Hilton Rose Retirement Home Ltd

Hilton Rose Retirement Home is a residential care home providing personal and nursing care to up to 27 people. The service provides support to older people, younger adults and those living with dementia. At the time of our inspection there were 25 people using the service.

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

People were supported by staff who understood how to keep them safe. Staff could describe how they reported any concerns and understood risks to people’s safety and how to minimise these. Staff were recruited safely and there were enough staff available to ensure people were safe. Medicines were administered safely by staff who had received training and were competent. Infection prevention control procedures were followed by staff to keep people safe from the risk of infection. When incidents occurred, these were reviewed to consider any learning which was shared with staff.

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.

The provider had quality monitoring systems in place which were effective in driving improvements. People relatives and staff were engaged in the service and the provider had developed relationships with other health professionals and local community organisations. Systems and processes were in place to identify improvements and drive change.

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 (19 March 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff had received appropriate Personal Protective Equipment (PPE) training and were observed wearing PPE in line with current government guidance.

The registered manager told us some residents found the use of masks daunting in the beginning. However, the staff team supported people to understand the need for masks and they are now commonplace.

During the outbreak of COVID-19 people were supported to maintain contact with family and friends through window visits, phone and video calls.

Staff were cohorted to support people who had tested positive, people had their own cutlery and their clothes were washed separately when they had tested positive for COVID-19 to minimise the spread of infection.

The registered manager converted an empty bedroom to a third lounge to enable people to maintain a social distance in communal areas.

The registered manager had clear cleaning schedules with hourly touchpoint cleaning and regular deep cleaning of all areas.

Hilton Rose accommodates 27 people in one adapted building. Hilton Rose is a care home that has previously been in Special Measures. It has been inspected since and a number of improvements were noted and Hilton Rose was rated as Good overall although we identified improvements in how people could be involved in activities. At this inspection, we found improvements had been made overall.

The nominated individual was also the 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.

People felt safe and at ease around staff that understood how to support people. Staff had received updated training and guidance about how best to support people to remain safe. The registered provider had also improved safety for people living in the home following a recent incident. People’s risks to their health and wellbeing were also known and understood by staff. Staffing had recently been increased at the home and staff were appointed following a recruitment checks into their background. People received support with their medicines and staff helped to reduce the spread of infection within the home by using aprons and gloves where appropriate.

Staff were supported through guidance and training. Regular staff and supervision meetings ensured staff were kept up to date about people’s care. 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 that practice. People were involved in making decisions about their care and their consent was appropriately obtained by staff when caring for them. People who could not make decisions for themselves were supported to have a decision made about their care and support which was in their best interest. People accessed help from a number of different healthcare professionals and were supported to maintain a healthy lifestyle. People were offered choices in their meals and could make day to day decisions affecting their care.

People liked and valued the staff supporting them. People’s needs were understood by staff who knew about people’s histories and preferences. People’s families were involved in planning their care where this was appropriate. People’s preferences for end of life care planning had also been discussed, where people chose to talk about this.

People’s choice of hobbies and interests were known by staff supporting them. People were encouraged to do things they enjoyed and play music that reflected their taste. People’s changing needs were reviewed and documented for staff to refer to. People understood they could complain if they needed to and the process for doing so.

The registered manager had been at the home for a number of years and was supported by staff who had also there for some period of time. The registered manager had incorporated improvements identified in previous inspections and had worked with staff to share learning. The registered manager undertook regular checks of the quality of care being offered and worked with stakeholders to improve learning about best practice in caring and supporting people.

Hilton Rose Retirement Home provides accommodation for people requiring personal care for up to 25 people. At the time of the inspection there were 22 older people who were living with dementia at the service.

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.

People felt safe. People were supported by a staff team who knew how to keep people safe from the risk of harm and abuse. People were kept safe as potential risks had been assessed and staff were working in ways to reduce these risks. People were supported by sufficient numbers of staff who had been recruited safely. People received their medicines as prescribed from suitably trained staff.

People received care and support from a suitably trained staff team who had access to ongoing training and support to enable them to carry out effective care and support.

People were asked for their consent to care and support and the principles of the Mental Capacity Act 2005 were being followed. People’s capacity was being assessed where appropriate and where required decisions were being made in the best interests of people.

People were supported to have sufficient quantities to eat and drink. People told us they felt they were not always offered a choice of food. People’s specific dietary needs were catered for and specialist professional advice was being followed.

People were supported to access healthcare services when they needed to. People were supported by a staff team who were able to recognise changes in people’s health and well-being and knew how to report and respond to any changes.

People were supported by a staff team who were kind and treated them with dignity and respect.

People were encouraged to maintain their independence and were supported to maintain relationships that were important to them.

People had opportunities to engage in activities and events, however people were not always supported to follow their personal interests or hobbies. People were supported by staff who knew their care needs well and were supporting them appropriately. People and their relatives were involved in the planning and review of their care where possible.

People and their relatives knew who the registered manager was and felt confident to approach them with concerns or complaints. Complaints were being investigated and action taken.

People, relatives and staff were provided with opportunities to give feedback on the service. The registered manager had systems and processes in place to monitor and analyse the quality of the service, and they used information from quality checks to drive improvement.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. We used the evidence we collected during our inspection to answer five questions. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. One person told us, "I feel safe here." Staff we spoke with understood their role in safeguarding the people they supported. However, we found that the provider had not responded appropriately to one allegation of abuse and had not made the necessary alert to the local safeguarding team. We found people were not protected against the risk of unlawful control of their liberty because the provider had not acted in accordance with legal requirements.

Staff knew about people's risk management plans and we saw they were supported in line with those plans. This meant people were cared for in a way that protected them from harm.

People were not always protected from the risks associated with the recording of medicines.

Systems were not in place to make sure the registered manager learned from events such as accidents and incidents, complaints and checks made on the service. This increased the risk to people.

We found records in relation to the storage of medicines, health and safety and incidents were inaccurate. This increased the risk to people.

Is the service effective?

People told us their care needs were assessed with them. We saw evidence that people were involved in their care planning and reviews. We saw care plans were regularly reviewed and updated.

People had their medicines at the dose, time and frequency they were prescribed to ensure medicines were effective. Staff monitored the effect of medicines and reported these to people's health care professionals.

Is the service caring?

People were supported by kind and caring staff. We saw staff were patient and encouraged people to be independent. One relative told us, "The staff are kind."

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to engage in a different activity each day.

People were asked their views about the service and the provider acted on comments that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. We found staff discussed people's care needs with them.

Is the service well led?

The provider had some risk management systems in place. We found the provider did not check that risks were managed effectively.

We found record keeping was poor in relation to the recording of medicines, incidents and checks on equipment.

People we spoke with were positive about the care and support that they or their relative received. One person told us: "They are all very good here". Another person said: "We are here to be looked after and I can say we are".

We saw that people could choose how they spent their day. Visitors told us that they were able to visit when they wished and were always made to feel welcome.

People told us that they enjoyed the food which was varied. People said that they were offered a choice.

We found the home was clean. There were appropriate systems in place to reduce the risk of cross infection. People who lived at or visited the home told us they found the home to be clean.

People told us that staff were caring. They told us that staff assisted them when they needed it. One person said: "I can't fault the staff". A relative said: "They all seem very good, I cannot fault them".

The home had appropriate systems in place to enable people to raise concerns and be confident that their concerns would be investigated and addressed.

We found that systems now in place provided greater assurance that people's privacy and dignity were more fully promoted.

Improvements made to the home since our last inspection made it a more pleasant and safer place to live.

People who lived at Hilton Rose and their relatives told us during this and the previous inspection that they were very happy with the care provided at the service. One person said, "We are well looked after". Care records had been improved and provided staff with more information about people's needs and how they should be met.

We found that improvements to the management and storage of medicines gave greater protection for people against the risks associated with medicines.

It was positive to see the improvements that had been made since our previous inspection and that the service was now compliant with the regulations. We saw that there were improved systems in place to monitor the quality of care, management of medicines and the safety and comfort of the environment of the home. This will provide greater assurance that any issues will be more proactively identified and responded to.

People we spoke to were positive about the care they or their relative received, Staff were seen to be kind and usually provided the care and reassurance people needed. Improvements were needed in relation to the care that people who were diabetic received and liaison with other health professionals who should support them. There was also a need to ensure that staff addressed care instructions from other health professionals to ensure that people consistently received the care and treatment they needed.

The service had made some improvements to ensure that medicines were administered safely, However further improvement was needed to the storage and management of medicines to promote people's health and wellbeing.

Improvements were needed to the environment of the home to ensure it was a safe and comfortable place to live.

The availability and use of some equipment within the home was not appropriate and may put people who were living at the home at risk.