Archived: Hillfield

Hillfield provides residential and nursing care for up to 50 people, some of whom are living with dementia. The service is based within a residential area in the west end of Newcastle. At the time of our inspection there were 22 people living at the service.

The service had a manager in post who was in the process of registering with the Care Quality Commission (CQC). The previous registered manager had left the organisation and deregistered in August 2017. A registered manager is a person who has registered with the 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.

Although people and their relatives felt that the service provided safe care, we found a number of issues which needed to be addressed.

We found people’s thickeners where stored in unlocked cabinets within one of the dining room areas. Thickeners are usually powders added to foods and liquids to support people with swallowing difficulties. There is a risk associated with these if digested by people. The management of medicines required improvement, with security of medicines, times of administration, recording and disposal some of the issues we found during our inspection. People were able to access the third floor to the service which was currently out of use. This area was hazardous as it was being used for storage in parts and was not lit well.

Although parts of the service were clean and tidy and people deemed the service as clean, we found issues with infection control. Clinical waste was not secure outside of the building, equipment and rooms were not always satisfactorily cleaned and there were odours in places. We received negative comments on the laundry system and the manager and registered manager said they would look into this.

Quality monitoring systems were in place at the service but they had not been completed for a number of months in most cases and the manager did not have a full oversight of how the service was being delivered on a day to day basis. We found a very large cactus plant in the lounge area of the service which the manager had not seen since they started working at the service in July 2017. Feedback about communication between staff within the service was mixed, and was an area which needed to be improved upon. Staff commented that they were not communicated with very well, particularly in connection with handover.

Staff did not always receive the support they required to help them provide effective care to people. Staff had not always received timely supervision or annual appraisal. Recruitment was not robust, with no checks on the nurse registration requirements taking place. However, the provider had made positive efforts to recruit more permanent staff.

Record keeping was in need of review, with some care plans, risk assessments and other monitoring records, either out of date or not in place at all. A new deputy manager was in the process of reviewing this information. We also found records were not secure in parts of the service.

People on the whole felt that food and refreshments at the service was satisfactory as recent improvements had been made. Although we made one recommendation with regards to the dining experience at the service.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes.

People were supported to have choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People and their relatives felt that the staff at the service kept them up to date with information and enabled them to be involved with planning and review of their care needs.

People and their relatives were extremely positive about the activities available and the improvements made in this area. People had been able to participate in a range of planned events, including being taken out of the service for trips.

People and their relatives felt permanent staff were kind and caring but they were less positive about short cover staff (usually agency). We found some staff practices were not respectful and did not always support people’s dignity. For example, standing over people while supporting them to eat.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Following our inspection, the provider sent us an action plan of how they were going to address these concerns.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home. Arrangements for covering staff sickness and holidays were good, and a member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place.

People living in the home told us they felt they were safe and well-protected in the home. Relatives we asked shared this view. One person commented, 'I feel very safe here'. A relative told us, 'We have no worries about dad's safety, here. We know for a fact we don't have to worry.'

All risks to people living in the home, their relatives and staff were regularly assessed and appropriate steps taken to minimise such risks.

Systems were in place for checking safety equipment and systems such as fire alarms and hot water temperatures.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well as individuals. One person told us, 'The service is fabulous, now' and that, 'There have been significant improvements since the current manager started.' A relative commented, 'It's done my father a lot of good, coming here. He needed to put on weight, and he has done.'

Staff had received regular training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff, who showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person said, 'This is very much a caring home ' all the staff and especially the manager.' A relative told us, 'This is a very caring home. Staff really do a great job.'

Is the service responsive?

People's needs had been carefully assessed before they moved into the home. People told us they had been asked for their views and these had been recorded. Records confirmed people's preferences, interests and needs had been recorded and care and support had been provided in accordance with people's wishes. One person told us, 'They respond well to me as an individual, very much so. I've asked for changes to my care as I have changed, and they have responded well.' A second person commented, 'I like it here. They listen to me.' A relative said, 'Dad gets everything he wants, here. Staff do anything he needs.' Another relative told us, 'They are very responsive to his needs ' all of them.' People had access to activities that were important to them and had been supported to maintain personal relationships with their friends and relatives.

Is the service well-led?

The home had a registered manager in post. Staff had a good understanding of the ethos of the home and a range of effective quality assurance processes were in place. People who used the service were asked for their views about their care and treatment in regular meetings and their views were acted upon. One person commented, 'We are very fortunate with this manager. She works desperately hard for everyone, and has made changes for the better. She's been like a breath of fresh air.' Relatives were complimentary about the manager. One told us, 'She's definitely a good manager. She treats her staff well and motivates them.'

Staff also spoke highly of the manager, and said she always took their views into consideration. One care worker told us, 'The manager leads by example. She's often out on the floor talking with people and helping staff.'

Staff told us they were clear about their roles and responsibilities.

People's needs were carefully assessed before they were admitted to the home, and detailed and highly personalised care plans were in place to guide staff in meeting people's needs and wishes.

People spoke highly of the quality of the care they received in the home. One person told us, "I’m settled, here, it’s alright. I like the whole place, and the staff are very good.” Another person said, “I’m treated with respect. The staff listen to me.” Relatives also spoke highly of the care people received. One relative told us, “We are quite content with the care given. The staff listen to us.” Another relative told us they had “no complaints whatsoever" about the home.

People were given their prescribed medicines at the correct times by trained and competent qualified staff. Medicines were stored safely.

Systems were in place to make sure that no unsuitable people were employed to work in the home.

Comments and complaints were taken seriously and responded to appropriately.

Comments from visitors were very complimentary. A health professional who visited the regularly said, 'All the staff are very, very caring, and the qualified staff are fantastic with palliative care. People get very good care, here'. A family member said, 'We couldn't get better care anywhere, it's incredible. The carers are brilliant'.

People told us they had plenty of choice about how they spend their day, and gave us examples of deciding what to wear, what to eat, when to get up and go to bed, and spending time in their rooms. Staff told us people could have anything they wanted.

Systems were in place for preventing abuse, and staff had been given the necessary training in recognising and responding to issues of concern. Where there had been any safeguarding concerns raised the home's response had been appropriate.

Staff had received all the areas of training required by law, and were given opportunities for extra training, as part of their personal development. They were being given regular supervision and appraisal of their work.

Systems were in place for checking the quality of the service being provided, including questionnaires; audits; checklists; and visits by company representatives. Where issues had been identified, there was evidence that steps had been taken to address the problems.