Hill House - Care Home with Nursing Physical Disabilities

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. The provider used nationally recognised assessment tools to monitor and support people's skin integrity and nutritional needs. Staff had a good understanding of each person’s needs. Staff told us they knew the needs of people via handover meetings and care plans. One staff member told us, "Knowing (information) first thing means we can accommodate people's need with less inconvenience to them." The manager stated they had implemented a system of named nurses, ensuring people had a designated point of contact for their care to support a more inclusive approach to care planning.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Hydration charts were not always accurately maintained and did not include fluids consumed when people had been out or provided with drinks by family members. The manager was taking steps to improve recording by exploring how relatives could contribute information about drinks consumed.

People’s care plans clearly outlined their dietary preferences and requirements, which kitchen staff understood and consistently followed. Clinical assessment tools, including the Malnutrition Universal Screening Tool (MUST) and the Waterlow scale, were updated regularly and used effectively to identify risks and inform care, with preventative measures implemented.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Information and guidance received from healthcare professionals were not consistently acted upon. Staff did not always follow instructions in a timely manner. For example, prescribed medicines were not always collected promptly. In addition, guidance provided by healthcare professionals was not consistently cascaded across the staff team, which resulted in some repeated contact with professionals to clarify instructions. The manager had already identified these concerns, and new systems had been implemented to ensure clinical guidance was centrally recorded and accessible to all staff. Staff confirmed new systems were in place with one staff member stating, "I feel like it is working so much better now."

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were encouraged and supported to understand and make healthier choices, including those relating to their diet, lifestyle, physical activity, and personal and oral hygiene. The provider promoted self-management and independence, enabling people to maintain contact with relatives and friends using their own devices.

We observed people independently accessing and making use of outdoor spaces, which further promoted autonomy and choice. Records demonstrated that appropriate referrals had been made to external agencies when required, ensuring people had access to additional professional support. Staff had completed first aid training, and first aid kits were generally well stocked, supporting the service’s ability to respond to minor injuries.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Monitoring and improving outcomes were not always robust. Records showed that epileptic seizures were not consistently documented, and clinical charts were not always effectively monitored or audited. Although staff demonstrated awareness of the need to complete clinical charts, this was not consistently reflected in practice. The registered manager had implemented oversight arrangements through a centralised system, however, this had not fully mitigated the identified gaps in recording and quality assurance. As a result, opportunities to fully monitor and improve people’s outcomes were sometimes missed.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Whilst systems were in place to assess people's capacity to make decisions, some Mental Capacity Act 2005 (MCA) assessments did not contain sufficient detail to demonstrate how capacity had been assessed in accordance with MCA principles. For example, some records did not clearly evidence the steps taken to support people to make their own decisions before assessments were undertaken. A stakeholder also told us they had identified a lack of understanding of MCA processes and the completion of associated documentation, which was consistent with our findings.

Best interest decisions had been completed where required and involved people who knew the person well to help ensure decisions reflected their wishes and preferences. Staff sought people's consent before providing care and support, and we observed this practice throughout the inspection. The provider had implemented a monitoring system to support the regular review of MCA documentation. In addition, the manager had commenced a review of all MCA assessments to identify and address any gaps and strengthen compliance with the MCA.