Hill View

Updated 16 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by an inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Hill View is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hill View is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 11 people who used the service and four relatives. We spoke with five members of staff including the nominated individual who was also the provider. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with the registered manager, two assistant managers and a member of care staff.

We reviewed a range of records, this included four people's care records. We looked at medicines’ records and two staff files in relation to recruitment. A variety of records relating to the management of the service and fire safety were also reviewed, including incident records, complaints, compliments, quality assurance processes including audits and policies and procedures.

After the inspection

We contacted the fire service during this inspection to share our concerns. The Cambridgeshire Fire and Rescue Service shared with the CQC a copy of the report of the fire deficiencies found during their most recent visit. This visit was in response to the concerns shared by the CQC.

After the inspection the provider updated us with the work that had started around environmental fire safety risks.

Updated 16 December 2022

About the service

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.