Wall Hill Care Home Limited

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service continued to be in breach of a legal regulation in relation to people receiving person-centred care.
 

This service scored 45 (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 always treat people with kindness, empathy and compassion. Although people’s dignity and privacy were respected.
People told us staff treated them kindly. One person told us, “I like living here. The staff are nice. They help me.”
Staff told us they always knocked on people’s door before entering and asked people for permission to enter their room.
However, whilst we observed many instances of kindness displayed by staff towards people, we observed 1 staff member respond inappropriately to a person who was displaying distressed behaviour. We also observed another staff member leaving a person in a state of distress and only returned when another staff member came to assist the person. The registered manager investigated both instances and followed their disciplinary procedure.
 

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences.
We received mixed feedback from people regarding being treated as individuals, 1 person told us, “Staff ask me if I'm okay and ask me what I want to do, but there’s not a lot to do here though.” Another person told us “I want to be more independent; I want to be able to do more.”
We observed staff adapting their communication to meet people’s understanding. One staff member told us, “I love coming into work. I love the place. The [new] manager is trying to do the right things, but we need more permanent staff. The problem is with agency staff, they don’t communicate well with people.”
Whilst each person had their own care plan, we raised concerns over care plans not being reflective of people’s current needs. These were at times outdated and required updating. The manager told us they were in the process of updating all people’s care plans, during the site visits they showed us some of the updated care plans, which were much more individualised and current with people’s care and support needs. By the end of the inspection, the provider told us the manager had updated all identified care plans.
 

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.
People told us there were not many activities to engage with. One person told us, “It's okay living here, I feel safe but it's a bit boring. The TV is always on but there's not much to do.” Another person told us, “There is not a lot going on here”. Staff told us they did not have the time to carry out activities with people. One staff member told us, “There is not enough activities taking place. We are supposed to do activities, but we don’t always have time, it’s fitting it in. We do try sometimes; we just have not got the time.” Another staff member told us, “Staffing issues makes it difficult; we have been very low staffed at times.” A further staff member said, “I wouldn’t put my family in here as there are not enough activities.”
We reviewed daily notes for people who were being cared for in their bedrooms, staff recorded task orientated notes, such as support with personal care and repositioning, although there were limited recordings of social engagement. The registered manager told us they were working with staff to improve their recording skills.
We carried out observations and commented on the lack of meaningful activities taking place and the opportunities for people to engage in positive risk taking. We observed one person being encouraged to fold napkins, however there were limited activities and independence skills being promoted throughout both days of our visit. The provider responded to our feedback by explaining staff carried out regular activities with people and encouraged people to take part in activities of daily life, such as setting the table and making drinks, but staff did not always record this. The provider told us they planned to work with staff to improve daily records.
We raised concerns over the number of people receiving a shower. In 1 week, 5 people out of 31 people had been recorded as being supported to have a shower or bath. This meant we could not be assured people were receiving regular personal care. The provider told us this was due to people’s choice, although the provider was experiencing issues with the water temperature controls in the baths, they were trying to resolve this. However, this meant people’s personal care preferences could not always be met.
Staff shared their concerns with us regarding the equipment available when supporting people with their personal care. Staff told us they were expected to use one face cloth for washing rather than 2 (1 for the top part and another 1 for the lower part of a person’s body) and they said the larger bath towels were in poor condition. The provider told us there were 2 face cloths available per person and additional were available in the cupboards, although the provider did not share whether these concerns had been discussed with the staff team. This meant we could not be assured people were supported to have an enjoyable personal care experience.
 

Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.
We observed people shouting at other people living in the home. One person cowered behind a book as they were shouted at by 2 other people. Another person was accused and threatened repetitively throughout the first day of our inspection. At times, staff continued with their tasks and did not challenge these behaviours. We had to ask staff to intervene on behalf of people.
One person told us they felt uncomfortable due to 2 people displaying intimate behaviours in a communal room. We observed these behaviours and requested the risk assessment for the person who appeared to instigate the behaviour. This recorded staff were to prompt the person when they showed inappropriate behaviour in public. We did not see staff prompting the person. Whilst a staff member was supporting a person to sit into a chair, we observed the staff member leaving the person when they were bent over a table holding onto the table, the person was shouting out in pain. We raised a safeguarding referral for this person. We observed an agency staff member causing accidental pain to a person when waking them up in a communal room due to not being aware of their current health condition. This meant the provider did not effectively handover risks associated with people’s health to staff on duty. The new manager responded to our feedback by introducing a new agency staff member induction document.
Staff told us how they supported people’s immediate needs such as continence care and repositioning. However, we observed 1 person had been left in the same chair throughout the first day of inspection.
One relative told us the provider responded appropriately when their family member experienced a fall.

The provider did not always support staff wellbeing and enablement.
The registered manager told us staff received regular supervision, although we saw no evidence of this. Three staff told us they had not received a supervision. One staff member did not know what supervision was and needed this to be explained to them, they then told us they had not received supervision. We observed minutes from a senior meeting, where all senior staff were asked if they had received their supervision. The minutes recorded all senior staff had said ‘no’.
However, staff told us they felt supported by the [new] manager. One staff member told us they had seen improvements since the [new] manager started and felt able to approach the [new] manager to address any concerns. Another staff member told us about the positive support they had received from a member of the management team when they had needed support.