Archived: Hillside Residential Care Home

Hillside Residential Care Home is a residential care home providing personal care and accommodation for up to19 older people. It is a privately owned family run business. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hillside Residential Care Home does not provide nursing care and none of the staff employed at the home are registered nurses.

The home is situated in Wilmslow and is close to shops and other public amenities with easy access to main road networks. The premise is a two storey building with accommodation on both floors. Some of the bedrooms have en-suite bathroom facilities.

Seventeen people were being accommodated at Hillside Residential Care Home at the time of our inspection started.

At the time of the inspection there was a registered manager at Hillside Residential Care Home. 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 registered manager was present during our inspection and engaged positively in the inspection process. The manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors. Prior to our inspection representatives of the local authority told us that Hillside Residential Care Home was known to have a warm, welcoming and relaxed atmosphere and our findings supported this. People living at the home told us that they appreciated the homely atmosphere, they felt valued and that they belonged at the home and praised the manager and the staff for the standard of care provided.

The service was previously inspected in May 2016 when it was found to be caring but requiring improvement in all other areas including safe, effective, responsive and well led care.

During this inspection visit we found that some improvements had been made but not sustained, the manager had not always capitalised on opportunities to learn and improve from past events. We identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to safe care and treatment including safe management of medicines, staffing, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of this report.

The atmosphere in the home was welcoming and sociable. People told us that they were well cared for and spoke highly on the manager and staff.

People told us that they felt safe living in the home and staff were committed to providing good standards of care.

Measures designed to reduce risk were not always put into practice so some people remained at risk of harm or their needs not being met.

Safeguarding systems, processes and practices protected people form abuse, neglect, harassment and breaches of their dignity and respect.

There was an adequate number experienced staff on duty but some lacked training knowledge and skill in key areas of their work which meant they were not always sufficiently equipped to meet the needs of the people living at the home.

Care staff told us that they appreciated the support, direction and leadership provided by the manager but there were expected to complete task for which they had not been trained and this was having an adverse effect on morale.

We could see that people were involved in decisions about their care. They told us that staff listened to them and acted on what they said. However, staff needed further training on gaining consent to care and did not always understand the purpose and application of the Mental Capacity Act. .

People enjoyed a varied and nutritious diet, which catered for their individual needs and preferences. They were provided with plentiful drinks, were encouraged to take fluids where required and had access to sufficient drinks throughout the day and at night. People were fully but informally involved in assessing the quality and presentation of meals served, by direct discussion with the cook who was said to be attentive to their needs.

Social activities were organised in the home which were tailored to peoples’ individual needs. They told us that they enjoyed them and there was always something to do.

Staff were aware of the need to support people approaching the end of their life but lacked adequate training and support. Furthermore, care planning arrangements were not always person-centred to ensure the relevant person’s wishes and needs were understood, met and respected.

The home had an effective complaints procedure. People’s concerns and complaints were taken seriously but opportunities to learn from past events were missed and as a result problems were allowed to continue unaddressed.

The home had some quality assurance measures but they failed to identify the areas of concern we identified during our inspection. Additionally, the manager had decided against carrying out a survey of staff, service users, relatives and community care professionals’ views in 2017. Recording of care interventions including food, fluid, administration of medication and repositioning to prevent pressure area damage was inadequate and as a result people were exposed to unnecessary risk of harm.

People, their relatives, friends and staff praised the manager for their leadership, guidance and the way they had involved them in the day to day running of the home.

The service was previously inspected on January 2015 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Hillside Residential Care Home is a residential care home providing personal care and accommodation for up to19 older people. It is a privately owned family run business. The home is situated in Wilmslow and is close to shops and other public amenities with easy access to main road networks. The premise is a two storey building with accommodation on both floors. Some of the bedrooms have en-suite bathroom facilities.

Sixteen people were being accommodated at Hillside Residential Care Home at the time of our inspection.

At the time of the inspection there was a registered manager at Hillside Residential Care Home. 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 registered manager was present during our inspection and engaged positively in the inspection process. The manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors. During the inspection we found Hillside Residential Care Home to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content.

During this inspection visit we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People’s social needs were not being met, effective systems for mitigating risk had not been established and quality assurance and auditing systems were not established or were ineffective. You can see what action we told the registered provider to take at the back of the full version of the report.

People’s social needs were not being met. People told us they were bored and activities did not occur regularly.

The registered provider did not ensure that risk assessments relating to the health, safety and welfare of people using the service were detailed and regularly reviewed.

The service lacked governance systems to assess, monitor and improve the quality of the service. For example, effective systems to seek feedback of the experience of service users were not in place and auditing systems were not robust.

People’s needs were assessed before they came to live at the home; however we found some assessments had not been completed in detail and some risk assessments had not been reviewed for a number of months. Care plans were based on the needs identified within the assessment.

Medicines were ordered, stored, administered and disposed of safely. However we found the registered provider did not carry out an audit of medicines on a regular basis.

People, visitors and professionals gave positive feedback about the compassionate and caring nature of the staff team. Staff were kind and caring and communicated with people appropriately. Staff valued people, showed concern for their well-being and involved them in decisions about their care.

People and visitors knew how to raise a concern or complaint, but said they had not needed to do so.

Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the manager if they had a concern.

Records showed that people had access to GPs, chiropodists and other health care professionals (subject to individual need).

We found that the home was properly maintained and ensured people’s safety was not compromised.

The registered provider had policies in place to safeguard people from abuse; however we found the provider did not have a safeguarding tracking tool in place to log and record any safeguarding referrals/concerns and their outcomes.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

There was a staffing rota in place and everyone we spoke to including staff and people living in the home all felt there was enough staff on duty at any time. All staff felt they received plenty of training and felt competent to do their job. A person living at the home told us 'Yes there are enough (staff) here.'

Is the service effective?

People's needs were being met at the home. We found that people's needs were assessed and care files included information about their diagnosed health conditions and also their preferences. On the day of inspection the care plans were in the process of being re structured which we were told would be completed imminently. We found that mandatory training was up to date.

Is the service caring?

People told us they were happy with the care they received at the home. One person said, "I like everything here and everybody." We observed that staff providing people's care were kind and encouraging.

People appeared to be treated with dignity and the staff could tell us what they were able to do to maintain a person's dignity. One person living at the home told us, "They (the staff) always keep me private.'

Is the service responsive?

People's needs had been assessed before they moved to the home. People's records identified personal preferences and choices and the support that needed to be provided. The home worked with other services to ensure all care needs were met for the person such as a GP or district nurse.

Is the service well-led?

Staff felt listened to and supported by their manager and that her door was always open to them.

There were 19 people living in the home when we visited Hillside Residential Care Home. During our inspection we talked with seven of the people who lived in the home and a relative who was visiting. We also spoke with three members of care staff. We looked at staff rotas and menus as well as care records.

Hillside Residential Care Home had a registered manager but they were not present on the day of our inspection. We were told that they were out of the United Kingdom on holiday. We returned to the home on 4th September so that we could look at more records. We were able to speak to the registered manager on this occasion.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer two of the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found '

Is the service safe?

We found that the staffing levels at Hillside Residential Care Home were not sufficient to provide adequate and safe care for the people who lived in the home.

Is the service caring?

We found that the standard of care recording in the home was not such as to ensure the welfare and safety of the people who used the service. We found that a member of staff did not always treat people with respect when they needed assistance.

This was a responsive inspection to concerning information and we did not look specifically at other areas.

People told us 'It is very satisfactory here' and another said 'They (the staff) are very polite to us here'. A third person told us 'They (the staff) are all very caring ' they treat us with respect'.

We inspected the arrangements for providing people with food and drink. One person told us that it wasn't necessary to provide them with a choice at mealtimes because 'I can eat everything ' I don't need a choice'. Another person told us 'The food is smashing'.

Staff showed us the arrangements for storing and administering medicines. We found that new arrangements had been introduced since we last visited and that these conformed to the regulations. We also looked at arrangements for the training and support of staff. When we asked people who use the service about the staff they told us that they thought they were 'very experienced'.

We looked at arrangements for complaints and saw that a procedure was in place. Although there had been no complaints recorded we suggested that the policy might require some amendment to reflect current arrangements.

People told us that they thought that there had been some staff shortages recently and that this had meant that staff had had to rush at times to complete their tasks but that this had been rectified with new staff being recruited. People told us that there was a good cook and that they enjoyed the food but we did not see people exercising choice over their meals.

The bedrooms that we saw were pleasantly decorated and roomy. We saw that communal areas were homely. People told us that standards of cleanliness in the home were good following the appointment of a new housekeeper.

We saw that the staff were friendly, treated people with respect, and interacted and engaged on an individual basis with people using the service.