Hill House

Updated 9 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Hill House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hill House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The nominated individual had submitted an application to register with CQC. We are currently assessing this application.

Notice of inspection

This inspection was unannounced. Inspection activity started on 22 February 2023 and ended on 3 April 2023. We visited the home on 22 February, 9 March, and 22 March 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and commissioners of the service. We used information gathered as part of a monitoring activity completed on 8 February 2023 to help plan the inspection and inform our judgements. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During our visits we used observations to help us understand the experience of people who could not talk with us. We spoke with 5 people who received the service, and 5 of their relatives. We received feedback from 4 external professional who had contact with the service. These included the local authority, a GP, a Fire Safety Inspector, and a trainer. We spoke with 12 members of staff. These included care staff, agency staff, senior care staff, catering, domestic and maintenance staff. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. These included sampling 9 people's care records, multiple medication records, and 3 staff files in relation to recruitment checks. We also looked at a variety of records relating to the management of the service, including staff rotas and training records, meeting minutes, audits, quality assurance reports, and action plans.

Updated 9 June 2023

About the service

Hill House is a 'care home' providing personal care up to a maximum of 37 people. The service provides care for younger and older adults, some of whom live with dementia, in one adapted building. There were 25 people living in the home on the first day of our inspection, 23 on the second, and 22 people thereafter.

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

The service was not well-led. The provider had failed to carry out their regulatory responsibilities. They did not have effective quality monitoring procedures in place to identify shortfalls and drive improvements in the service people received. This exposed people to significant risk of harm. The provider failed to deliver safe, person-centred care and had not made improvements they said they would make.

The provider did not safeguard or protect people from harm. They had not referred all potential safeguarding events to the local authority in line with protocols. Staff did not ensure people received care and treatment in a safe and effective way. We found multiple failures in the safe use of medicines.

Risks to people's safety were not fully assessed or reduced. Staff did not support people to move safely. Systems were not followed to help maintain people’s skin condition. Staff did not follow the provider’s policy in relation to falls, and emergency healthcare was not sought promptly in line with this. Fire related risks were not well-managed, people had access to substances hazardous to their health, and the home was not clean nor well-maintained. This placed people at risk of harm.

The provider’s systems did not enable staff to effectively identify and manage people's dietary needs. This put people at risk of not receiving sufficient or appropriate food and fluids.

People’s care needs were not effectively assessed or reviewed and care was not planned in line with best practice guidance. Care plans were contradictory and not updated to reflect people’s changing needs. They did not contain enough personalised information to support staff to respond to people’s needs safely and effectively. Gaps in care records meant we could not be assured care had been carried out as planned.

Staff had not received effective training or regular supervision. This resulted in staff not having the skills to meet people's needs and we found multiple areas of poor practice.

People were not always treated with dignity and respect. We saw many missed opportunities for people to be involved in decisions about their care. Opportunities for people to be involved in social engagement and activities were limited. People were not consistently 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.

People liked the food and the staff. Some staff interacted with people in a kind and caring way. Relatives told us they felt involved in their family member’s care, and staff kept them up to date if anything changed.

The nominated individual was receptive to our findings and suggestions. They stated a commitment to improving the service through greater oversight and governance to ensure people received safe care that met their needs and wishes. They had started to implement new quality audits during our inspection. However, these needed time to be implemented and to become embedded in practice.

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 (report published 30 May 2018).

Why we inspected

The inspection was prompted in part due to concerns about safeguarding people from harm, safe care, staff training and support, nutrition and hydration, person-centred care, privacy and dignity, poor maintenance and cleanliness, and good governance. We reviewed of the information we held about this service. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse, safe care and treatment, staffing, nutrition and hydration, person-centred care, premises and equipment, consent, dignity and respect, and good governance at this inspection

Please see the action we have told the provider to take at the end of this report.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.