Wall Hill Care Home Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Inadequate. At this assessment the rating has changed to Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was previously in breach of the legal regulation in relation to safe care and treatment and safeguarding people from abuse. Improvements were found at this assessment, and the provider was no longer in breach regulation relating to safeguarding people from abuse, but not enough improvements were not found at this assessment relating to safe care and treatment. Therefore, the provider remained in breach of this regulation.

This service scored 59 (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 did not consistently demonstrate a proactive and positive safety culture. Although improvements had been made since the previous inspection, particularly within the analysis of incidents and accidents, further progress was needed when recording staff debriefs and follow-up actions following incidents involving distressed behaviours.

Since the last inspection, the provider had implemented a range of systems and processes in response to the concerns we raised, and many lessons had clearly been learned. However, some key areas still required attention. Care plans were not always updated to reflect people’s current needs, and support for oral health was not consistently recorded. In response to our feedback, the provider introduced new systems and processes, which we will review during the next inspection.

Relatives shared positive feedback about how the provider responded to accidents. One relative described a health emergency their family member experienced, they told us, “The provider handled this emergency really well and kept us informed.”

Staff reported that incidents and accidents were routinely shared during handovers and team meetings, supporting ongoing learning and communication.

The provider did not consistently manage or monitor people’s safety.

Whilst improvements had been made to monitoring systems, particularly regarding people’s fluid intake, nutrition, and repositioning needs, further improvements were needed when monitoring people’s weight and catheter care.

In response to our feedback, the provider introduced new systems aimed at addressing these areas. We will assess the effectiveness of these systems during our next inspection.

People told us they felt their health was monitored safely by staff. One person said, “Staff look after me here. They [staff] are always making sure I’m happy and have enough to eat and drink.”

Staff described how they used the systems in place to monitor people’s needs. One staff member explained how the system prompted them when someone needed to be repositioned, helping ensure timely and safe care.

The provider did not always share concerns in a timely or appropriate manner. Since the last inspection, there had been notable improvements, particularly around incident monitoring and making referrals to the safeguarding team. However, further improvement was needed when escalating concerns to healthcare professionals. For example, 1 person had experienced significant weight loss. Although the provider had raised a safeguarding referral earlier in the year and escalated the issue to relevant professionals, the person continued to lose weight. Additional escalation should have occurred to ensure the concern remained actively addressed. Following our feedback, the provider raised a further safeguarding referral and re-escalated the issue with professionals.

People told us they felt safe living in the home. Staff were able to describe how they would report concerns. One staff member said, “If I saw anything concerning, I’d go to the senior on duty. If they didn’t act, I’d escalate it to the manager, and if needed, I’d take it further to the safeguarding team or CQC.”

The registered manager submitted Deprivation of Liberty Safeguards (DoLS) applications for people who required this level of protection.

Staff did not always deliver care in a way which met people’s needs safely or ensured risks were consistently managed. Since the last inspection, there had been noticeable improvements, particularly in supporting people to make their own decisions and take positive risks. However, further development was needed in documenting when people placed themselves at risk by declining care.

For example, 1 person’s weight was meant to be recorded weekly, but there were gaps in the records. The provider explained the person often declined to be weighed, though this was not documented. Similarly, records of oral care support were incomplete for some people, making it unclear whether care was declined or not provided. The provider responded to our feedback by introducing new monitoring systems.

People told us they were supported to make their own choices. One person said, “I can get up when I want to. I normally get up early, but I can stay in bed if I want to. Staff will bring me a cup of tea.”

Staff described how they supported people’s choices and decision-making. Where people lacked capacity, staff explained best interest decisions were made. One staff member shared an example, “People have a choice, if they want to get up, we support them. Sometimes [person’s name] likes to sit up with us during the night, it’s up to them.”

The provider identified and managed potential risks within the care environment effectively. Equipment, facilities, and technology supported the safe delivery of care.

Relatives told us the home felt safe and welcoming. One relative commented, “The home is clean, it’s a nice environment. There have been some refurbishments recently, it’s looking much better.”

Staff shared they had recently received support from visiting health professionals, who assessed each person’s needs to ensure they had appropriate equipment in place.

Health and safety checks and audits were carried out regularly to monitor and maintain a safe environment.

The provider ensured there were enough qualified, skilled, and experienced staff on duty to safely support people. Staff worked well together to deliver care that met people’s individual needs.

People and relatives told us there were enough staff available. One relative said, “Staff are very respectful, there seems to be plenty of them. They always come quickly if we need them.”

Staff told us staffing levels had improved since the last inspection. One staff member said, “There are enough staff on duty. In the past, there weren’t enough. Now we have more time to carry out activities with people. It’s really nice, the best part of the job is having time to sit and engage with people, doing things they enjoy.”

The provider used a dependency tool to determine appropriate staffing levels. This tool helps assess people’s needs and calculate the minimum number of staff required to support them safely. The provider had increased staffing further to allow time for staff to engage in meaningful activities with people.

Staff were recruited safely and received training and supervision to support their roles.

The provider assessed and managed infection risks effectively. They identified potential issues, controlled the risk of spread, and shared concerns with appropriate agencies promptly.

Relatives told us the home was clean and well maintained. One relative said, “[My family member] always seems clean and well presented. Staff are always around cleaning. The home is very clean.” Another relative said, “The cleanliness of the building has much improved.”

Staff explained the home was cleaned regularly, and we observed staff carrying out cleaning tasks and wearing appropriate personal protective equipment (PPE) when required.

Cleaning audits and checks were in place to monitor the home and reduce the risk of infection.

The provider did not always ensure medicine records accurately reflected people’s current needs.

There had been several improvements since the last inspection, particularly in the management of time-specific medicines and the safe storage of medication. However, discrepancies remained between the medicine sections in care plans and the actual medicine administration records, as previously identified during the last inspection.

In one instance, a person’s medical allergies were noted in a health professional’s letter but had not been updated in their care plan or medical records. The provider responded promptly by updating the relevant documentation.

Despite these issues, people told us their medicines were managed safely. One person said, “Staff help me to remember to take my tablets.”

Staff spoke about the importance of administering medicines at the correct time and described how some people needed to wait 30 minutes before eating after taking their medication.

An observation of medication administration showed people received their medicines safely, and medicines were stored securely. Medication Administration Records (MAR) matched the correct quantities, and storage practices followed manufacturer guidance.