Hillgrove Residential Home

Hillgrove Residential Home is a residential care home owned and managed by the provider Mayflower Care Homes Limited. It is registered to provide accommodation and personal care to up to 23 people. At the time of this inspection there were 19 people living at the home.

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

The systems in place to monitor the quality and safety of the service were not effective. Audits were not in place for all aspects of the service, they were not completed regularly and did not identify the risks that we highlighted during the inspection. Systems were not in place to gather regular feedback from staff, people or their relatives, regarding the service, to enable changes and improvements to be made as necessary.

Although risk assessments and care plans were in place, risks to people had not always been assessed or mitigated to maximise people’s safety, such as those relating to COVID-19, falls and fire safety.

Medicines were not always managed safely. Protocols were not in place for all medicines prescribed 'as and when required' and stock balance checks were not all accurate. Staff had undertaken medicine training, but records of competency assessments were not available for all staff who administered medicines.

Appropriate infection prevention and control measures were not all in place to prevent the spread of infection. Not all areas of the home had been thoroughly cleaned and although cleaning schedules were in place, they did not cover all areas of the home. Staff told us they completed regular tests for COVID-19, however records did not support this. Staff had undertaken infection control training and had access to appropriate PPE.

Staff recruitment records showed that all staff had a disclosure barring check prior to commencing in post, however, not all other safe recruitment practices were adhered to. We made a recommendation about this in the main body of the report.

People’s relatives told us they felt their family members were safe at Hillgrove and feedback regarding care provided was positive. There were enough staff to meet people’s needs in a timely way and staff were aware of how to raise any safeguarding concerns they had. Relatives told us they were kept informed of any changes regarding their family member and had been able to have contact with them during the COVID-19 pandemic.

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 20 February 2019).

At our last inspection we recommended that the provider ensured the rating of the service was displayed on their website as required. At this inspection, we found that this had been actioned.

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention and control and staffing issues. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the infection prevention and control measures in place, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to infection prevention and control, management of medicines, risk management and the governance of the service 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• The service had procedures and protocols in place which ensured people were admitted into the service and people could visit the service safely in accordance with national guidance.

• People and their relatives were supported to understand the isolation procedures and infection prevention and control measures. The service helped to alleviate people feeling lonely, by providing access to safe supervised visiting, in accordance with national guidance, and video and telephone calls with friends and loved ones.

• Staff were supported in isolation/sickness absence by the provider. Staff support and wellbeing was considered and enhanced during the pandemic.

• Personal protective equipment (PPE) was widely available and used correctly and there was an extensive testing program in place for staff, people using the service and visitors.

• The home was mostly clean and hygienic. Areas in the home had been redesigned to enable effective social distancing.

• Staff were trained in infection prevention and control (IPC) and had refresher training and guidance in COVID-19 guidelines. There were good links with the local community IPC team for guidance and support.

• There was an IPC policy and associated procedures in place. Contingency plans were in place for future service disruption, including due to infection outbreaks and winter pressures.

Hillgrove Residential Home is a ‘care home’ located in the Bidston area of the Wirral. The home accommodates up to 23 people over three floors in one large detached Edwardian building and has a patio/garden to the rear of the property. At the time of our inspection 18 people were living at the home.

People living in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home had an experienced registered manager who was also the registered provider and had worked at the home for many years. 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.

When we completed our previous inspection in October 2017 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as parts of the premises required repair and were unclean; fire safety provision and infection control standards were insufficient. We found a breach of Regulation 17, as the registered provider did not have effective systems in place to assess, monitor and mitigate the risks to the health, safety and welfare of people who used the service. We also found a breach of Regulation 18, as staff had not received appropriate training and appraisal in relation to their job role. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve in our key question areas of Safe, Effective and Well-led.

During this inspection we found that all the completed improvements recorded in the action plan had indeed been completed and this had led to improvements in our key question areas of Safe, Effective and Well-led. Overall, we found that the home had made sufficient improvements and was no longer in breach of the Regulations.

The registered manager explained that a number of environmental improvements had been made at the home since our last inspection. We found that the home was well-maintained, safe, clean and homely.

During this inspection we found that the registered manager had a variety of methods to assess and monitor the quality of the service provided at the home. These included regular audits of the home, staff and residents’ meetings and questionnaires to seek feedback about the home.

Records showed that staff received regular training relevant to their roles and were supported with regular supervision and appraisal meetings. Staff told us that they felt supported in their roles and all other staff, including the registered manager and deputy manager, were approachable and helpful.

We saw that there were policies and procedures in place to guide staff in relation to safeguarding vulnerable adults and whistleblowing. Staff had received training on this and information about how to raise safeguarding concerns was readily available in various places throughout the home. People living at the home and their relatives told us that they felt safe there. We noted that staff at the home took appropriate action when any such concerns arose. However, the home did not always notify CQC of these concerns as is required.

Registered providers are also required to display its most recent CQC inspection rating both at the premises and on its website, if applicable. We found that our last inspection rating and report was clearly displayed at the home. However, the provider’s website did not display this rating. Therefore, we have made a recommendation to address this.

Medication was safely administered, stored and recorded at the home by staff who had the required knowledge and skills. The home also had robust systems in place to ensure the safety and quality of medicines administration was maintained.

Staff were safely recruited by the home. This ensured that only people who were suitable to work with vulnerable adults were employed by the home.

There was a good range of activities on offer to people living at the home, which were provided enthusiastically by the staff. We observed staff regularly engaging with people throughout the day, chatting, laughing and joking with them.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed by the service. We saw that the service carried out appropriate capacity assessments when necessary. Deprivation of Liberty Safeguard (DoLS) applications had been appropriately submitted to the Local Authority and there was a system in place to closely monitor and renew them when needed.

The people we spoke with told us that they enjoyed the food and drink available at the home. One person said, “The food is very tasty.”

The people we spoke with gave us positive feedback about the staff at the home. We saw that staff had very caring and well-established relationships with the people living at the home.

The care plans we looked at were person-centred, well-maintained and regularly reviewed. The care plans gave staff clear guidance in an easily-accessible format on how to meet people’s needs.

The home is a detached house set in its own grounds in the area of Bidston, Wirral. There is a small car park and garden with seating available within the grounds. Accommodation is provided on three floors with a passenger life enabling access to bedrooms on the first and second floor. All bedrooms are single occupancy and have a wash basin. There are communal bathroom facilities on each floor. There is a communal lounge, a lounge/dining room and a quiet lounge for people to use.

At the time of 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.’

The home’s installations and lifting equipment had all been tested and certified as safe. For instance gas, electrics, hoists, fire alarm and the passenger lift. We found however that other parts of the home were in need of repair or were unclean. For instance, some of the home’s fire doors were faulty which meant they would not offer the required protection in the event of a fire. Some rooms did not have access to water sufficiently hot to enable good hand hygiene. Some of the home’s light fittings were broken and some of the plug holes in people’s hand basins were covered with limescale. This meant that the parts of the premises were unsafe and unclean.

Other improvements to the standards of infection control were also needed. We found some people who were sharing a bedroom also had shared hand towels or bars of soap. This was not good practice. People in shared accommodation should have their items clearly marked for their own personal use in order to prevent the spread of infection. We spoke with the manager about this. They assured us that all shared items would be removed. Systems were not in place to monitor and manage the risk of Legionella bacteria and the risk of this developing in the home’s water supply had not been assessed. We spoke with the manager about this and shortly after our inspection we received confirmation that a Legionella risk assessment had been organised.

Staff were recruited safely but some of the criminal conviction information relating to staff members may have been out of date. This was because some staff had been employed for over ten years without this information being renewed. Staff records showed that staff had adequate supervision in their job role but we found limited evidence that staff had received an appraisal of their skills and abilities or sufficient training to do their job role effectively. This meant the manager could not be confident that the skills and knowledge of staff members was sufficient or up to date.

We found that improvements to the way the home was managed were required. This was because the audits conducted by the manager in relation to health and safety, maintenance and infection control failed to identify and address the issues we found during our inspection. Similar issues in relation to health and safety, maintenance and infection control were also identified at the last inspection. This meant that the manager had been made aware previously that these areas required improvement but had failed to take sufficient action to address them. Other audits completed by the manager were either generic or not always accurate. This meant they were meaningless.

The home has been rated ‘requires improvement’ because of these issues. This is the second time the home has been rated requires improvement.

There were however lots of positives about life at the home that showed other aspects of good leadership. We spoke with four people who lived at the home and four relatives during our visit. Everyone we spoke with was positive about the home. It was clear they were happy with the care provided by staff. People told us the staff were kind and caring and our own observations of people’s care confirmed this.

There were enough staff on duty to meet people’s needs and people told us they got enough to eat and drink. They said the food was good and they had a choice. We saw that people’s weight was monitored regularly to ensure they maintained a healthy weight.

People’s care records were person centred and contained information about their needs and preferences. Information about what people could do independently was identified and staff had guidance on how to support people to remain as independent as possible.

Some people had short term memory loss that impacted on their ability to make decisions.

We saw elements of good practice in relation to the implementation of the Mental Capacity Act 2005 (MCA). For instance people’s capacity had been assessed for some of the specific decisions made about their care. Best interest discussions had been held and people had access to independent advocacy as and when need. This ensured people’s views and wishes were fairly represented. People’s capacity was not always assessed in relation to decisions to deprive them of their liberty and we spoke with the registered manager about this. They assured us they would review this without delay.

Activities were provided to occupy and interest people and on the days we visited we observed people enjoying a group quiz and a ball game. We saw that staff took the time to sit and chat to people in addition to meeting their support needs. This promoted their well-being. All of the interactions between people and staff were positive and the home had a warm, homely atmosphere. Staff we spoke with demonstrated a good knowledge of people’s needs and were able to tell us about people’s preferences and likes and dislikes. This showed us that staff knew people well. The culture of the home was open and transparent and it was obvious that people felt content with the support they received.

Hillgrove Residential Home is in a large detached building in a residential area of Birkenhead. The building is of a Victorian style with well-kept gardens. The home is registered to provide care and accommodation for up to 23 people. At the time of our visit 19 people were staying at the home.

Accommodation is in 23 bedrooms over three floors, the upper floors are accessible by a staircase and a passenger lift. All of the bedrooms are single occupancy and have a wash basin. There are toilets and bathrooms on each floor.

The home required and had a registered manager. 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.

The local authority had raised some concerns with the registered manager after a recent visit. The concerns related to the homes health and safety, including the use of supplies and equipment to prevent cross contamination and infection. The local authority also became aware during their visit of a safeguarding incident that had not been reported to the relevant organisations and some people living at the home required a Deprivation of Liberty Safeguard and no applications had been made. The local authority also made recommendations relating to making appropriate referrals for people to outside healthcare professionals.

We used this information to help plan our inspection. During our inspection we found that action had been taken and was on-going in relation to the concerns that had been raised.

During our inspection we found breaches of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was not an effective use of the systems and processes available at the home to assess, monitor and improve the quality and safety of the services provided to people. You can see what action we told the provider to take at the back of the full version of the report.

The registered manager regularly completed a number of checks and audits of the home. These were kept up to date. However the audits had been ineffective in identifying areas needing improvement. For example, improvements required to the equipment at the home, safety of the premises and planning people’s care. At the time of our inspection many of these issues had been rectified or works were in progress. However the systems at the home had not been effective as they had not highlighted the areas requiring improvement.

Due to some of the people who lived at the home having dementia, it was difficult for them to speak with us during our visit. People who spoke with us, told us they were well cared for and were happy living at the home. We observed the care of and interacted with people who didn’t speak with us. It was clear by how relaxed and comfortable they were with staff, that they felt safe at the home.

From the interactions between people staying at the home and staff members it was clear that they had warm, positive relationships. We saw people were treated with patience, kindness and with respect.

People’s friends and relatives spoke very highly of the home, the registered and deputy managers and the standard of care their relatives received. Visitors told us that they were always made to feel welcome at the home.

We saw that there was enough staff to safely meet people’s needs. At times staff were busy however we did not see people waiting for care or support. A senior staff member was on call 24 hours a day.

When we visited the service operated within the principles of the Mental Capacity Act 2005. Appropriate referrals had been made to the local authority for people who would benefit from a DoLS authorisation. This was done along with an assessment of the person’s capacity.

Staff received training appropriate to their role. This included training on safeguarding vulnerable adults. Staff were knowledgeable about safeguarding and knew who to contact if they suspected abuse had occurred.

People’s medication was stored, recorded and administered in a safe way. People had care files which were individualised and person centred. There were appropriate risk assessments on people’s care files in respect of their health, safety and well-being.

The home had adaptations to the environment to enable people to get around the home independently, such as ramps, hand rails and dementia friendly picture signs. The environment at the home was clean and bright and had no unpleasant odours.

Staff members were enthusiastic about their jobs and told us they were happy in their roles. They told us that they felt well supported by the registered manager and the deputy manager. They had regular supervision meetings and staff team meetings.

The registered manager had an open door policy. During our visit we saw people calling into the office to see her. People told us they were comfortable with her and had confidence that if they went to see her with any concerns they would be resolved. We saw that the manager interacted with people who lived at the home throughout the day in a friendly manner. From our observations, it was clear that she knew people well and had positive relationships with them.

There was a variety of activities available to meet people’s needs and preferences. We also saw that people’s special events, such as birthdays were celebrated.

People said, 'the staff are really helpful' and 'it's a comfort knowing (mum) is well cared for.' Most people using the service had a relative who had lasting power of attorney and they had discussed their preferences and care needs with staff when they had come to live in the home, and had signed care plans. A few people did not have any relatives and the Court of Protection had appointed a person to make decisions in their best interests.

We saw that plans for care were reviewed regularly and adapted as people's needs changed.

We saw that the service had comprehensive policies and procedures documented for all aspects of services provided and for dealing with emergency situations.

People using the service said that there were always enough staff on duty to care for people and answer questions. Staff told us, and we saw evidence that confirmed they had received training to deliver care safely.

The premises were safe and suitable for the purpose of carrying on the regulated activity, accommodation for persons who require nursing or personal care.