Wall Hill Care Home Limited

Wall Hill Care Home is a residential care home providing regulated activity to up to 35 people. The service provides support to people living with dementia and physical disabilities. At the time of our inspection there were 27 people using the service.

Wall Hill Care Home accommodates people in one adapted building across 2 floors. There are 2 communal lounges and a dining room that people can access.

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

People were not always safeguarded from abuse and avoidable harm. Where safeguarding concerns were identified, they had not always been escalated to the local authority as legally required. Medicines were not always administered safely. For example, 1 person had received an overdose, but it had not been identified by quality checks. The provider did not always learn lessons when things went wrong.

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. However, the policies and systems in the service did not always support this practice as they failed to identify where Deprivation of Liberty Safeguards (DoLS) authorisations were not up to date. The provider addressed this immediately following the inspection and DoLS authorisations have now all been applied for.

The registered manager was not always clear about their role and responsibilities. For example, the provider did not always submit statutory notifications to CQC in line with their regulatory requirements. Audits were not always effective in checking the quality of the service. For example, checks did not identify where statutory notifications and safeguarding referrals had not been submitted. Quality checks of medicines did not always identify medicines errors or where stock counts were high. Systems were not in place to analyse accidents and incidents to enable the provider to identify trends. Staff were given the opportunity to provide feedback through surveys and team meetings, but their feedback was not always acted on quickly. The nominated individual had identified training opportunities, but further delegation was needed to ensure sufficient daily oversight of the home.

People told us they felt safe. Staff knew the types of abuse and understood how to share safeguarding concerns. Controlled drugs were stored and administered safely. Risk assessments were in place to guide staff how to meet people’s needs safely and mitigate risk to them. Staff were knowledgeable about how to manage people’s risks. People were supported by a sufficient number of staff to meet their needs safely and did not have to wait for their care. The home was clean and staff wore Personal Protective Equipment (PPE) in line with current guidance.

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 (published 24 June 2022).

Why we inspected

The inspection was prompted in part due to concerns received about risk management and the governance of the service. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to medicines, safeguarding and the governance of the home at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wall Hill Care Home is a residential care home providing personal care for up to 35 people. The service provides support to older people over 50 years with physical disabilities and dementia. At the time of our inspection there were 24 people living in one adapted building.

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

We have made a recommendation about gaining people’s views on the service.

Improvements were needed to quality assurance systems as they were not always effective in supporting management to identify errors. Care file audits needed completing more frequently to identify where information needed updating to ensure staff were able to support people in line with people’s needs. Risk assessments were in place, but some needed more information to enable staff to better support people. Statutory notifications were not consistently being sent to the Care Quality Commission (CQC).

There were enough suitably trained staff to safely support people. Recruitment was on-going, and agency staff were used if necessary. Staff understood how to protect people from abuse. Infection prevention control measures were in place and staff wore PPE and tested in line with current guidelines to prevent the spread of infections.

The provider had taken action to ensure the building was safe for people and plans were in place to continue to make required changes for people’s safety.

Lessons were learned when things went wrong and there was a positive culture around continuous learning.

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.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 29 January 2020).

Why we inspected

We received concerns in relation to the management of the service and wanted to be assured actions had been taken following a serious incident to ensure the premises were safe for people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has not changed following this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wall Hill Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wall Hill Care Home Limited is a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 35 people.

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

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 (published 28 January 2020).

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

We undertook this targeted inspection to check on a specific concern we had about people’s safety and oversight in relation to the environment, specifically window restrictors. Targeted inspections do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. During this inspection we reviewed the part of the key questions of Safe and Well Led.

The overall rating for the service has not changed following this targeted inspection and remains good.

During this inspection we found the provider was not compliant with current guidance in relation to window restrictors in care homes. This placed people at risk of harm. The provider took immediate action during and following the inspection to make changes to the environment to reduce risks to people’s safety.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wall Hill Care Home Limited is a residential care home providing personal and nursing care to 29 people aged 65 and over at the time of the inspection. The service can support up to 35 people in one adapted building.

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

People were supported by safely recruited staff, who had the skills and knowledge to provide effective support. Staffing levels were reviewed to ensure there were enough staff available to meet people’s needs. People’s medicines were managed safely, and staff followed infection control procedures.

Effective care planning and risk management was in place, which guided staff to provide support that met people’s needs and in line with their preferences. 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.

People had access to healthcare professionals and were supported with their nutritional needs. There were systems in place to ensure people received consistent care and support.

People were supported by caring staff who promoted choices in a way that people understood, this meant people had control and choice over their lives. Staff provided dignified care and respected people’s privacy. People’s independence was promoted by staff.

People were involved in the planning and review of their care and received support in line with their preferences. Information was provided in a way that promoted people’s understanding. There was a complaints system in place which people understood. People’s advance wishes were sought.

Systems were in place to monitor the service, which ensured people’s risks were mitigated and lessons were learnt when things went wrong. People and staff could approach the management team who promoted an open culture. Staff and management were committed to providing a good standard of care with people’s needs being at the heart of the service.

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 Requires Improvement (published 25 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

What life is like for people using this service:

At the last inspection in February 2017, the service was rated as Requires Improvement overall, with breaches of the regulations in relation to medicines management, the safety of the environment and ineffective quality assurance systems. The provider wrote to us to tell what action they would take to comply with these regulations. At this inspection, we found that the provider had made considerable improvements and there were no longer breaches of the regulations. However, we found new areas for improvement and the service remains ‘Requires Improvement’. This is the third time the service has been rated as ‘Requires Improvement’.

Staffing levels were sufficient to keep people safe. However, staff were continually busy and were unable to deal effectively with unexpected situations while continuing to meet other people's needs in a timely manner. People’s lunchtime experience was compromised because staff were not always available to serve meals and provide support and encouragement. Whilst the provider had improved the effectiveness of their quality assurance systems, they had not recognised the need to continuously assess, monitor and review staffing levels to ensure they were sufficient to meet people’s needs at all times. We have made a recommendation that the provider sources a system that meets best practice guidance.

Although staff were stretched and could not always spend a meaningful amount of time with people, we received positive feedback from people and relatives about their relationships with staff. We saw that staff were kind and caring but on occasions, staff did not recognise that their actions failed to promote people’s privacy and dignity. Improvements were needed to ensure the provider’s training and support for staff was in line with best practice and underpinned by the key values of kindness, respect, compassion and dignity in care.

People were protected from the risk of harm by staff who understood their responsibilities to identify and report any signs of potential abuse. Risks associated with people’s care and support were managed safely. People received their medicines as prescribed. Significant improvements had been made to ensure the environment was safe for people and the provider had considered the needs of people living with dementia in the adaptations and décor.

People were supported to have choice over their daily routine. However, when people lacked the capacity to make certain decisions themselves, people were not always supported to have maximum choice and control of their lives. The registered manager and staff did not fully understand the legal requirements and did not always support people in the least restrictive way possible; the policies and systems in the service did not support this practice. We have recommended the provider researches current guidance to ensure they meet legal requirements.

People did not always receive personalised support and their care plans did not always reflect their preferences. People had discussed their care needs when they moved to the service. However, we found people’s likes, dislikes and preferences were not always recorded and people were not supported to engage in reviews of their care plans, to ensure they continued to reflect their preferences.

The service worked well with other organisations and health and social care professionals were positive about the registered manager and staff. People were supported to have a varied and healthy diet and to access other healthcare professionals to maintain good health.

There was a positive atmosphere at the service. The management team and staff were approachable and people felt able to raise concerns and complaints. People and relatives were asked for their feedback on the way the service was run. The provider acted on their comments to make improvements to the service where possible.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement (report published 28 April 2017).

About the service:

Wall Hill Care Home provides accommodation and personal care for up to 35 older people and people living with dementia. The service is provided in an adapted property, with four communal lounge areas, a dining room and bedrooms on both floors. There is a small garden at the rear of the property. On the day of our inspection there were 34 people living there.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: As this is the third time the service has been rated as Requires Improvement, we will request an action plan from the provider following this report being published to demonstrate how they will make changes to improve the rating of the service to at least Good. We will revisit the

service in the future to check if improvements have been made.

Wall Heath Residential Care Home provides accommodation and personal care for up to 34 older people and for people living with dementia. On the days of our inspection there were 32 people living there.

At our last inspection on 27 April 2015, the provider was in breach of regulations 11, need for consent, 12 safe care and treatment and 14, meeting nutritional and hydration needs. The provider sent us an action plan to tell what measures they would take to comply with these regulations. At this inspection we saw improvements had been made. However, there were areas that needed to be reviewed and improved to ensure people received a safe service.

The home has not had a registered manager for week. An acting manager was in place who told us they had submitted an application to be registered with us. 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.

Since the last inspection improvements had been made to ensure practices safeguarded people from the risk of potential abuse. People told us they felt safe living in the home and there were enough staff to care for them. However, some medication practices were unsafe and placed people at risk of harm.

People were placed at risk of harm because systems and practices exposed them to dangerous cleaning chemicals. Staff did not have access to appropriate lifting equipment which placed people and staff at risk of injury. Accidents were recorded, monitored and action was taken to avoid a reoccurrence.

Since our last inspection staff had a better understanding of the Mental Capacity Act and the Deprivation of Liberty Safeguards [DoLS]. However, there are areas that could be improved to ensure practices do not compromise people's human rights. Improvements had been made to ensure people’s meal preferences were catered for. People were supported by staff who may not be suitably skilled but they did receive regular one to one [supervision] sessions. People were supported by staff to access relevant healthcare services when needed.

People were at risk of receiving unsafe and an ineffective service because the provider’s governance did not assess or monitor the service provided to people. Meetings were carried out to enable people to tell the provider about their experience of living in the home. People were aware of the management team and staff felt supported by the managers to carry out their role.

People received care and support from staff who were caring and compassionate. People’s involvement in their care planning ensured their specific needs were met in a way that promoted their privacy and dignity.

People were actively involved in their care assessment and were provided with opportunities to pursue their interests. However, the environment was unsuitable for people living with dementia which may add to their confusion. People were able to maintain contact with people important to them. People felt confident to share their concerns with the managers which were listened to and acted on.

You can see what action we told the provider to take at the back of the full version of the report.

People who used the service who told us they were happy with the care they received. One person told us, 'The staff and the service are very good'. Another person told us, 'They treat me very well and staff always listen to what I say'.

We saw that the provider had systems in place that prevented the risk of cross infection. We saw staff used protective equipment and staff we spoke with understood the importance of infection control. People who used the service told us that staff wore gloves and aprons and the service was always kept clean.

Staff we spoke with felt supported by the provider. Staff told us they received regular appraisals and training to carry out their role.

The provider had a system in place to record and investigate complaints about the service. People we spoke with told us that they knew how to make a complaint and any issues were acted upon.

At this inspection we saw that the provider had put systems in place to ensure that we were notified of any deaths or serious incidents to people who used the service.

People received care to meet their individual needs. People told us that they were happy with the care provided and that staff listen to peoples wishes and were treated in a dignified way when providing support. People who used the service told us, "Staff treat me respectfully".

We saw that people who used the service enjoyed mealtimes and specific dietary needs were take in to account by the provider and monitored regularly.

We spoke with staff who were aware of their responsibilities to keep people who used the service safe from harm. People we spoke with told us, "I feel safe and comfortable here" and "I would speak to the manager if I wasn't be treated right".

The provider had a suitable system in place to ensure that the staff employed were suitable to work with vulnerable adults and staff employed at the service had received appropriate training.

The provider had effective systems in place to gain the views of people who used the service and made improvements when required.

The provider did not have suitable arrangements in place to inform the Care Quality Commission of any deaths or other incidents that had occurred to people who used the service.