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Hill View Requires improvement

Reports


Inspection carried out on 2 March 2021

During an inspection looking at part of the service

Hill View is a residential care home that can provide accommodation, personal care and support to up to 16 adults. At the time of this inspection there were 14 people living at the home.

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.

Inspection carried out on 20 January 2020

During a routine inspection

About the service

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.

Inspection carried out on 4 July 2017

During a routine inspection

Hill View is a care home providing accommodation for up to 16 older people who require personal care, some of whom live with dementia. It is not registered to provide nursing care. 13 people were living at the service on the day of our inspection.

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.

Inspection carried out on 2 January 2015

During a routine inspection

Hill View is a care home which provides accommodation and personal care for up to 16 older people and people living with dementia. At the time of our inspection there were 14 people living in the home.

The home is a bungalow on the edge of Sawtry close to the A1(M) road. There is an enclosed rear garden and car parking and small garden area to the front. The bedrooms are single occupancy and there are communal bath and shower facilities. There is a communal lounge, dining room and conservatory for people and their visitors to use.

This unannounced inspection took place on 2 January 2015. The previous inspection was on 15 July 2013 and the provider was meeting the regulations that we assessed.

The home had 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 risk of harm for people was reduced because staff knew how to recognise and report abuse. There was a recruitment process in place and only suitable staff had been employed to work in the home. There were sufficient staff numbers to meet people’s care and support needs.

People were protected from unsafe management of medicines because staff had received the necessary training and there were procedures in place for staff to follow.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Staff understood MCA and DoLS and were aware of what they meant for people in the home. People who lacked capacity for decision making had best interest assessments completed but the decisions and actions to be carried out on behalf of the person needed to be better recorded.

Staff received an induction when they first started working in the home and were supported in their roles through regular supervision and annual appraisals.

People’s health and care needs were assessed and reviewed. People had access to a wide variety of health professionals who were requested appropriately by staff and who provided staff with guidance to maintain people’s health and wellbeing.

People were provided with adequate amounts of food and drink to meet their nutritional and hydration needs.

People were encouraged to take part in their individual social activities and interests, which they enjoyed.

People living in the home and their relatives found the staff and managers to be caring and kind. Relatives were kept up to date about their family member’s health and welfare.

People and their relatives were confident that any concerns or complaints raised with the management would be dealt with appropriately. Relatives advocated on behalf of people in the home, but independent advocates could be found for them by the staff or management if required.

The provider had an effective quality assurance system in place which was used to help drive improvements to the quality of people’s care provided and the home that they lived in.

Inspection carried out on 15 July 2013

During a routine inspection

We spoke with nine people living in the home, two family members and six members of staff during our inspection on 15 July 2013.

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.

Inspection carried out on 5 November 2012

During a routine inspection

Everyone we spoke with said the home was small and homely, and we noted that there was a feeling of calm in the bungalow. There were fresh flowers in many rooms, and there was a bowl of fresh fruit in the lounge. People told us they were sometimes taken out when the weather was fine. A trip to the local shopping centre was planned before Christmas and a hairdresser and chiropodist came to the home.

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.

Inspection carried out on 21 December 2011

During a routine inspection

We spoke to the majority of people at the home and they were satisfied with all aspects of their health and welfare. A number of people had lived at the home for many years and had a good rapport with staff, many of whom had worked at the home for many years. People more recently admitted to the home said they had settled well and staff were kind.

Reports under our old system of regulation (including those from before CQC was created)