Archived: Hill House

Hill House is a residential care home providing accommodation for persons who personal care for up to 20 people aged 65 and over. At the time of the inspection, the service was supporting 14 people.

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

Environmental risks within the service had not always been identified or action taken to reduce the risk. There were risks to people from poor infection control practices. There were enough competent staff to support people safely according to their needs and preferences. Medicines were mostly managed safely. People received care from staff who understood how to recognise and report issues of concern.

There were limited opportunities for people to participate in activities to ensure they were stimulated. Care plans were detailed and provided good information for staff to follow to support people effectively including the support people wanted at the end of their life. People knew how to raise a complaint and their views were listened to and investigated.

Staff received training and support to carry out their roles and responsibilities. People enjoyed a balanced and varied diet. Staff worked with external professionals to support people’s health and wellbeing. 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 and their relatives were complimentary about the care provided at Hill House and the staff team were kind and caring. Staff knew people well and supported people with dignity and respect. People were encouraged to be as independent as possible.

We made a recommendation regarding equality and diversity.

People, relatives and staff were positive about how the service was managed. Some concerns raised at the previous inspection had not been addressed. Audits were completed, however these required further improvement to ensure they were effective in identifying issues across the service. The management team were proactive in promptly addressing the issues found at inspection.

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

Rating at last inspection: Good (published 19 August 2017).

Why we inspected: This was a planned inspection based on the previous rating. We have found evidence the provider needs to make improvement. Please see the safe and well led sections of the full report.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

Our previous inspection of 6 January 2016 found that the service required improvement. There were breaches in regulation that related to the service not having sufficient systems in place to protect people from risks associated with medicines, the environment, wheelchair use and cross infection. Systems were not effective in identifying these concerns within the service so that they could be addressed. Improvements were also needed to ensure that people were involved in the planning and review of their care and that care plans evidenced people’s choice and preferred routines. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the provision of safe care and treatment, good governance and the safety and suitability of premises.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hill House on our website at www.cqc.org.uk. This comprehensive inspection was undertaken to check that further improvements to meet legal requirements had been made.

There were 12 people living in the service when we inspected on 25 May 2017. This was an unannounced inspection. During this inspection we found that although improvements had been made, there were some areas where further improvement were still required.

Appropriate arrangements were in place to ensure people’s medicines were obtained and stored safely, however improvements were required in how medicines were administered and clear guidance was needed on medicines that had variable doses.

Further action was required to ensure that all risks within the service were reduced.

People received care that was personalised to them and met their individual needs and wishes. Staff were knowledgeable about people’s choices, views and preferences and acted on what they said. The atmosphere in the service was friendly and welcoming.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. Procedures and processes guided staff on how to ensure the safety of the people who used the service. Recruitment checks were carried out on prospective staff with sufficient numbers employed who had the knowledge and skills to meet people’s needs.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS). Staff sought consent from people before supporting them with their care.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People’s nutritional needs were assessed and they were supported to eat and drink sufficiently.

Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

The management team were approachable and there was an open culture in the service. Quality assurance processes used to identify shortfalls and address them and as a result the service continued to improve.

People told us that they liked living in the service. One person told us, 'It is very nice here. The food is very good. It is friendly.' Another person said, 'Someone comes if I ring the bell.' People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. However, in two of the five care plans we looked at, there had not been a documented review for four months.

We saw evidence that the provider had engaged with a range of other services and were responsive to the needs of the people who used the service. We spoke with a health care professional who told us, 'They are brilliant. They act on the advice that we give.'

We reviewed the records of three complaints and saw these had been acknowledged, investigated and responded to within the timescales in the provider's complaint policy and procedure.

We looked at the daily notes for four people and these were updated at least daily. We saw that people's care records were kept electronically and that staff had individual 'log on' details in order to access and update people's records. There were some paper records which were not kept securely but the registered manager noted this and said they would move these records.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We tracked the care records of four people who used the service which showed that people were provided with the care and support that they required and preferred to meet their assessed needs.

We saw that the home had safeguarding procedures in place and the records confirmed that all staff received training in safeguarding adults during the first weeks of employment and regular updated training. The relevant local authority safeguarding procedures were available for staff guidance.

Staffing levels were appropriate to meet the needs of residents. Staff were seen having time to enable them to spend time in conversation with people who use the service. The duty rota was seen and confirmed the staffing levels were as discussed.

We also saw records of audits of the kitchen and meals, the environment and medication administration records. In addition, we also saw evidence of regular audits and review of care plans and risk assessments. This told us that the senior staff were aware of the ongoing and changing needs of people who use the service.