Archived: Hillersdon Court

We found the following examples of good practice.

Current guidance was being followed in relation to infection prevention and control. Personal protective equipment (PPE) was available throughout the home and staff were wearing PPE appropriately. Visiting was in line with government guidance, anyone entering the home carried out a Lateral Flow Covid-19 test, temperatures were taken and PPE provided.

The manager had a programme in place to ensure people and staff were tested regularly. The manager spoke highly of staff, and was proud of the hard work and commitment staff had maintained at the home throughout the Covid-19 pandemic. Although five staff had tested positive to Covid-19 since the beginning of the pandemic, no people living at the home had been affected.

Staff were supporting people to remain safe, however, due to people’s dementia and memory loss it was not always possible to ensure people remained socially distanced. The manager had made some changes to seating arrangements in the dining room to support this. Cleaning schedules were in place, this included regular cleaning of high touch areas around the home to help prevent the spread of infection.

The manager had a comprehensive oversight of Covid-19 related risk. Risk assessments had been completed by the manager to maintain people’s safety and the safe running of the service. This included individual risk assessments for people with underlying risk, for example pregnancy and age. A contingency plan was in place in the event that an outbreak should occur.

Hillersdon Court accommodates up to 20 people who require assistance with personal care. The service specialises in providing support to older people and people with dementia. At the time of this inspection 15 people were living in the service. People had varying levels of care and support needs. Some people were independently mobile and others required assistance with all aspects of their care. The home was on two floors with seven bedrooms on the ground floor and 11 bedrooms on the first floor.

There was a registered manager in post. ‘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.’

At the last inspection in January 2017 the home was rated requires improvement, there was a breach of regulation and a requirement notice was issued. The breach was in relation ineffective systems to assess and monitor the quality of services and in relation to record keeping. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in well-led to at least good.

We carried out this inspection to check the provider had made suitable improvements and to ensure they had met regulatory requirements. We found improvements had been made in relation to the areas identified at the last inspection but we made a recommendation to improve record keeping.

There were good recruitment procedures and enough staff to meet people’s individual needs. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Incidents and accidents were well managed. People’s medicines were managed safely.

People’s needs were effectively met because staff had the training and skills they needed to do so. Staff were well supported with training and appraisal. Staff supported people in the least restrictive way possible. People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them. People were supported to attend health appointments, such as the GP or dentist. People had enough to eat and drink and menus were varied and well balanced. Feedback from visiting professionals was very positive. One professional told us, “I have always found that the staff at Hillersdon are friendly and appear to go about their business in a caring and professional manner.”

People were supported to take part in a range of activities and regular one to one time was provided to people. Visitors told us they were welcomed and people were supported to maintain important relationships and friendships.

The environment was clean and well maintained. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks were all up to date. There were on-going improvements to the environment, for example the dining room and lounge areas had been swapped and feedback received regarding this change had been very positive.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis. People and relatives were given information on how to make a complaint and said they would be comfortable raising a concern or complaint if they needed to.

Hillersdon Court provides accommodation for up to twenty older people, some of whom are living with dementia. At the time of our inspection there were 18 people living at the service. People had varying levels of care and support needs. Some people were independent with regards to their mobility and others required assistance with all aspects of their care. The home was on two floors with seven bedrooms on the ground floor and 11 bedrooms on the first floor. The ground floor also included a kitchen, the dining room, a communal lounge with access to the garden and an office.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Throughout our inspection, people spoke positively about the home. Comments included, “We are happy living here.” and, “The staff are very caring and patient to everyone in the home.” Although staff and managers knew people well and had a good understanding of their individual needs and choices the lack of consistent recording of information meant people’s records did not always reflect the care they required or received. People’s individual risk assessments and care plans were person-centred and reviewed monthly however these were not always updated to ensure that people received care based on their current needs.

Aspects of medicine management needed to be improved. There was no guidance for staff to understand where to apply topical creams and a lack of clear person centred PRN guidance to ensure that people only received these medicines when they needed them.

People told us they felt safe living at Hillersdon Court. There were sufficient levels of staff to protect people’s health, safety and welfare. The provider had recently increased staffing levels based on the increased dependency of people’s needs.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. Staff encouraged and supported people to eat and drink well. One person said, “I thoroughly enjoy the food here.”

Staff knew the individual personalities of people they supported. We saw staff were kind, compassionate and patient and promoted people’s privacy, dignity and choice. People were encouraged to be as independent as possible and we saw friendly and genuine relationships had developed between people and staff. A staff member told us, “We know the residents like family. I love working here.”

Training schedules confirmed staff had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected. Staff had received regular supervisions with their manager to discuss additional training needs and development and annual appraisals.

Robust recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. Staff received an induction followed by a week of shadowing experienced staff.

People’s health and wellbeing was monitored and staff regularly liaised with healthcare professionals for advice and guidance. A healthcare professional told us, “They are very responsive and proactive. If they have any concerns they are on the phone straight away.”

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place. The registered manager was familiar with the processes involved in the application for a DoLS, and had made the necessary applications to the authorising authority. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure decisions were made in the person’s best interests although these had not always been recorded.

People’s friends and family were made welcome and relatives spoke positively about Hillersdon Court. One visitor told us, “People are well cared for and we always receive a warm welcome from staff.”

During this inspection we found that significant improvements had been made throughout the home and people who used the service stated they were happy with the changes. One person told us "'It's lovely here now, so much brighter everywhere'.

We found that comprehensive and well maintained person centred support plans enabled care workers to meet people's assessed needs in a structured and consistent manner.

Care workers had developed awareness and a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

In accordance with their individual care plans, people were supported to make choices about their daily lives. They had input into how the home was run and were able to influence decision making processes.

Positive comments from people using the service indicated satisfaction with the home and the services provided:

'I'm happy living here. I'd rather be in my own home of course but it's comfortable here, the food's good and the staff are all so caring'.

'There is everything I need here and always company when I need it. I like my room and the staff are very kind'.

Appropriate arrangements were in place in relation to storing, administering handling and recording medicines.