Archived: Hilbre House

We found the following examples of good practice.

Family members were provided with guidance to follow good infection control practices.

Staff wore appropriate personal protection equipment (PPE) in line with guidance.

The provided had developed an action plan and had made improvements to their practices following feedback from the local infection control team.

The provider had an appointment system in place for people to be able to receive visitors safely.

Staff carried out regular cleaning in line with the provider’s cleaning schedule.

The provider assessed the risks of COVID-19 to people living in the home.

Staff had access to PPE throughout the home.

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

There was no staff team at Hilbre House. Nearly all the staff who had been working at the home had recently left their employment. The provider put in place an interim emergency rota for care staff. Staffing at the home was stretched and unsustainable and people were mostly receiving care from staff that they were not familiar with.

The provider recognised that the current staffing arrangements lacked stability and were taking steps to improve this.

Medication was not always stored and administered safely. Medication recording errors had not been investigated within a reasonable timeframe. The provider arranged for a refresh of medication training and practices at the home within a short period of time.

Aspects of the home’s environment were not safe and some practices at the home did not ensure people were kept safe from the spread of infection. There was no staff member who was taking the lead with infection prevention and control (IPC)

The management of the home was unstable. Prior to our inspection the provider had made the registered manager of the service redundant. This meant that the service did not have a registered manager in place.

The provider had failed to effectively monitor the care and accommodation being provided to people to ensure it was safe and of high quality; and had failed to take appropriate action when things went wrong.

People’s care plans showed that they had been consulted with, in regard to choices about their care. Family members told us that communication with the home was fine.

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 18 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing arrangements at the home. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the “Is the service safe?” and “Is the service well-led?” sections of this report.

The provider took prompt action to mitigate the risks in relation to the homes environment and quickly sought appropriate medication training.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to failing to ensure safety monitoring was effective at the home, staffing and good governance.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hilbre House is a residential care home providing personal care and accommodation for up to 20 people. At the time of the inspection 17 people were using the service. The home is a detached building, in a residential area with a coastal location and views over Liverpool Bay.

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

This home is required to have a registered manager as a condition of its registration. A registered manager along with the provider is legally responsible for how the service is run and for the quality and safety of the care provided. Hilbre House has not had a manager registered with the Care Quality Commission (CQC) since January 2018. This is a breach of the conditions of registration for this service, which will be considered separately to the inspection.

People told us that they felt the staff were respectful and caring towards them. One person told us, “They are wonderful here.” People’s relatives told us they thought staff at the home were caring. We saw many positive, warm and caring interactions between people and staff members. People appeared relaxed and comfortable at the home. Staff spoke with people respectfully and made good use of questions and humour when supporting people.

The home was safe, clean, well maintained and decorated in a homely style. There were different places to sit and relax for people who preferred quiet and busier environments and there were different bathrooms and shower rooms to meet people’s needs and preferences.

We saw that people’s opinions, choices and preferences were sought throughout the day and people were involved in decisions about their care. There was evidence that this was imbedded into the culture of the home, in everyday as well as significant decisions. 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.

Each person individualised care plan included important information on people’s care needs, background and preferences. Each person also had an activities profile which contained information on people’s preferences and the support they may need to be involved in social activities. People’s families told us that they thought the social activities available were responsive to people’s needs. One family member told us, “I like that there seems to be things going on at the home and people are interacting. To see my dad getting involved is fantastic.”

People’s care plans contained a record of what the person was able to and wished to do for themselves independently. This dignified people and encouraged them to remain as independent as possible. We also saw that people were provided with information and communicated with in a variety of ways that was meaningful to them. Any risks that may arise when caring for a person were individually assessed and guidance for staff on how to reduce these risks was in people’s care plans.

The home manager had overseen a series of improvements at the home; they ensured that staff were clear about their roles and were communicating effectively. They had completed a series of regular audits and checks of the safety and quality of the service provided for people and had built relationships with outside agencies. People and their family members also told us they felt listened to, consulted with and engaged by the home manager and other staff. This all helped to ensure people received responsive care and support that met their needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 October 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of those regulations.

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.

Hilbre House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hilbre House is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection there were 20 people living in the home.

The last registered manager had left the service in January 2018. 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. A new manager had been in post since January 2018 and was present on the second day of the inspection. They had begun the process to apply to the Commission to become registered. Feedback regarding the management of the service was positive. Staff told us they could go to the manager at any time and relatives described the manager as, “Great” and told us they had, “A very caring attitude.”

At the last comprehensive inspection in December 2017, the registered provider was found to be in breach of Regulations 12 (safe care and treatment), 17 (good governance) and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as inadequate and placed in special measures. We completed a focused inspection in February 2018 to check whether the significant risks identified at the last inspection had been addressed and found that they had. The overall rating was changed to requires improvement.

During this inspection we found that not all of the improvements had been sustained and the provider was in breach of Regulations 11 (consent), 12 (safe care and treatment) and 17 (governance).

At the last comprehensive inspection, we identified that the fire risk assessment needed to be updated and were informed a contractor had been commissioned to complete this. At this inspection however, we saw that it had not yet been updated. Systems were in place to monitor the environment, however it was not always safely maintained. We observed a broken dado rail that posed a risk of injury and cleaning chemicals were not always stored securely. This meant that vulnerable people had access to these chemicals which could cause them harm.

Most medicines were stored safely; however, we saw boxes of medicines left out in one person’s bedroom and medicines that required storage in the fridge were not kept at the correct temperatures. When people were prescribed medicines as and when they needed them (PRN), there were not always protocols in place to inform staff when to administer them.

We found that DoLS applications had been made appropriately. However, records regarding applications, when they were authorised and were due to expire, were not always clearly recorded, or known by staff. Records showed that consent was not always gained and recorded in line with the principles of the Mental Capacity Act.

Systems in place to monitor the quality and safety of the service were not robust or effective. They did not include all areas of the service provided and those audits that had been completed, did not identify all of the issues raised during the inspection. Meetings took place to enable the registered provider to be kept informed of what was happening within the service.

The Commission had not been made aware of all notifiable incidents, such as those relating to pressure sores of grade three and above.

Staff were supported through an induction when they started in post. Supervisions had taken place this year, however annual appraisals had not been completed. Staff had access to training to support them in their role, although further training was required and had been arranged.

People told us they felt safe living in Hilbre House. They were supported by sufficient numbers of staff who had been safely recruited and had a good understanding of adult safeguarding.

Risk to people was assessed appropriately and actions taken to minimise risk of harm. The manager was made aware of all accidents and incidents, but there was no recorded oversight or review to ensure that any trends or themes could be identified.

People were supported by staff and other health professionals to maintain their health and wellbeing and equipment was available to help meet their needs.

People told us they enjoyed the meals available and always had a choice. Staff were aware of people’s dietary needs and preferences and these were met by the service.

People told us staff were kind and caring. We observed staff maintain people’s dignity and privacy throughout the inspection and care plans prompted staff to promote independence.

Not all people living in the home had English as their first language and we saw that staff had developed ways to ensure they could communicate with all people and help ensure their views were heard.

Relatives visited throughout both days of the inspection and told us they were always made to feel welcome.

Care plans were in place regarding most people's identified needs. They were detailed and reflected people’s preferences in relation to their care and treatment. Care plans were reviewed regularly and updated as people’s needs changed.

People told us they had choice about their care and how they spent their day. A staff member told us, “There are no strict rules here. People have their own routine and we just follow it.” We saw a number of pets in the home, such as a cat, a budgie and goldfish.

There was a range of activities available to people both within the home and in the local community that were based on how people preferred to spend their time. This included swimming, walks, quizzes and films, as well as trips out in the new adapted taxi.

The manager was undertaking training to support people effectively at the end of their life. Staff worked with other health professionals during these times to ensure people received the most effective care.

People had access to a complaints procedure and people knew how to make a complaint if they needed to.

The manager had developed links with external agencies such as the GP and pharmacy to help ensure joined up care is provided. They had also made links with a local school and a choir had visited the home to sing to people.

Hilbre House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hilbre House is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection there were 15 people living in the home.

We carried out an unannounced comprehensive inspection of this service on 12 and 15 December 2017. Breaches of legal requirements were found in relation to the safety of the environment, management of medicines, risk management, staffing and the management of the service. The service was rated as inadequate and placed in ‘special measures.’ Following the inspection, CQC used its urgent powers to keep people safe. The provider made an appeal against this action which was upheld as we found that action had been taken to minimise the risks identified at the last inspection.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches of regulations. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hilbre House on our website at www.cqc.org.uk.

The previous registered manager had recently left the service. A new manager had been appointed and was in the process of registering with CQC. 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.

In December 2017 we found that medicines were not managed safely as they were not stored safely. During this inspection we saw that improvements had been made and medicines were now stored securely. The provider was no longer in breach of regulation regarding this.

During this inspection we found that actions had been taken and risks regarding the environment had been resolved. New window restrictors had been fitted as required to most windows, the linen cupboard had been de-cluttered and chemicals were stored securely.

A new call bell system had been fitted and was available in each person’s bedroom and en-suite bathroom. This meant that people living in the home had a means of calling staff if they required support. The provider had made improvement to the safety of the environment and was no longer in breach of regulation regarding this.

During this inspection we found that steps had been taken to begin addressing all concerns regarding risk management that we identified at our last inspection and some had been fully completed. New evacuation equipment was available and this was reflected within people’s personal emergency evacuation plans. However, the new fire risk assessment and emergency evacuation procedure were not yet available.

During the last inspection concerns were raised that people had been admitted to the home with assessed nursing needs, which the provider is not registered to provide. During this inspection we found that a new admission procedure had been put into place to help ensure all people who moved into the home had their needs assessed to ensure they could be met. The provider was no longer in breach of regulation regarding this.

A staffing analysis system had been implemented to help establish how many staff were required to be on duty. As a new call bell system had also been installed, this reduced the risk of people not having their needs met in a timely way. The provider was no longer in breach of regulation regarding this.

Since the last inspection, ten staff had completed safeguarding training. This helped to ensure that staff could recognise any potential signs of abuse and report their concerns appropriately.

At the last inspection we found that identified actions for improvement were not always addressed. During this inspection we saw that recommendations from external audits had been implemented and most, although not all, concerns we identified at the last inspection had been addressed.

Systems had been implemented to ensure that staff had access to the management team out of hours should any advice be required.

Policies and procedures were in place to guide staff in their role. Regular staff meetings were also held and staff were encouraged to share their views.

Ratings from the last inspection were displayed within the home and on the provider’s website as required.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Hilbre House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hilbre House is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection there were 21 people living in the home.

A registered manager was in post, but was not available during the inspection as they were on a period of leave. 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.

During this inspection we found that the provider was in breach of regulations and was not meeting legal requirements. The breaches of regulation were in relation to risk management, medicines management, staff support systems and the leadership and running of the service.

People we spoke with told us they felt safe living in Hilbre House. We found however, that adequate systems were not in place to ensure the safety of all people living in the home, such as call bells in all rooms. We also found that the environment was not always safe for all people as not all windows were restricted as required and chemicals were not stored safely. This could pose risks to vulnerable people.

Emergency evacuation procedures did not provide information as to how all people would be supported to leave the home in the event of an emergency and not all people had a personal evacuation plan in place.

Risk was not always assessed accurately and people did not always receive safe care and treatment. The service accepted people into the homes with assessed needs that they were not registered to provide. The service did not adhere to agreed changes regarding pre admission procedures to help ensure people’s needs could be effectively met from the day they were admitted to the home.

Medicines were not always managed safely within the home as they were not stored securely and not all medicines were administered as prescribed.

The provider did not always demonstrate a caring approach as identified risks were not always addressed to ensure people would receive safe care and treatment.

Audits completed within the service did not highlight all of the concerns raised during the inspection. When actions were identified, we found that not all had been addressed in a timely way, including those raised from audits completed by external professionals.

There was no evidence that the provider maintained full oversight of the service and in the absence of the registered manager, the leadership of the service was unclear.

Not all statutory notifications had been submitted to the Commission as required by law.

There were a range of policies and procedures in place to help guide staff in their practice, however not all were up to date and not all were followed in practice, such as the pre admission procedure.

There was a safeguarding policy in place, however not all staff we spoke with were knowledgeable about safeguarding processes and how to raise concerns. A whistleblowing policy was in place which encouraged staff to raise any concerns without fear of repercussions.

Staff were supported in their role through induction and regular supervisions, however they did not receive an annual appraisal and not all staff had completed training necessary to enable them to meet people’s needs effectively.

We looked at how staff were recruited to the home and saw that most safe recruitment practices were adhered to. However, we found that there was not always sufficient staff on duty to meet people’s needs in a timely way, specifically overnight. We also found that staff rotas did not accurately reflect the staff on duty.

The home appeared clean and well maintained and personal protective equipment was available for staff to help prevent the spread of infection.

Applications to deprive people had been made appropriately. We found that people’s consent was sought and recorded in line with the principles of the Mental Capacity Act 2005.

People’s nutritional needs were assessed regularly and met by the service. When risks were identified, appropriate referrals were made for specialist advice. People told us they had enough to eat and drink and enjoyed the meals provided to them.

People told us that staff were kind and caring and that they were treated with respect by staff and relatives agreed. We observed people’s dignity being promoted during the inspection.

Care files we viewed showed that people were encouraged to be as independent as possible and the provider had policies in place which reflected that one of the aims of the service was to encourage people to be as independent as possible. Equipment was provided to people when needed, in order to maximise their independence.

Information regarding the service was available to people.

Relatives were able to visit their family members at any time and we saw that they were always made welcome. For people that did not have friends or family to represent them, information regarding advocacy services was available within the home.

Care plans were detailed and centred on the needs and preferences of the individual person. They had been reviewed regularly but were not always updated to reflect changes to the recommended care.

A system was in place to manage complaints and those we viewed had been investigated and responded to in line with the provider’s policy.

In order to gather feedback regarding the service, staff meetings took place and quality assurance questionnaires were distributed for completion. This could be further developed to include meetings for people living in the home or their relatives. The people we spoke to who lived in Hilbre House, told us they enjoyed living there, that it was friendly and they felt able to raise any issues with the management of the home.

Ratings from the last inspection were displayed within the home and on the provider’s website as required.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

The service had 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. There was a registered manager in post, they had been registered since October 2016.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The provider told us that some people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. The service had accessed support from the local authority to ensure processes were appropriately followed. We found that in applying for these safeguards, peoples’ legal right to consent to and be involved in any decision making had been respected.

People told us they felt safe and we saw that staff knew how to ensure they were safe. From our observations it was clear that staff cared for the people they looked after and knew them well.

Staff told us that they felt well supported by the manager in their job roles. We saw that the manager was a visible presence in and about the home and it was obvious that they knew the people who lived in the home extremely well and the people knew who the manager was, often using their name.

Staff were recruited safely and there was evidence that staff had received a proper induction and suitable training to do their job role effectively and the staff had been supervised regularly.

Each person living in the home had a plan of care and risk assessments in place. These were specific to them and were regularly reviewed.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime. The cook had a good knowledge of the dietary requirements, likes and dislikes of the people living in the home.

People's medicines were handled safely and were given to them in accordance with their prescriptions. Other healthcare professionals were contacted for advice about people’s health needs whenever necessary.

The home was clean, safe and well maintained. We saw that the provider had an infection control policy in place to minimise the spread of infection and a good supply of personal and protective equipment. For example, hand gels, disposable aprons and gloves. We also saw the home was in the process of being updated with adaptions being carried out on bathrooms and the emergency call bell system.

The service had a registered manager. 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.

During the inspection we found breaches of Regulations 11 and 17 of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

Some of the people who used the service had a diagnosis of dementia which had an impact on their ability to consent to decisions about their care. People’s mental capacity had not been assessed in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had not been applied for.

There were enough staff to meet people’s needs and staff received training to enable them to provide care to people safely, however we did not see evidence that every member of staff who worked in the home had completed all of the training.

We observed staff supporting people at the service and saw that they were warm, patient and caring in their interactions with people. People were seen to be relaxed and comfortable in the company of staff. People who used the service and their relatives told us they were happy with the service provided.

The premises were clean and bedrooms were appropriately decorated and furnished. Regular health and safety checks of the environment were not clearly recorded and some people did not have a call bell available to use when they were in bed.

The registered manager did not engage with us during the inspection and there were no other management staff identified on the staff rota. Some quality audits had been carried out but these were not comprehensive. We found no evidence that people had been asked for their views of the service during recent months.