Archived: Hilda House Care Home Adults L D

The home was last inspected on 11 March 2015 when we found no breaches of legal requirements. We made a recommendation about the recording of best interests decisions in line with the Mental Capacity Act 2005.

Hilda House Care Home Adults LD provides care and support for up to three people. There were two people living at the service at the time of our inspection; both had lived in the service for many years. The provider was a husband and wife partnership, Mr Brian and Mrs Geraldine Cowan. We will refer to them as 'The provider' throughout this report.

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 and associated Regulations about how the service is run. Mrs Cowan was the registered manager. There were no additional staff employed at the service.

We found there were safe procedures for the management of medicines and the provider had received refresher training in this area. Medicines were stored safely and records were accurate and up to date.

The provider had received training in the safeguarding of vulnerable adults and knew what to do in the event of concerns. A policy was in place and there were no issues of a safeguarding nature under investigation at the time of our inspection.

Risk assessments and checks on the safety of the premises and equipment were carried out. Individual risks to people were also assessed and mitigated. A record of accidents and incidents was kept.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The service was working within the principles of the MCA and applications had been made to deprive people of their liberty and subsequently authorised. Decisions taken in the best interests of people who lacked capacity were appropriately recorded.

The provider had undertaken regular training and development to ensure they remained up to date with current best practice.

People were supported with eating and drinking. Meals were prepared freshly on the premises and people had choices about what they would like to eat. People’s weights were recorded and monitored. They had access to a range of health professionals.

The premises were clean and tidy and generally well maintained. Some areas required redecoration and the provider told us this happened on a regular basis. People’s bedrooms were homely and personalised and reflected their choices.

We observed kind and caring interactions with people. Their dignity and independence was respected and promoted. Privacy and confidentiality of information was maintained.

Person centred care plans and personal profiles were in place outlining people’s goals and needs, and how these would be addressed. Communication was provided in pictorial easy read format when necessary.

People had access to a range of activities they enjoyed, tailored to their individual preferences. People were supported to maintain friendships in the local community.

A complaints procedure was in place although there had been no recent complaints received by the service.

There were systems in place to monitor the quality and safety of the service, including regular audits and checks.

We found that statutory notifications had not been made in line with legal requirements. We clarified that the provider fully understood their legal obligations in relation to these. Notifications are made by providers in line with their obligations under the Care Quality Commission (Registration) Regulations 2009. They are records of incidents that have occurred within the service or other matters that the provider is legally obliged to inform us of.

Feedback mechanisms were in place to obtain the views of people and their relatives about the quality of the service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found:

The provider of the service was a husband and wife team, Brian and Geraldine Cowan. Geraldine was the manager and was registered with the Care Quality Commission. They also ran a respite service from their luxury caravan on a nearby caravan site and a day care service known as 'Shared Interests.' Only the care home, Hilda House was registered with the Care Quality Commission since the respite and Shared Interests services did not require to be registered.

We spoke with one person's relative who told us that she was happy with the care provided by staff. We also spoke with a local authority care manager to find out his opinion. He spoke positively about Hilda House.

Is the service safe?

People told us that they felt safe and said they were 'happy' living at Hilda House. The home was clean and checks had been carried out to monitor health and safety. No concerns were identified. However, we found that records were not always accurate or fit for purpose. Medication administration records did not include all necessary information and information in one person's care plan was not up to date. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found that there were enough staff employed to meet people's needs. We read the results from a recent local authority's quality monitoring visit which found them to be 'fully compliant' with staffing levels.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager informed us that no one was currently subject to Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to ensure that people are looked after in a way that does not inappropriately restrict their freedom. The provider may find it useful to note that the manager was not aware of the recent Supreme Court judgement regarding what constituted a deprivation of liberty. Following the first date of our inspection, the manager received information about this ruling from the local authority. She explained that she would consider what implications this case had on people who lived at Hilda House.

Is the service effective?

It was clear from our observations and in speaking with staff themselves that they had a good understanding of people's care and support needs.

We found that people were provided with a choice of suitable and nutritious food. One person told us, 'The food is good.'

Is the service caring?

The relative with whom we spoke informed us that she was 'happy' with the care that was provided and staff were 'caring.'

People looked clean and well presented. We saw that staff showed patience and gave encouragement when supporting people.

Is the service responsive?

The care manager with whom we spoke said that staff were very 'flexible' at meeting one person's needs with whom he was involved. He told us that any issues or concerns were identified 'promptly.'

We saw that referrals were made to consultants, GP, podiatrist, dentist and other health and social care workers.

People had access to activities that were important to them. We read that people accessed the local community and trips to nearby towns such as Duns and Eyemouth. Two people also enjoyed holidays in the provider's luxury caravan at a local caravan site.

Is the service well-led?

The relative with whom we spoke informed us that she had no concerns or complaints about the home.

Annual questionnaires were carried out. However, we found that the views of people, their representatives and staff were not sought regularly. In addition, medication audits did not examine all areas of medication management and an infection control audit was not undertaken. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We saw relationships between staff and people were good and there was a relaxed atmosphere. People told us staff asked them for their consent before they provided their care.

People's needs were assessed and care and treatment delivered in line with their individual care plan.

People lived in a home that was comfortable and well maintained. It had been adapted to suit their individual needs.

People were protected because appropriate checks were carried out before staff started work.

People were made aware of the complaints system. Their comments and complaints were listened to and acted upon.