Hill House - Care Home with Nursing Physical Disabilities

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 68 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff and the management team demonstrated a good understanding of the people they supported. Staff feedback indicated they understood the importance of ensuring people were at the centre of their care and that their choices were respected. We observed many positive and caring interactions between staff and people using the service. Staff were familiar with people's communication needs, preferences and routines. Bedrooms were decorated in ways that reflected people's personalities and individual tastes. Personal items, photographs and keepsakes were displayed throughout, demonstrating people's identities were valued and respected by the service.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of continuity. For example, we reviewed one incident where a staff member did not follow the guidance outlined in a person's care plan, which resulted in the person requiring emergency medical attention. Following the incident, leaders took action to reduce the risk of a reoccurrence. The manager identified gaps in staff competency and, working alongside the clinical lead, developed a comprehensive competency matrix for staff supporting people with complex clinical needs. This provided greater oversight of staff skills, training and competency assessments, helping to ensure staff were equipped to respond appropriately to people's specific healthcare needs and emergencies. Relatives told us there had been a reduction in the number of regular staff available during evenings and weekends, and that the service was increasingly reliant on bank and agency staff to cover shifts. Some relatives felt this had an impact on continuity of care and relationship building. One relative said, "I have noticed that they have had to rely more on bank staff, which is a problem in itself, because you don’t get that continuity of care, it is harder for residents to build that rapport especially where there are potential communication issues." This highlighted the importance of consistent staffing arrangements, particularly for people who relied on familiar staff to understand and support their communication needs.

The manager acknowledged these challenges and confirmed the service's reliance on agency staff was reducing as additional permanent staff were being successfully recruited and appointed.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People were supported to remain informed and engaged. Regular newsletters, notice boards and visual displays provided people with up-to-date information about activities, events and key members of the staff team. Information about planned entertainment and introductions to new staff members, including the regional director, manager and clinical lead, was also shared to help people feel connected to the service.

Assistive technology enabled people to access information in formats suitable to their needs and supported them to communicate and stay connected with family, friends and professionals. Clear posters containing pictures and written instructions were displayed throughout the building to support people to use technology confidently. The use of accessible information helped people understand and make effective use of technology to enhance their independence and day-to-day experiences.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Improvements were required to ensure people and those important to them were consistently listened to and felt confident that their views and concerns would be acted upon. Feedback from a relatives' survey demonstrated that some people were unclear about how to raise a complaint, while others told us they had not been fully satisfied with the outcome when concerns had been raised. Complaint records were not consistently maintained. People told us they had raised concerns and complaints; however, there was not always documentary evidence available to demonstrate these had been formally recorded, investigated or responded to in line with the provider's complaints process. This meant the provider could not be assured that all complaints were appropriately managed or that opportunities to identify themes and drive service improvement had been fully explored.

The provider had already recognised these shortfalls and had begun to implement improvements. A new complaints file and monitoring matrix had been introduced to support the identification of trends and themes and strengthen oversight of concerns raised. In addition, one-to-one meetings had been established for family members and their loved ones to promote privacy, confidentiality and more meaningful engagement. These actions were positive; however, further time was needed to embed the changes and demonstrate sustained improvement.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Staff had access to an emergency community team and an on-call system, ensuring support was always available. Feedback from professionals confirmed these arrangements were used appropriately when required. Referrals to specialist services, including Speech and Language Therapy (SALT), were made promptly to help ensure people's assessed needs were met. Staff worked proactively with healthcare professionals, such as GPs, and sought advice and support when necessary. The service benefited from regular involvement from a range of health and social care professionals, which helped to promote coordinated care and positive outcomes for people.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People’s care was tailored to their individual needs. Care plans identified where specific equipment or adjustments were required, helping to remove any potential barriers to receiving appropriate support. For example, for those requiring additional communication tools, the service utilised technology to enhance people's communication to ensure they were involved at every stage of their support. A sensory room was available for those who wished to relax and reduce any distress or to provide sensory stimulation. Staff received training in equality and diversity and inclusion to ensure everyone was treated fairly and without discrimination, regardless of age, sex, race, disability or religious belief. There were no reports from people or their relatives of discrimination or unequal treatment.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Care plans contained detailed, person-centred information that reflected individuals' preferences, values and choices. The service also recognised the importance of commemorating people's lives and held memorial events, providing opportunities for people, relatives and staff to come together to remember and celebrate those who had died.

Where people had Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in place, these were appropriately completed and readily accessible to staff. Staff had received training in end-of-life care, helping to ensure they had the knowledge and skills required to support people with dignity, compassion and respect at the end of their lives.