Hill House

Updated 5 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Hill House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hill House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, this included

notifications made by the service and concerns raised with the Care Quality Commission. We sought feedback from the local authority quality assurance team and safeguarding team. We used all of this information to plan our inspection.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We met most of the people who lived at the service and spoke with nine of them about their experience of the care provided. We also spoke with three visitors, including family members and a friend, to get their view of the service. We observed people and staff in the communal areas throughout the day.

We spoke with ten members of staff including the registered manager, the deputy manager, care staff, maintenance person, cook and housekeeper.

We reviewed a range of records. This included five people's care records and medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, maintenance records, cleaning schedules, staff rota's, monitoring charts, fire documents and external servicing records were reviewed.

We continued to seek clarification from the provider to validate evidence found. We contacted six professionals who worked with the service. We received feedback from two. We also received feedback from two relatives.

Updated 5 August 2022

About the service

Hill House is a 'care home'. Hill House accommodates 30 people in one adapted building. They provide care and support for older people and some people were living with dementia. At the time of our inspection there were 29 people living at the service.

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

The provider had made improvements at the service to embed quality assurance processes to monitor the quality and safety of the care people received. They had produced an action plan which they were working through. At the time of this inspection previous breaches had been met but the quality assurance processes required further embedding to ensure all records were up to date and accurate.

Since the last inspection, a new manager has been appointed and has been registered with the Care Quality Commission. People using the service, relatives, staff and professionals commented on the improvements at the service since the arrival of the registered manager. One relative said, “There’s better quality staff, who are kind and caring. Admin and communication have improved greatly. The atmosphere is so much better”. A professional said, “I have positive encounters with the registered manager and deputy manager when I visit, who appear to really care about their residents”.

People received safe care at the service. All those spoken with said they felt safe at the service. Relatives and professionals also expressed their confidence in the service. Comments included, “I am settled and happy here. I can't grumble and I wouldn't be anywhere else”. A professional said staff seemed “well informed and able to recognise when referrals to other services are appropriate.” A relative told us, “(Person’s) health and wellbeing has improved; she is amazing now and getting on so well”.

Since the last inspection, staffing levels had increased to ensure people received care in a timely way. Staff training had been addressed to ensure they had the skills to meet people’s needs and staff received supervision and appraisals to ensure their practice was as expected.

Improvements had been made to ensure pressure relieving equipment was used safely. All pressure mattresses were set at the correct setting. Staff knew when people were at risk and followed instructions to keep people safe.

Medicines were safely managed. Improvements in medicines management had been made since we last visited. However, attention was needed to ensure records relating to topical creams were accurate.

People were protected from abuse as staff knew who to report concerns about people's safety to.

We were assured that the provider was preventing visitors from catching and spreading infections. The registered manager was facilitating visits for people living in the home in accordance with the current guidance.

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 registered manager sought the views of the people living at the service and their relatives. Residents’ meetings had been re-established and provided a forum for discussion about any changes to the service and to hear of any suggestions for improvements.

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 requires improvement and there were breaches of regulation (published 15 April 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider review staffing levels and the deployment of staff to ensure people's needs were met in a timely way. At this inspection we found the provider had increased staffing levels.

Why we inspected

We undertook this unannounced focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hill House 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.