Hillyfield Rest Home Limited

Hillyfield is a residential care home providing accommodation and personal care to up to 17 older people. At the time of our inspection there were 11 people using the service. Hillyfield is set in a rural setting and provides single room en-suite accommodation.

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

People and their families told us they felt safe as they trusted the staff. People were supported by staff who had been trained to recognise and report safeguarding concerns. People had their risks assessed, monitored and reviewed. Staff understood the actions needed to mitigate avoidable harm whilst respecting people’s freedoms and choices. Medicines were managed safely, and infection, prevention and control measures were in line with best practice. Recruitment processes included references and criminal record checks ensuring staff were suitable to work with older people.

The culture of the home was open and transparent. People, their families and staff team spoke positively about the management of the home and communication. Staff understood their role, felt supported and involved in the development of the service. Quality assurance processes were effective at monitoring quality standards and regulatory requirements and driving sustainable improvements.

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 and update

The last rating for this service was requires improvement (published 4 September 2021). 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.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

We carried out an unannounced comprehensive inspection of this service on 28 July 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing, fit and proper persons employed and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillyfield Rest Home on our website at www.cqc.org.uk.

Follow up

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

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

Environmental risks were not managed effectively; People did not have regular fire evacuations to keep them safe. Peoples individual emergency evacuation plans were not always updated. Lifting equipment was not always checked in line with health and safety legislation to ensure peoples safety.

We could not be assured risks associated with people’s needs were always assessed appropriately or managed. Diabetes management and peoples pressure care was not always found to be appropriately managed to keep people safe.

Relevant recruitment checks had not been undertaken. Staff had not received all of the training relevant to their role and had not been receiving regular supervision

A lack of robust record keeping meant medicines were not always managed safely.

During our inspection we found there was a lack of effective management and leadership in the home. Governance systems were not effective in ensure people received high quality care.

The service had started a programme to transfer peoples care plans from a paper-based system to an electronic system. However, conversations from staff informed us staff were not sure which people were on which system or when the transfer would be completed. Therefore, we were not assured staff would be following the most up to date care plan for each resident.

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 good (published 09 October 2019).

Why we inspected

This inspection was prompted in part due to concerns received about medicines, staffing, infection control and poor management. A decision was made for us to inspect and examine those risks.

We undertook this focused inspection to check people were safely cared for. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillyfield Rest Home Limited on our website at www.cqc.org.uk.

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 monitor the service.

We have identified breaches in relation to health and safety, medicines, staff recruitment, training and good governance, record keeping and management oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Hillyfield Rest Home is a residential care home providing personal care to up to 17 older people. At the time of the inspection there were 14 people living in the home. Hillyfield Rest Home provides care in an adapted building close to the local village centre. The home has bedrooms over two floors and shared living spaces on the ground with an accessible garden and summer house.

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

Staff were caring, kind and knew people well. One person’s relative told us, "The staff are lovely, very kind and caring." People were involved in planning their care and staff took time to understand people’s personal histories and get to know them and people who were important to them.

Staff understood people’s individual needs and how best to support them, and had a good understanding of dementia and how this impacted people. Staff encouraged people to do as they wished and provided personalised support. One member of staff told us, "Some places are very regimented but it’s not like that here. It felt very warm, like home"

People received safe care and support which protected them from the risk of harm or abuse. The home was clean and well maintained. People’s medicines were managed safely and people could manage their own medicines if they wished. Incidents were openly reported and reviewed to improve care.

Assessments and support plans were based on national guidance and reflected professional advice. People had access to healthcare services and the service sought support from other agencies and healthcare professionals as appropriate. People fed back positively about the food, which was cooked from scratch on the site. Supporting people’s individual nutritional needs was a strength in the home.

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 was well-led, with a close-knit staffing team who felt involved and empowered. The management team were open and involved people’s families and were working to further improve links into the local community.

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

Rating at last inspection

The last rating for this service was good (published 20 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

The inspection was unannounced and was carried out on 20 and 21 October 2016 by one inspector.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to respond to and meet people’s needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink to meet their needs and were provided with choices of meals.

The service was responsive to people’s needs and staff listened to what people said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People were confident they could raise concerns or complaints and that these would be dealt with.

People and, when appropriate, their families or other representatives were involved in discussions about their care planning. People were encouraged to provide feedback on the service provided both informally and through a satisfaction questionnaire.

The service was well led. Staff felt supported by the management to raise any issues or concerns. The quality of the care and treatment people experienced was monitored and action taken to promote people's safety and welfare. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

There were enough qualified, skilled and experienced staff to meet people's needs. One person said: 'I think there are enough staff here'. The other person told us: 'I have never noticed a deficiency'. Staff we spoke with demonstrated that they were aware of people's needs. Staff interacted with people using the service in an inclusive, friendly and caring manner. We saw that appropriate records were maintained and that suitable arrangements were in place for supporting people with medicines.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People who lived in the home confirmed that staff supported them in ways that they were happy with. They told us that staff understood their needs and acted accordingly. One person said: 'They know what I'm going to do before I do it', and 'If I want anything I've only to ask'.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Two people who use the service told us about the friendly atmosphere in the home and another person said: 'I have never heard an angry word from the staff'.

People confirmed that they were supported by suitably skilled and experienced staff. One person described staff as: 'Very patient and very caring'. Another person said: 'I couldn't see anything wrong with any of them'.

People we spoke with were not all aware of the formal written complaints procedure but confirmed that they were confident that the management would deal with any complaints appropriately. We observed that there was an open and inclusive atmosphere in the home.