Archived: Hillside

Hillside is a care home with nursing care support. It provides a light and welcoming environment for up to 68 older and younger adults living with physical disabilities. Accommodation is spread over two floors. People had access to a range of communal areas. We observed people freely accessed garden areas.

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

People were supported by a service which was exceptionally well-led. The registered manager and staff routinely advocated for people’s best interests. The home fostered a culture of inclusion and challenged discrimination at all levels. People were routinely involved in decisions about their care and their life skills were valued and respected.

People were encouraged to be as independent as they could be. People had developed positive relationships with staff. People told us they liked living at the home. Comments included, “Home is wonderful, it makes you feel wonderful,” “I feel loved” and “I feel cared for.”

People were protected from avoidable harm. Staff knew how to support people in a way that minimised the risk of harm. Staff knew how to recognise abuse and had the confidence to report any concerns.

People told us they had a positive experience of moving into the care home and felt they had regained their independence. Comments included “Coming to Hillside was like seeing the light at the end of the tunnel,” “I have enjoyed living here a tremendous lot. The staff, management and catering team treat me like part of the family and sometimes I cry with joy because I am so overwhelmed” and “You’re free and that is how I feel.”

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 support this practice.

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 23 May 2017)

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.

We previously inspected the service on 1 and 2 March 2016. We found two breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. We asked the provider to send us an action plan on how they would make improvements to the service. They told us they would implement the improvements by 31 May 2016. At this inspection we checked to see what improvements had been made. We found the home had made significant improvements in both of the areas identified.

Hillside is a nursing home for adults. It is registered to provide care up to 68 younger and older adults. At the time of our inspection 59 people lived at the home.

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.

People who were prescribed medicines and were unable to take these independently had support from staff who had received training. General medicines were stored securely, however stock control required improvement for medicines that had potential to be abused. We have made a recommendation about this in the report.

People were supported by staff who had been recruited through robust procedures. People told us they felt there were enough staff on duty for them to receive safe care.

Staff had access to training to equip them with the right skills to support people. Staff were appraised and development plans were in place. We noted people who lived at the home were encouraged to assess new staff and help them develop.

People had good access to external healthcare professional and a GP visited the home each week. People were confident any changes in health would be responded to by staff.

Consent was sought from people or their legal representative. Where required the service made applications to the local authority to deprive someone of their liberty. The registered manager was aware of the need to inform CQC of certain events and had done so when needed.

People had access to a wide variety of activities both inside the home and the local area. We noted some people attended regular support groups outside of the home. The home had a virtual reality headset where people could enjoy different experiences. One person had gone deep sea diving and another had gone on a bird flight. People spoke positively about their experience.

Positive caring relationships had developed between staff and people they supported. We observed there was good team work among staff.

People were involved in developing their care plans. Care plans were comprehensive and reviewed regularly.

We previously inspected the service on 22 July 2014. The service was meeting the requirements of the regulations at that time.

Hillside provides nursing care for up to 67 people, including older people and younger adults. 54 people were living at the service at the time of our visit.

The service did not have a registered manager in post. The previous registered manager left the service in May 2015. 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 started at the home on 7 March 2016.

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Individual risks were managed well at the service but we found people had not been protected from hazards they may come into contact with around the building. For example, clinical waste was accessible in a sluice room as the door was not always kept locked. Standards of food hygiene and general cleanliness also needed attention to prevent the spread of infection.

Staff were recruited using robust procedures to make sure people were supported by workers with the right skills and attributes. Staff received appropriate support through a structured induction, regular supervision and an annual appraisal of their performance. There was an on-going training programme to provide and update staff on safe ways of working.

People told us it took a long time for their call bells to be answered when they rang for assistance. A typical comment was “It takes them 20 minutes or more to come, not good at all.” We checked the call bell log and did not find evidence of this. However we have asked the service to monitor this and make further investigations.

Care plans had been written to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s circumstances. Staff were able to tell us about people’s needs and how they supported them. Referrals were made to external agencies where people needed specialist support.

Systems were in place to monitor the quality of the service. Some staff were fully aware of the values and visions of the provider.

Staff did not always respect people’s privacy and dignity as staff did not always knock prior to entering a person’s room.

We found whilst there was a process for recording formal written complaints, no record was kept of any day to day concerns and complaints raised by people who live at Hillside. We have made a recommendation about the recording of complaints or any issues raised by people who live at the home.

Mental capacity assessments took place where needed. Deprivation of liberty safeguards (DoLS) applications had been approved by the local authority and had been reported to CQC as required. However consent and user involvement was not routinely recorded. People told us they did not feel involved in decision about their care and treatment. We have made a recommendation about seeking and recording consent from people or their legal representative.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to processes about medicine, infection control practice and risk management. You can see what action we told the provider to take at the back of the full version of this report.

We received an action plan which set out what actions had, or were to be taken, to achieve compliance by the end of September 2013. We carried out a visit on the 16 October 2013 to see if the action plan had been implemented as planned and the necessary improvements made.

We looked at supervision and training records. We spoke with the manager and staff, including two who were responsible for supervision.

We found, against a background of significant staff changes, the frequency of staff supervision and training had been improved and was now satisfactory. We judged this meant current staff were now being supported effectively. This was through regular training and supervision which enabled them to carry out their challenging roles, at a time when staffing levels had been and remained under pressure.

We looked at four care plans. We saw they included an initial assessment of the person's needs and were subject to regular review to make sure they remained up to date and relevant. This showed people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Although the decorative order of the home was not good in places, we saw no evidence the premises were unsafe. When we spoke with two people on the Lowry unit they told us they thought the premises were quite good and comfortable. They offered to show us their own rooms. These were furnished and fitted out with items of their own and reflected their individual tastes and interests.

People we spoke with had a positive view of the staff team and felt they had the skills and experience required to provide appropriate, safe and effective care and support. Staff told us they felt there was a good 'team spirit' in the home, however, not all staff training and supervision was up to date