Archived: Hillcrest Residential Home

Hillcrest Residential Home is a care service for up to 13 older people who may be elderly, have a physical disability or could be living with dementia. The service does not provide nursing care.

There were eight people living in the service when we inspected on 3 August 2018. This was an unannounced inspection.

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.

At our last inspection of March 2017, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service had failed to ensure the safe and proper administration of medicines. The service did not have an effective quality assurance monitoring process in place. There were no policies and procedures regarding the MCA and consent in place. The service had not informed us of important information as it is required to do.

In the key line of enquires questions for safe, effective and well-led we rated the service as ‘requires improvement’. In the key line of enquires for care and responsive we rated the service ‘good’. This resulted in the overall rating of the service for that inspection being ‘requires improvement’.

At this inspection of August 2018, we noted there have been improvements to the service but further improvements are necessary as the service remains at a rating of ‘requires improvement’. There were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In the key line of enquiries question for effective the rating has improved to ‘good’ but safe and well-led were still rated as ‘requires improvement’.

The administration of medicines had improved since our last inspection but still required further improvement to be safe. Medicines were now administered individually and staff completed the medication administration record (MAR) chart after each administration.

The formal monitoring and audit systems now in place continued to require further operational evidence to show how the registered manager and senior staff assessed the quality of the service, identified shortfalls and ensured that these were addressed promptly. This resulted in a lack of oversight of the whole service from the registered manager and identification of areas that required improvement. People using the service did not have a Personal Emergency Evacuation plan.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in relation to the Mental Capacity Act 2005 (MCA) were up to date.

The service had sent notifications to the Care Quality Commission of important events that had happened at the service.

There were sufficient numbers of staff employed at the service to care for the people living in their home. The rota was clear with regard to which staff were working. The registered manager or senior staff on duty were cooking the meals for people to cover a vacancy in the catering team.

The recruitment process for the employment of staff was clear and safe procedures were followed.

There remained some gaps in training records but staff had received some training and supervision since our last inspection and further training and supervision was planned.

People had sufficient amounts to eat and their dietary nutritional needs were met. People were encouraged to attend appointments with health care professionals to maintain their health and well-being.

There were strong and caring relationships between the people using the service and the staff that supported them. People were encouraged to be as independent as possible by a staff team who knew them extremely well. People were not always able to call for assistance if needed by the use of their call bells due to their capacity but we saw staff checking upon people to determine their well-being on regular occasions.

The service had a complaints system and also recorded compliments. The service worked with other professionals providing multi-agency support to enable people to stay in their own home as long as they wished.

There were nine people living in the service when we inspected on the 13 and 17 March 2017. This was an unannounced inspection.

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.

At our comprehensive inspection of 02 October 2014, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which was: Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Cleanliness and infection control. At our focussed inspection of 18 June 2015, we found that improvements had been made but needed embedding in the service.

You can read the report from our last comprehensive and focused inspection, by selecting the 'all reports' link for Hillcrest Residential Home 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.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were needed to ensure that medicines were administered safely and in line with best practice.

There were insufficient numbers of staff and improvements were required in the recruitment process to check that staff were suitable to work with vulnerable people. Staffing issues had been identified by the manager and they were trying to address this.

There were some gaps in training records and staff required refresher training to ensure that they were knowledgeable and could support people safely and effectively.

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; the policies and systems in relation to the Mental Capacity Act 2005 (MCA) were not up to date. Whilst the service had made reference to people's ability to consent within their care records, there were no formal capacity assessments in place to determine people's level of understanding in accordance with the MCA. Staff understanding of what the MCA meant in practice was limited.

People told us that they had good relationships with the staff that supported them and people were encouraged to be as independent as possible by a staff team who knew them well. People cared were not always able to call for assistance if needed.

People had sufficient amounts to eat and their dietary nutritional needs were met. However, where people’s needs changed, these had not always be re-assessed to ensure that the people were having enough fluids to keep them well.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

There were no formal monitoring or audit systems in place to show how the registered manager assessed the quality of the service, identified shortfalls and ensured that these were addressed promptly. This resulted in a lack of oversight of the whole service and areas that required improvement from the registered manager. The service had failed to notify us when a person using the service sustained a serious injury.

As part of our inspection on 15 April we followed up on the non-compliance found at the last inspection. We found that improvements had been made to address our previous concerns. However we found shortfalls with assessing and monitoring the quality of the service and records. We have asked the provider to submit an action plan telling us how they will address these concerns.

During this inspection we spoke with nine people who used the service. We also spoke with three members of staff including the registered manager. We looked at five people's care records. Other records seen included: care plans and risk assessment reviews, complaints log, fire safety checks, maintenance logs, water temperatures, and safety checks on equipment.

We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe, Is the service effective, Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff asked to see our identification and asked us to sign in the visitor's book. This meant that appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access the service.

People told us they felt safe, protected and their needs were met. One person said, 'They (staff) are very on the ball and look after me very well. I have no complaints. I feel safe and secure here, nothing troubles me.'

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, we saw that policies and procedures were in place. The registered manager confirmed that relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded.

Records seen confirmed that staff were booked onto upcoming or had received training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and DoLS. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Records seen confirmed external checks were carried out to ensure the safety of the premises and equipment was maintained and serviced.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Records showed that staff supervision and training was planned and delivered as required. This meant that staff had the support and skills to deliver care effectively.

Is the service caring?

Staff interacted with people who used the service in a caring, respectful and professional manner. People told us they were happy with the care they received and their needs were met. One person told us, 'The staff can't do enough for you they are very attentive, kind, and all round decent people.'

Staff had a good understanding of the people's care and support needs and knew them well.

Is the service responsive?

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor, district nurses, mental health teams and chiropodists.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and were supported and trained to meet people's needs.

People's care records and risk assessments were accurate and up to date.

Records seen were kept securely. However during our inspection the registered manager had difficulty accessing certain records we requested and these could not be located promptly when needed.

The provider did not have systems in place to show how feedback from people who used the service about their views and experiences was valued, taken into account and influenced the running of the service.

The provider did not have systems and procedures in place to monitor and assess the quality of the service provided. There were no records to identify shortfalls in the service and how they had been addressed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvement they will make in relation to their records.

Three people told us the food was well cooked and lots of choice. One person said, 'The cakes are first class.'

We found that the service was meeting the social needs of people and worked in co-operation with other providers of care to meet people's needs. The service had not recorded that it had sought people's consent when their care plans had been reviewed and updated. The environment was undergoing refurbishment of the roof and double glazed windows with internal decorating with which the people who used had selected the colours used.

The service had not provided regular staff training or supervision which meant that staff may not have been u to date with the requirements of current practices. We also found that the complaints policy was out of date. We were not aware that anyone wanted to make a complaint at the time of us visit and service did not have any outstanding notifications of which needed to be informed to us.

At our last inspection we found that a rolling programme of staff supervision was not in place. There was therefore a risk that staff had not had sufficient opportunity to discuss their work and professional development needs with their manager. When we re-inspected the service in January 2013, the manager provided evidence that a new supervision format had been developed which included discussion around the needs of people using the service and training and professional development.

At our last inspection, staff demonstrated limited knowledge around caring for people with some medical conditions such as stroke, Parkinson's disease and diabetes. In January 2013 the manager provided evidence to show that training has now been booked in these areas.

Staff had also not been trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.The manager confirmed in January 2013 that a course has been booked.