported some people with activities. We saw that people responded positively to the activity coordinator’s encouragement and support.
Relatives we spoke with told us they felt comfortable raising concerns and most relatives told us they felt that the manager would act on concerns to improve the service. A healthcare professional told us that they had needed to prompt the manager on occasions before the manager addressed their concerns.
People were not supported by staff who were directed and supported in their roles. The registered provider and manager had not acted on concerns that they had identified about the quality of care people received. The manager failed to maintain oversight of the service and to resolve additional concerns that we brought to their attention during our visit.
People were not supported within a culture that was person-centred. We observed staff disputes and several occasions where people were not approached with respect or in line with their needs. Concerns about staff practice had not been addressed to ensure that people’s dignity was promoted or to ensure that people received safe and responsive care.
Within two days of the inspection visit the provider submitted a number of documents related to the inspection findings and we received assurance that action had commenced to address issues of concern that had been raised. We have referred to any such immediate action in the body of the report.
You can see what action we have asked the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
The service was last inspected in 13 July 2013, and was meeting the regulations. Since that time the provider has undertaken significant changes to the property, to the people they support, and the type of service they provide. The registered provider made the necessary application to CQC to enable them to do this. Although a care service had operated from this address for many years, the service offered, people accommodated and the management team had significantly changed since our last inspection. The service was very new, and still under development.
Staff had been provided with training about the Mental Capacity Act 2005 (MCA). However the staff we spoke with were not all sure how this act applied to their work. Where it had been identified that people had been restricted of their liberty applications to the local supervisory body had been made.
People we spoke with told us they felt safe living at Hill House and our observations showed people felt happy and relaxed in the home and with the staff who were supporting them. Staff were not aware of all the actions they needed to take to ensure people stayed safe. Risks people experienced had not all been well assessed or planned for.
People could not be certain they would always receive their medicines safely and as the Doctor had prescribed.
There were enough staff on duty. Staff had been provided with training to ensure they had the competencies required to meet the needs of the people living at the home.
People were supported to attend a wide range of health appointments. This helped to maintain their physical and psychological well-being.
People told us they enjoyed the food provided and we observed people receiving the help they needed with eating and drinking.
Everyone we spoke with told us, and we observed that staff worked with kindness and compassion. The staff provided people with the support and reassurance they required to help them stay calm and to feel settled.
People had not been supported to make plans for their life or to regularly undertake activities that were of importance and interest to them.
The registered provider sought feedback from people, and had used this to further improve and develop the service.
The registered manager was aware of his responsibilities and people we spoke with told us he was approachable.
People were complimentary about the care staff who supported them. Comments included, 'I like it here' and 'I'm ok thanks.'
We spoke to relatives of people who lived at the home about the care and support being provided. Comments received included, 'They take my relative out to the Mandir (Hindu temple) as well' and 'The service is actually very good.'
From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support. We examined care plans and found that people's needs were properly assessed and that care was planned and delivered in line with individual care plans.
We found that people who use the service were protected from the risk of abuse, as the provider had taken reasonable steps to prevent it from happening.
There were enough qualified, skilled and experienced staff to meet people's needs. The provider had an effective system to regularly assess and monitor the quality of service that people received.
Overall, we found the service to be a good, pleasant and effective service, well managed with enthusiastic, caring and committed staff.
We found people were able to attend the Gurdwara, Mosque, Temple and Christian places of worship as they chose. One person said, "I am encouraged to go to the temple, they book me a taxi." People told us they like having staff available who can speak in their preferred languages. One person said, "My staff explain in my language, and I give them the answers." One staff member told us there were at least ten different languages spoken by the staff team, and on some shifts there were also staff who could use sign language.
We found the furnishing and presentation of the home improved. We found the home was clean. Some furniture had been replaced and a plan to improve the remaining furniture was in place. One staff member said," I think people are happier. It is certainly a much nicer place to work."
People had a wide range of health care needs. We found people were supported to attend the appointments they needed. Care records showed that plans had been developed to inform staff how these needs should be met and monitored.
We did not find that all staff had the training they needed. We have required the provider to improve in this area.
We found evidence that some progress had been made to address risks to people using the service. The problem with the excessively hot water had been addressed. The problems noted with the management of risk relating to the new floor that was being fitted during the May inspection visit had been addressed as the new floor had been fitted.
When we returned to the home to see how things had improved on 20 June 2012, we did not spend time with people who used the service. We found evidence that people were being consulted with and the provider had actively commenced seeking out their views via a survey. The survey to people using the service asked them about their experiences of the home and gave them a chance to say how they thought things could be improved. 13 people living at the home had responded. The surveys stated people were either happy or very happy. Suggestions about how the service could improve included people being more involved in running the home and more opportunities for different activities. The provider had used the surveys to write a report. This stated the issues raised would be addressed by having more regular surveys and feedback,and that staff would review people's activity plans and provide more activities of choice.
We spoke at length with one person. They were very positive about the care and support they received. We spoke with them in their bedroom, and saw the room was very attractively decorated and furnished to their taste. The person told us staff were kind, and provided the help and support they needed. We asked the person how they got on with other people who live in the home. They told us they had little time for the other residents, but that they did not feel intimidated or afraid in the home.
The expert by experience spoke with most of people living at the home during our visit. The overall message conveyed by the people who lived at the home was positive, with one lady saying, 'It's quite nice and cosy here at the home'. We found that the home promoted people's rights and choices and supported people's independence. The people who lived at the home told us that they were allowed to attend college, go the library, see their relatives, go shopping, and go to the Mosque and Gurudwaras.