Hill View

Hill View is a residential care home providing personal care to up to 16 people. The service provides support to older people and people with dementia in one adapted building. At the time of our inspection there were 13 people using the service.

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

There was a lack of provider oversight at the service. There was no evidence of learning and improvement actions from all the breaches of regulations found during the last CQC inspection. There had been no improvement to the monitoring of the service provided since the last inspection. There were delays in the provider acting promptly to ensure the environment people lived in and fire safety compliance was safe. This put people, their visitors and staff at an increased risk of harm.

The providers governance systems and monitoring had failed to identify areas that required improvement. Audits were not effective in identifying the issues found during this inspection. Fire policies, procedures and fire risk assessments contained out of date and conflicting information. Fire risks although known, were not minimised by quick proactive actions by the provider to make sure people were kept safe and that the service met the fire regulations. Health and safety audits had not identified that safety checks such as legionnaire water monitoring were not being undertaken.

There had been no improvement to the number of staff who worked at night since the last inspection. The provider could not evidence that the number of staff working at night were safe. They had failed to monitor the time it took the on-call staff at night to respond to requests for support. They did not monitor that the time it took on-call staff to respond, did not leave people in pain or discomfort for prolonged periods of time. A staff member who worked alone at night had not had all the necessary training to support people with medicines such as pain relief as and when needed. Potential new staff to the service underwent checks to make sure they were suitable to work with people. However, a lack of auditing of these records showed there were gaps in some staffs’ employment history that had not been explored.

Staff were not following current government guidance around good infection control procedures. Staff were seen not wearing face masks in line with current guidance. People’s feedback on the service provided via a survey, had not been collated to evidence an overall picture and establish any areas that needed improving.

Staff used their training knowledge to safeguard people wherever possible and support people to keep safe from poor care and abuse. If staff had any concerns about people, they knew where to report this both internally and outside of the service. Staff encouraged people to eat healthily and drink enough. People received their medicines as prescribed.

We have recommended that the provider and registered manager follows medicines best practice guidance.

Staff were kind, and knew people’s individual needs, and preferences well. They also knew people’s assessed risks and these risks were monitored by staff. Staff listened and respected people’s concerns and suggestions. Staff gave people privacy, treated them with dignity and respect when supporting them, and helped maintain people's independence. Staff involved people and their relatives, when reviewing people’s support and care requirements. Staff responded to people’s changing care and support needs. Care plans were reviewed and updated when changes occurred.

Compliments about the service provided by staff had been received. Complaints were investigated and resolved wherever possible and actions were taken to reduce the risk of recurrence.

Staff had observations of their practice, supervisions, appraisals and ongoing support from the registered manager. This helped staff maintain and improve their skills to fulfil their role and responsibilities.

The registered manager led by example and had cultivated an open and honest staff team culture. The registered manager and staff team worked with other organisations, health and social care professionals to provide people with joined up care. However, records of this were not always detailed enough to demonstrate the conversations had and any actions taken.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests.

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 24 February 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do to improve. However, they were unable to evidence that the CQC had received this action plan. At this inspection we found some improvements had been made, however there had been no improvement to the governance monitoring of the service and provider oversight. We also found a continued breach around staffing and a new breach of regulations around fire safety and a lack of legionnaires testing and the risk this posed to people, their visitors and staff. As such the provider continues to remain in breach of regulations.

At our last inspection we recommended that the registered manager access up to date guidance. We also recommended at our last inspection that the registered manager review best practice guidance around signage to help support people with dementia orientate themselves around the building. At this inspection we found there had been some improvements.

The service remains rated requires improvement. This service has been rated requires improvement for the two consecutive inspections in 2020 and 2022.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection following breaches of regulations found.

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 have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified a continued breach in relation to a lack of provider oversight and poor governance and quality monitoring of the service and staffing at this inspection. We have also identified a new breach about safety to people, their visitors and staff.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 with the 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.

There was an area where visitors could visit their family member/friend by appointment via a separate side entrance to the home. There were gaps between each visit to prevent people encountering other visitors or staff and to clean. Staff also supported people to maintain contact with their relatives /friends, to support their well-being, using video calling and telephone calls. End of life compassionate visits were also available.

External visitors including health or social care professionals were admitted into the home in line with government guidance. There were plans in place to zone people into different areas should an outbreak occur. They had already discussed with staff who would work in the COVID-19 zone and who could not because of risk.

People were asked to isolate in their rooms, if they had been to an external health appointment or were recently admitted into the home, for 14 days. For people who lacked the mental capacity to understand self-isolation, extra staff could be rostered on to help. People had their temperature checked at least twice a day and staff had their temperature checked when they started their shift. Whole home testing was completed in line with the national testing guidelines.

Staff changed into their work clothes in the staff room/office and put on their personal protective equipment (PPE) before starting work. Staff were lateral flow device tested twice a week. Staff waited for their results before starting their shift.

There was an infection control lead within the home. Two senior staff had clinical commissioning group (CCG) training on infection prevention and control. This was then rolled out to all staff. Staff had internal COVID-19 training that included putting on and taking off PPE safely, good cleaning, and handwashing. Hand hygiene and PPE spot checks were completed on staff.

Staff were observed to be wearing their PPE correctly including face masks. Staff wore uniforms that were bare below the elbow, had their hair tied back if shoulder length or longer and were wearing a minimum amount of jewellery. This promoted good infection control practices.

Hill View is a residential care home providing personal care to 14 people aged 65 and over, some of who were living with dementia at the time of the inspection.

Hill View accommodates up to 16 people in one adapted single storey building.

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

The service was not well managed, and the provider and registered manager lacked oversight of staff performance, quality standards and the care that was being delivered. Audits were not effective and had not identified the issues found during the inspection.

Risks had not all been identified and minimised to ensure people were kept safe. There were not enough staff available to ensure peoples assessed needs were met at all times. Staff had little time to support people with interests and activities and people were unoccupied for long periods.

Staff received regular training, however, this was not always effective, and staff did not have enough knowledge in key areas to meet people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice

Staff did not have clear guidance in place that detailed what medicines people were prescribed and to ensure they were administered in line with the prescriber’s instructions. There were no systems in place that ensured lessons were learned.

Care plans did not provide enough guidance to ensure staff had the detail one how to provide care and support to people in line with their needs and choices. We have made a recommendation to seek further guidance from National Institute of clinical Excellence on best practice.

There was limited signage to help people find their way around the home. We have made a recommendation that the provider looks at best practice guidance for developing an environment for people living with dementia.

Staff felt well supported through supervisions and had support with staff meetings.

Staff were caring in the way they supported people with their needs.

Staff and people felt they could approach the registered manager who acted on concerns raised to make improvements to people's care.

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 3 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches in relation to staffing, consent and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

This unannounced inspection took place on 4 July 2017. At the last inspection on 16 January 2015 the service was rated as ‘Good’. At this inspection we found overall the service remained ‘Good’.

A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Systems were in place to manage risks to people using the service and to keep them safe. This included assisting people safely with their mobility and whilst eating.

Medicines were managed safely and people received their medicines as prescribed.

There were enough staff employed to ensure people that people’s needs were met. Staff had received training to safely assist and support people. The recruitment and selection procedure ensured that only suitable staff were recruited to work with people using the service.

The registered manager and staff had an understanding of their responsibility under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have choice and control over their lives as much as possible.

People’s needs were assessed, so that their care was planned and delivered in a consistent way. There was a variety of activities and interests available for people to take part in so they did not become socially isolated.

The management and care staff were knowledgeable about the people they supported and knew their care needs well. Staff offered people choices such as to how they spent their day and the meals they wished to eat. These choices were respected and actioned by staff.

People's nutritional needs were met and people were supported to have enough to eat and drink. A range of healthcare professionals visited the home to support people to maintain good health.

People were clear about raising any concerns they had and were confident they would be responded to.

Staff understood the values of the home in relation to providing people. We observed staff supporting people in a respectful and dignified manner during our inspection.

The quality of the care was monitored by a range of audits that were carried out regularly. People had been consulted about how they wished their care to be delivered and their choices had been respected. People, their relatives and staff were provided with the opportunity to give their feedback about the quality of the home provided.

Further information is in the detailed findings below.

The day was very hot and we noted that people had drinks available and ice lollies were taken round to everyone so that there were different methods to ensure people had enough fluids. One person told us they were on their third ice lolly and it was great. We also saw that many people had fans and these helped keep the temperature down in their bedrooms.

People told us they felt safe in the home. One person said, "I've never thought about whether I feel safe, but actually, I think I do". People told us that the staff were, "...very good" and "...everyone is so nice".

One person said, "I don't think you could wish for somewhere better".

All those we spoke with said the food was very good. They told us they could have anything they wanted if there was nothing on the menu they liked.

People said staff were, " Very helpful and take their time", and we saw that staff did not rush people and ensured they were as independent as possible. One person said, "I couldn't have wished for a better place", however one person said that because some people in the home had a level of confusion they felt they were unable to have interesting conversations, which meant they stayed in their room.