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Hillsborough Residential Home Requires improvement

Reports


Inspection carried out on 5 December 2019

During a routine inspection

About the service

Hillsborough Residential Home ("Hillsborough") is a residential care home providing accommodation and personal care to 22 people aged 65 and over at the time of the inspection. Hillsborough Residential Home Limited also provided personal care to people in their own home. However, at this inspection, no-one was receiving support with personal care. The registered manager and provider told us they planned to review whether they would accept more people to that part of the service in January 2020.

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

The service was not always safe. Some improvements had been made since the last inspection and regular checks of the environment and of records were completed. However, not all risks relating to the environment had been identified or assessed, and records did not show people’s care had been delivered as required, to reduce risks to them. Infection control practices were now being monitored but had not identified times when staff were not following best practice.

Staff recruitment processes had improved but there were still gaps in the checks being completed. Staffing levels had improved but we have made a recommendation about staff deployment. Records of incidents and accidents were now in place.

Medicines management and practices had improved and were safer. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, the principles of the Mental Capacity Act 2005 (MCA) had not been followed for two people who lacked capacity.

Improvements to the environment were still required; this included identifying people’s needs in relation to the environment.

The registered manager had increased the amount of checks to monitor the service. Records showed changes and improvements had been made as a result of audits, events or staff ideas. However, these had still not effectively highlighted all the gaps identified at this inspection. Concerns raised during the last inspection, such as environmental risks, ensuring risks to people were reduced, infection control practices, recruitment practices and not meeting the Mental Capacity Act 2005 (MCA), had not been fully resolved.

People told us they were happy living in the home and staff told us they particularly enjoyed working in the homely atmosphere. The provider’s passion for caring for people was clear.

People told us they were happy with the food and the choices available to them. People were supported to remain healthy and staff were knowledgeable about people’s needs. People saw healthcare professionals regularly but records of these visits were not always easy to find. We have made a recommendation about this.

People received support from staff who cared about them. People were supported to express their views in the way they wanted to. When people raised concerns, records did not always show what action had been taken. We have made a recommendation about this. People’s privacy and dignity were mostly respected but we have made a recommendation about the storage of people’s medicines records and continence aids.

People had care plans in place to describe their needs and preferences. The registered manager had identified that some more detail was required and had a plan to ensure this happened. Staff were responsive to people’s requests and gave people choice and control over their care. Improvements were being made to the options available for how people spent their time. Complaints had been recorded and appropriate action taken.

There was a plan in place to ensure all staff training was up to date. Staff’s understanding of people’s needs and of best practice was being developed.

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

Inspection carried out on 2 April 2019

During a routine inspection

About the service: Hillsborough Residential Home (“Hillsborough”) is a residential care home that was providing accommodation and personal care to 21 people aged 65 and over at the time of the inspection. Hillsborough Residential Home Limited also provided personal care to people in their own home. They were providing support to five people; four of whom received personal care.

People’s experience of using this service:

•People did not always receive their medicines safely and were not always protected by infection control practices.

•People did not always have the required risk assessments in place relating to their health and social care needs, to help keep them safe.

•Staff were not always recruited safely to ensure they were suitable to work with vulnerable people.

•Systems of leadership and governance did not ensure that there were effective checks of the quality of the service taking place.

•Staff had not always received the appropriate training, professional development, and supervision to carry out their duties.

•People and relatives were positive about the service and the care given in the residential home and in their own homes. People told us the food was delicious.

Rating at last inspection: The rating at the last inspection was Requires Improvement (Report published 05 April 2018).

We found seven breaches of the Health and Social Care Act (2008), and made recommendations in respect of the environment, and the Accessible Information Standard (AIS).

Why we inspected: We inspected the service in line with our inspection methodology. We followed up on the breaches of Regulations and the recommendations from the previous inspection.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this registered provider is requires improvement. Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated requires improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 6 December 2017

During a routine inspection

We carried out an unannounced comprehensive inspection on the 06 and 11 of December 2017.

Hillsborough Residential Home is registered to provide residential care for up to 22 people. At the time of our inspection there were 22 people living at the service. The provider was also registered to support people with personal care within their own homes; known as a community care service. At the time of our inspection, there were nine people receiving support.

Prior to our inspection we had received concerns about the safety of the building and people’s access to the kitchen. We looked at these concerns as part of our inspection and found that improvements were required.

Hillsborough Residential Home had a registered manager who was also the registered provider. 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 provider was supported by a deputy manager. The deputy manager was in the process of undertaking a qualification in leadership and management to enable them to become the registered manager of the service.

At our last inspection in June 2015 the service was rated Good. However, at this inspection we found the service to require improving.

Overall, people living at the care home were supported by sufficient numbers of staff to be able to meet their needs. However, staff told us that sometimes they were understaffed because the provider did not find additional cover when staff were on annual leave or unwell. Staffing rotas also showed this. People were looked after by staff who were trained to meet their needs. New members of staff completed an induction to introduce them to the day to day aspects of the service, and to relevant policies and procedures.

People’s care plans and personal risk assessments contained good detail about how important it was that their physical care needs were safely monitored. However, when people had a specific risk relating to their healthcare, risk assessments were not always in place to help guide staff to provide safe and consistent care. The provider had not considered whether the format of people’s care plans met with their individual communication needs.

Accidents, incidents and falls were monitored to establish if there were common trends, so as to help minimise repetition. People had personal emergency evacuation plans (PEEPs) in place. This meant the emergency services would know what to do, for each person living in the home in the event of an emergency such as a fire.

Policies relating to the environment were not always being adhered to by staff. For example, the kitchen door which should have been closed to ensure people’s safety was found to be open. We also noted the environment was cluttered, with many items of furniture which impeded people’s movement. People were not always supported in the environment because signage was not always clear and may not have always been in a suitable format for people to understand.

People’s medicines were managed safely, with good recording processes in place. People’s health needs were met. Staff worked closely with external health and social care services to help ensure a co-ordinated approach to people’s care.

People were protected by the providers safeguarding processes, staff knew what action to take if they suspected someone was being abused mistreated or neglected. Overall, people were supported by staff who had been recruited safely to ensure they were suitable to work with vulnerable people. However, we did note for one employee the provider had not followed their own recruitment policy, by ensuring their employment history had been obtained.

People living in the care home told us the food was nice. However, some people who received

Inspection carried out on 11, 12 & 22 June 2015

During a routine inspection

The inspection took place on 11, 12, and 22 June 2015 and was unannounced to the care home and announced to the domiciliary care part of the service.

Hillsborough Residential Home provides care and accommodation for up to 22 people who are living with dementia or who may have physical difficulties. On the day of the inspection 20 people were living at the care home. The home is on two floors, with access to the upper floor via stairs or a stair lift. Some bedrooms have en-suite facilities. There are shared bathrooms, shower facilities and toilets. Communal areas include two lounges, a conservatory, two dining rooms and an outside garden and patio area.

The service also provides domiciliary care services to adults within East Cornwall. On the day of our inspection 12 people were using the service. The home care service provides palliative care, as well as supporting people with physical disabilities, sensory impairments and mental health needs, including people living with dementia.

At our last inspection in December 2013 the provider was meeting all of the Essential Standards inspected.

The service 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.

People were protected from avoidable harm and abuse that may breach their human rights. The registered manager and deputy manager understood how the mental capacity act and deprivation of liberty safeguards protected people to ensure their freedom was supported and respected. This meant decisions were being made for people with proper consultation. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision should be made involving people who know the person well and other professionals, where relevant. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty.

People’s medicines were managed well which meant they received them safely.

People were supported by sufficient numbers of staff who had the knowledge, skills and experience to carry out their role. The registered manager provided support and training for staff. Staff supported people with their individual nutritional needs and took appropriate action when concerns were identified. Drinks were offered to people regularly. People could access health care services and the registered manager had systems in place to ensure staff shared information about people’s health care to help ensure prompt action was taken when required.

People were supported by staff who promoted and showed positive and inclusive relationships. Staff were kind, caring, compassionate and tactile in their interactions with people. People were encouraged and empowered to remain independent. Staff were considerate and respectful which helped to ensure people’s privacy and dignity were promoted. People’s views were valued and used to facilitate change. The registered manager welcomed feedback to enable learning and improvement, for example, complaints were considered positively.

People received care which was personalised to their needs. Care plans and risk assessments did not always give clear direction to staff about how to meet a person’s needs and activities were limited. However, from our observations and conversations with staff it was clear they were knowledgeable about people. People received a co-ordinated approach to their care when they moved between services because people had in place summary care plans which were shared with other professionals to help ensure continuity of care for people.

The registered manager and deputy manager promoted a positive culture that was open, inclusive and empowering to people, staff and visitors. The quality monitoring systems in place helped to ensure continuous improvement.

Inspection carried out on 18 December 2013

During a routine inspection

We spent time talking with staff and observing care practices as well as talking to people who used the service. Comments included “They look after me.” and “I like being pampered.”

We observed that staff spoke with people in a friendly and respectful manner. People told us that they were able to make choices about their day to day lives. One person told us “It’s brilliant here.”

The care plans we looked at were personal to the individual and gave staff clear information to follow. This made sure that people received care and support which met their individual needs.

The environment was clean and there were systems in place to minimise the risk of infection.

There were robust systems in place to ensure that before staff began working in the home that they were safe and trained to look after the people.

The home kept a log of all complaints and concerns raised. One person told us “I have no complaints, but I could talk to staff if I did.” We read the log and saw that all concerns were responded to promptly.

We also inspected the Hillsborough Domiciliary Care Service which is managed from the care home. We found that care plans provided information for people using the service and staff to ensure people’s needs were met.

Inspection carried out on 13 March 2013

During an inspection to make sure that the improvements required had been made

We found that there have been improvements made to the way medicines are looked after in the home. We did not speak with people in the home on this visit, as we were following up on areas of concern from previous inspections. We observed the way some medicines were being given and checked medicines records for people in the home. We spoke with the manager and deputy manager about the work they had done to make these improvements. We saw that they had improved the way medicines are stored, administered and recorded.

Inspection carried out on 18, 24 January and 4 February 2013

During an inspection to make sure that the improvements required had been made

We inspected Hillsborough House to follow up on seven compliance actions and two warning notices made at the previous inspection.

People were positive about the care they received at Hillsborough House and the domiciliary care provided. They told us “they treat you like a human being here” and “this is best place I have been so far “

We saw that people were treated with dignity and respect. We saw that they had choices and they were included in their plan of care. We observed that people’s information was maintained to ensure their confidentiality was protected.

Staff told us that they felt supported in their role and they had received updated training in medication management and the safeguarding of vulnerable adults.

Records relating to people's care were detailed and personal to each person and reflected their choices and preferences.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Auditing of the views of people living at the home, their relatives and staff had been undertaken. This was to monitor people’s view of the service provided and make changes when needed.

We also inspected the Hillsborough Domiciliary Care Service which is managed from the care home. We found that care pans had been developed and further information provided for people using the service and staff to ensure people’s needs were met.

Inspection carried out on 28 November and 3 December 2012

During an inspection to make sure that the improvements required had been made

We inspected Hillsborough House to follow up on ten areas of non compliance identified at the previous inspection.

People told us “we are well looked after here, the owner is a lovely person” and “we have no grumbles”.

People said there was not a lot of activity provided and so there was not a lot to entertain them.

We saw that sometimes people were not treated with dignity and their privacy was not protected or respected.

Staff told us that they felt supported in their role and that they had sufficient induction and training to help them do their jobs. However, training in all areas of care was not provided, this included the protection of vulnerable adults and medication training which may place people at risk.

We looked at the care provided and records relating to five people. Records relating to people’s care were detailed and personal to each person. However, the plans of care were not all an accurate reflection of the person’s current care needs.

Medication systems were not well managed and may place people at risk.

Auditing systems undertaken by the management of the home had recently been put in place to monitor the environment of the home. A plan of maintenance and action was being developed to improve the fabric of the home.

We also inspected the Hillsborough Domiciliary Care Service which is managed from the care home. We found that some areas of the service needed further development to ensure people received a good standard of care.

Inspection carried out on 17 September 2012

During an inspection in response to concerns

We (the Commission) carried out this inspection as part after concerns were sent to CQC. We made an unannounced visit to the home on 17 September 2012 as part of the inspection, in part to follow up information we had received that suggested the home might not be fully compliant with the essential standards of quality and safety.

We reviewed all the information we held about this provider. We talked with people who use services, relatives, staff and talked with a visiting health professional. We checked the provider’s records, and looked at six care records of people who use services.

We talked with fourteen people who lived in the home and the staff on duty. We saw people’s privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. People living at the home were all complimentary about the home environment, food, staff and the care they received. Their comments included,

“More than happy with everything” and “The food and care is excellent”, “It is fit for royalty”.

People said that they would feel able to complain if they needed to. We talked to people using the service and staff about how people are kept safe. People told us, “I feel safe here and I like the staff”. A relative said, “We are always kept informed and couldn’t ask for a better place”. “Maria, the manager, is wonderful”

Staff were clear about the actions they would take should they have any concerns about people's safety.

We pathway tracked six people who use the service. Pathway tracking means we looked in detail at the care six people received. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them.

We spoke with one visiting health professional who confirmed that the staff at the home were helpful.

We looked at medication systems and we found that the management of prescribed and controlled medication was not managed consistently. The management of prescribed creams was not well managed and the registered manager assured us that this would be addressed promptly.

We found that many parts of the home to be unclean, untidy and there were offensive odours in some areas.

We found no auditing systems in place. Auditing systems put in place would ensure all areas would be monitored and any issues would be addressed.

All of this information helps us to develop a picture of what it is like to live at Hillsborough House Residential Home.

Inspection carried out on 30 December 2010 and 30 March 2011

During an inspection in response to concerns

We talked with a small number of people who reside at Hillsborough and asked them about living in the home. We were told:

'the staff are great and help you all they can', ‘the staff always come if I call for them’ and ‘the meals are always good’.

We spoke to some people who indicated that they are involved in deciding on their care needs and continue to be involved as reviews take place.

A number of people were observed during the visit this gave us information about the care and support they need and staff interactions with them.

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