Hill View

Hill View is a residential care home that can support up to 8 people. The service provides support to adults with a learning disability and/or autism, dementia, mental health conditions and physical disabilities. The service consists of a detached house and 2 self-contained annexes. At the time of our inspection there were 8 people living at the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture. People’s care appeared person centred and there appeared to be a positive culture within the service, which maximised people’s independence.

Right Support

The service was situated nearby shops, local groups and bus routes. We saw people were supported to regularly access community services. The service had various communal areas such as an activity room, conservatory, a large lounge and dining area, and a garden, that could be accessed by all. Staff promoted people’s independence and supported people to have maximum choice and control in their lives; the policies and systems in the service supported this practice.

Right Care

People received kind and compassionate care and were supported in a person-centred way. Staff had the training and knowledge to support people effectively. Staff promoted people's equality and diversity and knew them well as individuals. People's care, treatment and support plans contained a high level of detail to enable staff to support them in a way that promoted their well-being.

Right Culture

There was a positive culture within the service; staff were committed to providing high-quality, person-centred care that met people’s individual needs. Management proactively rectified issues identified on the day of inspection and were committed to making improvements within the service. Staff appeared to support each other and worked as a team to meet people’s needs. We received positive feedback from staff and relatives about the service.

Rating at last inspection and update

The last rating for this service was inadequate (published 10 February 2023).

This service has been in Special Measures since August 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures, however remains in breach of a regulation.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 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 safe and well-led sections of this full report.

The provider has taken action to mitigate the risks, and this has been effective.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Hill View is a residential care home that can support up to 8 people. The service provides support to adults with a learning disability and/or autism, dementia, mental health conditions and physical disabilities. The service consists of a detached house and 2 self-contained annexes. At the time of our inspection there were 8 people living at the home.

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

This was a targeted inspection to follow up 2 warning notices served at the previous inspection about safe care and treatment and how well led the service was. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Based on our inspection of safe and well led, we found not all aspects of the warning notice had been met to ensure improvements were made in specific areas to evidence compliance with the regulations.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Based on our review we found the service was still not demonstrating how they were fully meeting the underpinning principles of right support, right care, right culture.

Right support: Care records did not always guide staff to provide suitable care. People's records did not always show how decisions had been made about their support and how risks were reviewed and analysed.

Right care: Staff did not always have clear guidance on how to support people's individual needs.

Right Culture: The ethos, values, attitudes and behaviours of the provider did not always ensure people using services led confident, inclusive and empowered lives. The service failed to effectively evaluate the quality of support provided to people.

Governance approaches were still not fully effective in ensuring good standards of care, a safe environment, or to identify and lead required improvements. Some environmental risks within the home were known by the provider but had not been effectively assessed and responded to in a timely way to ensure people were safe. We were not assured that people were completely safe from environmental risks (fire and legionella).

Staff showed a good understanding of people’s needs and an operations manager was in place to support the provider to make the required improvements.

The provider had recruited an operations manager to support management across 4 of the provider’s locations, to make the necessary improvements to improve the quality and safety of care.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 inadequate (published 21 October 2022).

At the last inspection we served warning notices in respect of safe care and treatment and good governance. At this inspection we found although some improvements had been made, the provider had not met the warning notices in full and therefore remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the warning notices previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. Therefore, the overall rating for the service has not changed following this targeted inspection and remains inadequate.

Enforcement

The provider remains in breach of regulations found at the last inspection. These relate to keeping people safe from potential abuse, mitigating risks to people, making decisions for people who lack capacity or have fluctuating capacity, lack of staff training and management of the home.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Hill View is a residential care home that can support up to eight people. The service provides support to adults with a learning disability, dementia, mental health conditions and physical disabilities. The service consists of one two storey house and two self-contained annexes. At the time of our inspection there were 8 people using the service.

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

Some people told us they felt safe. However, others raised concerns about their health needs not being met. During our inspection, we found that people were not always supported safely.

Risks to people were not always identified or managed effectively; including risks around medicines, environmental risks and choking risks. People did not have clear, up to date information in their care and support plans, meaning that staff could not effectively care for people. There was no clear oversight in the management of records, leaving people at risk of harm.

Staff were not always equipped with the necessary training and therefore did not always have the skills, knowledge and competence that is required to meet peoples’ needs. There were not enough staff to meet peoples’ needs in a way that promotes their well-being. People’s safety was also compromised due to limited numbers of staffing at night. There was no effective system in place for staff to seek support out of hours.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice.

Relatives told us they were mostly happy with the care and support provided by staff. However, concerns were raised relating to lack of activities, complaints management, healthcare access for their relative, and communication.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Information was not provided to people in different formats relevant to their communication preferences and people were not always supported to exercise their social interests. However, the building design fitted into the local residential area and relatives felt their loved ones were mostly treated with kindness.

Right Care:

People were not always supported with care that was person centred and promoted people’s dignity, privacy and human rights. The service failed to ensure there were enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture:

The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services led confident, inclusive and empowered lives. The service failed to evaluate the quality of support provided to people or ensure risks of a closed culture were minimised.

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 16 August 2018). The service was also inspected on 30 December 2020 however was not rated at this time.

Why we inspected

The inspection was prompted in part due to concerns received about two other homes operated by the same registered provider. 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.

You can see what action we have asked the provider to take at the end of this full report. The provider has taken some action to mitigate these risks, however, these were not always effective.

The overall rating for the service has changed from ‘Good’ to ‘Inadequate’ based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

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

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to the safety of people using the service, managing risks, the leadership of the service, personalised care, consent for people, staffing levels and complaints.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hill View is a care home providing care and support for people who are living with learning disabilities. At the time of our inspection five people were using the service. The service can support up to 8 people. The service can accommodate up to six people in one adapted building and two people in two adapted cottages within its grounds.

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

There was a welcoming environment. We saw many positive interactions between staff and people. Relatives we spoke with told us they were confident that people were safe living at the service.

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.

There were effective systems in place to protect people from harm and staff understood their responsibilities to report any concerns. Staff felt supported and received training to ensure they had the skills and knowledge to meet people's needs.

All complaints were dealt with in line with the provider's policy. There were effective systems in place to monitor and improve the service.

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 16 August 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staff training, risk management and consent. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and effective domains of this report.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

The service had a registered manager in place who was also the provider. 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 on 31 May 2017, we asked the provider to take action to make improvements. These were in relation to risk assessments not always containing enough guidance to keep people safe; staff not receiving training necessary to support people’s needs and not establishing effective systems to identify risks so they could be addressed. At this inspection in July 2018 these actions had been completed.

People using the service told us they felt safe living at Hill View and relatives we spoke with agreed. People were kept safe from avoidable harm because the staff team had received training on safeguarding and understood their responsibilities.

The risks associated with people's care and support had been assessed, monitored and reviewed. People received their medicines as prescribed.

Appropriate pre-employment checks had been carried out on new members of staff to make sure they were safe and suitable to work there. There were sufficient staff to meet people’s needs and spend time with them.

New staff were provided with appropriate induction into the service and on-going training was delivered. This enabled the staff team to gain the skills and knowledge they needed in order to meet people's needs. Staff were also supported through regular meetings with their manager and an annual appraisal. Staff told us that they felt supported by the registered manager and that communication was effective.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People who used the service and relatives consistently told us staff were caring, patient and upheld people's dignity. Care plans were personalised and centred on people's preferences, views and experiences as well as their care and support needs.

Relatives and professionals had confidence in the leadership of the service and that if they had any concerns that these would be dealt with. We saw when concerns were raised these were looked into and responded to. Auditing and quality assurance systems took place to monitor the quality of the service so that action could be taken where identified.

Hill View is a care home without nursing that provides personal care and support for up to eight people with learning disabilities. At the time of the inspection there were five people living at the service.

There was a registered manager in place. 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. A new manager had joined Hill View at the beginning of May 2017. The new manager intended to apply to the CQC to become the registered manager of Hill View.

We asked for feedback from people’s relatives and they felt the service was safe. However, we found training which the provider had stated was mandatory, had not always taken place to ensure staff were fully competent to support people safely. This included training around medicines, moving and handling and safeguarding. The provider had safeguarding training planned for staff for the end of the month. The provider had policies and procedures in place in relation to safeguarding adults.

People’s care records contained risk assessments. These identified any risks related to each person and described the measures and interventions to be taken to manage risks. However, the risk assessments needed more guidance to ensure that staff could ensure people’s safety.

Staff had not undergone all necessary training to ensure they were able to meet the support needs of people in the service. Staff told us and we saw they had received regular supervisions with the manager, where they had the opportunity to discuss their care practice and identify further training needs.

Relatives said they were satisfied that their relatives were involved in all day to day decisions about their care. However, not all staff had received training about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were supported in line with the principles of MCA and DoLS. Staff need to have an awareness of these principles to ensure that people are supported to have maximum choice and control of their lives and in the least restrictive way possible. We made a recommendation to consult with the current guidance for the DoLS.

There were sufficient numbers of staff to support people safely. Staff had been checked before they started working for the service to ensure they were suitable to work with vulnerable adults.

Medicines were managed in a safe way and the environment had been assessed to ensure its safety.

People were supported to have the food they enjoyed and to maintain a healthy diet. Care records showed people’s health was monitored and referrals were made to other health care professionals where necessary for example, GP and mental health team.

Relatives spoke highly of the caring attitude and behaviour of the care staff in the service. They said their relatives were treated with dignity and respect by staff.

People had been assessed to see what support they required before moving to the service. However, not all information on the assessment had been incorporated into the care plan. People’s care plans did not always reflect people’s current needs, choices and preferences.

People were encouraged to plan and participate in activities that were personalised and meaningful to them. We saw evidence of people being supported to be involved in their local community.

We saw a complaints procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next.

The registered manager had not always notified the CQC about incidents that affected the service.

We found the provider had not taken all the necessary actions to ensure effective quality assurance systems. There were no audits in place to effectively identify and review areas of improvement.

Relatives and staff were confident that the new manager would take the steps to make the necessary improvements to the service.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified one breach of the Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.