Hill View

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 requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 59 (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. Lessons were learnt to continually identify and embed good practice.

Lessons were identified following incidents and accidents, which helped inform better practice. Staff told us they had seen a decrease in behavioural incidents for 2 people. Staff said this was because they had learnt from previous incidents. Incident reports supported this. One staff member commented, “It’s lovely, [person] has improved a lot”. Another staff member told us, “We share information about how to support this person with behaviour”. Leaders explained they reviewed accidents and incidents and used these to identify trends and themes to reduce incidents.

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

People’s hospital passports contained detailed information about their needs and preferences. Leaders gave examples of how staff had supported a person during an overnight stay at a hospital by seeking approval from a learning disability nurse. This enabled the person to receive continuity of care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

There was an effective process to ensure people were safeguarded from abuse. People told us they felt safe and relatives did not raise any safeguarding concerns. Staff had completed training in safeguarding and did not have any safeguarding concerns. Staff also told us they felt able to raise any concerns with leaders. There was a safeguarding checklist displayed in staff areas to inform staff how to appropriately safeguard people.

People had appropriate Deprivation of Liberty Safeguards which had been applied for or authorised.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At the last 2 inspections, records were unclear relating to a person's prescribed Speech and Language Therapy (SALT) guidance. This put the person at risk of choking. At this inspection, we found some records remained unclear. This was rectified on the day of inspection; a new referral was made, and guidance was updated and made clearer to staff.

People’s risks were assessed and the mitigations from these were recorded in people’s care plans. These were regularly reviewed to ensure they remained up to date. Staff told us they had enough information to manage risks effectively. Relatives told us they felt their family member was being kept safe in the service.

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

During our site visit we identified window restrictors were used, however on multiple windows these were found disconnected leaving windows wide open, and on other occasions window restrictors had the key left in them. This meant people were at risk of falling from height. We raised this with leaders during our first site visit and identified a further key in a window restrictor on the second day of inspection. This meant people were at continued risk of significant harm. The manager has now confirmed all window restrictors are in place with the keys removed.

Additionally, we found other health and safety concerns such as wear and tear on door strips.. The service’s internal audits had not identified these concerns.

However, the service completed regular checks on equipment and fire safety. Equipment was serviced on a regular basis by an external company.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff had been recruited safely and had received a range of training relevant to people’s needs. Staff had been trained to the appropriate level for specific training for people with a learning disability and autism. Staff told us there were enough staff to support people effectively. There were systems to support effective team working, such as handovers and team meetings. Comments from staff included, “Staffing levels are okay, we have agency cover if needed” and “Staff work well as a team, we communicate well, staff have a very good attitude, we are all friendly.” Relatives felt staffing levels were safe and met people’s needs.

The provider did not always assess and manage the risk of infection.

There were areas of the service that were not able to be cleaned thoroughly. This was because some areas had porous surfaces exposed due to flaking paint or damaged flooring.

However, staff completed regular cleaning of the service, and this was monitored to ensure compliance. Staff had received training in infection prevention and control and there was a policy which outlined procedures for staff.

Medicines were not always managed safely.

There was no system to record when some medicines were being taken out of the service, for example when a person went on a home visit. This meant staff did not have oversight of the medicines which were leaving and returning to the service. We raised this with the deputy manager who told us they would implement a system to manage this. Additionally, we found some room temperatures exceeded the maximum temperature required to store medicines safely, on some occasions. Leaders told us they used an air conditioning system to cool down the room; however we observed a ‘maximum’ temperature to be 27 degrees during our visit. This was 2 degrees over the required temperatures, and some medicines required storage temperatures to be below 25 degrees. This meant these medicines may not be effective. Leaders said they would seek advice from a pharmacist in relation to this.

However, people had care plans in relation to how they took their medicines. People also had clear protocols for when to administer ‘as and when’ medicines such as paracetamol. People received their medicines as prescribed. Staff worked in line with Stopping Over Medicating People with a Learning Disability (STOMP).