Hillbeck Residential Care Home

On this page

• 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 good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events.

There were robust systems in place to analyse incidents, to identify any contributory factors, and learning that could be taken to prevent these from reoccurring. Learning was shared with staff through handovers and regular team meetings, so that these could be discussed and improvements embedded in people’s care. After incidents such as falls or incidents between people, their care plans were updated with revised guidance and strategies for staff to protect people from harm as well as referrals to other stakeholders.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There were clear pathways in place of how staff should respond if people’s health needs changed or deteriorated. This included making referrals to other health or care professionals to ensure they received additional support to stay healthy and well. Stakeholders told us the systems had strengthened since the last inspection, and that the provider were proactive in contacting them if they were concerned about people’s wellbeing. One professional working with the home told us, “They are much more proactive, and we are contact with them daily. They always let us know if they are concerned about somebodies’ weight or if there has been a fall. The care staff themselves now feel more empowered to raise their concerns directly, rather than everything going through the manager.” We saw referrals were being made proactively, for example to ‘Speech and Language Therapy’ if people had lost weight to explore the causes of this and put in place strategies to ensure people received the nutrition they required.

The provider did not always work with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff did not always concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Where the risks to people were deemed sufficient that restrictions such as living in secure accommodation were needed, to ensure their safety, appropriate authorisations were not always sought and recorded.

Improvements were needed to ensure certain restrictions in place were in individual people’s best interest and that these decisions were clearly documented. The majority of people’s rooms were locked during the day and people did not have access to their own key. Even though most people could not independently walk to their rooms and staff could unlock these for them other alternatives had not been fully considered and this restriction was nor appropriately documented. Following the inspection, the provider put an alternative measure in place to ensure that people’s doors could remain unlocked. A small number of people also had door gates on their rooms which had similarly not been assessed or documented. These matters were addressed during the inspection once raised.

However there was positive safeguarding culture where all staff were trained and knowledgeable about their duties to keep people safe from harm. Where people were at greater risk of abuse or neglect, there was guidance in place about how that risk could be reduced to protect people. Where instances of abuse occurred or there was concern that it may have happened, the provider reported these concerns accordingly to the local authority and CQC in line with their responsibilities.

The provider worked with people to understand and manage risks by thinking holistically. Staff did provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people were clearly documented, assessed and measures put in place to ensure people’s safety. There was clear guidance in place for each person which was regularly reviewed and staff were knowledgeable about. For example, where people were at greater risk of falling there was guidance and adapted equipment in place to help people mobilise safely. If people had a risk of their skin deteriorating, there were systems including repositioning and regular application of creams to ensure people’s ongoing skin health. People and relatives told us that they felt risks were well managed with one relative telling us, “I have no concerns, if I had I would find someone or email and follow it up.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The care environment did not consistently support the sensory or cognitive needs of people, including those living with dementia.The communal areas in parts of the building were not being used during our inspection, and the majority of people were seated in a shared lounge and dining area. There was a very busy space with lots of noise and foot fall, as well as loud activities taking place whilst other people were trying to rest. This meant the service did not always promote people’s comfort and safety as overly noisy or busy environments can trigger emotional distress or anxiety for people. In particular for those with a sensory impairment or for those living with dementia.

The building itself was well maintained. There were regular checks to ensure the safety of equipment used, as well of important utilities such as electricity, gas and water. Any areas of concern or where repairs were required were promptly identified and resolved.

The provider made sure there were enough qualified, skilled and experienced staff.

There were sufficient staff employed to meet people needs, and feedback from staff, people and relatives were that this ensured support was provided in a timely way. One staff member told us “At night there are less staff than before, but we work as a team. The best thing about here is teamwork.” Another staff member told us, “Initially it was difficult when numbers were reduced but I think things are settled now.” We did not identify an impact on people receiving the care they required which was echoed by people and relatives. One relative told us “Yes (there are sufficient staff), I can always find somebody to get an update”.

Staff were knowledgeable about the people they supported and received training on how to do so safely. Their competency to perform complex tasks such as moving and handling and to administer medications were regularly assessed to ensure their safety to do these. Staff felt they received a good quality induction and support when they joined the service with one staff member telling us, “The training was brilliant. They are very supportive of new staff to learn at their own pace.”

There were robust recruitment processes in place including use of Disclosure and Barring Service (DBS) checks. These are checks against national police records to support providers in making safer recruitment decisions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was a good level of cleanliness through the service which was regularly checked to ensure this remained the case. Staff were trained and knowledgeable about how to keep people safe from infection. People were supported to maintain their personal hygiene, and where people might neglect elements of personal care staff told us about different strategies they had in place to encourage this.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People did not always receive their medicines safely and in accordance with the providers policy or good practice guidance. For example, one person was prescribed medications to be given during periods of emotional distress that had a sedative effect, it was not always recorded what other less restrictive options had been explored first. However, staff could clearly explain the other strategies they would use and there was clear guidance around this. Stock control also needed to be improved for certain liquid medications to ensure people were not receiving out of date medication that would be less effective. Improvements were made immediately once issues were identified.

The provider conducted regular medication audits to monitor how these were being managed, which was effectively identifying areas for improvement. People were supported by staff who were trained and competent to administer medications safely. The majority of areas of medication practice were undertaken safely to ensure people received the medication they needed, when they needed it. After the inspection, the provider requested a pharmacist to review all people’s medication to ensure they all remained necessary.