Hill House Nursing Home

We found the following examples of good practice.

Robust systems were in place to help manage the risks and prevent the spread of COVID-19.

Staff were facilitating visits for people living in the home in accordance with the current guidance. People did not raise any concerns with us about the visiting arrangements at the service.

There was a clear system in part for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing. Visitors to the service were asked to provide evidence of a negative COVID-19 test, wear PPE, have their temperature checked and wash their hands or use the hand sanitiser provided.

Staff checked to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19.

Staff had received training in infection prevention and control and the use of PPE including masks, gloves, aprons and hand sanitiser. There were sufficient stocks available, and staff were seen to be wearing PPE appropriately.

People and staff took place in regular COVID-19 "whole home" testing. People and staff who tested positive followed national guidance and self-isolated for the required amount of time.

Staff helped people to socially distance by spacing out tables and chairs in communal areas.

Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches.

The management team had been open and transparent and worked closely with the Local Authority and infection prevention and control teams throughout COVID 19 outbreaks at the service.

All practice and procedures had been reviewed, updated and where necessary, changed in line with the latest guidance.

We were assured this service met good infection prevention and control guidelines.

This inspection took place on 4 and 5 April 2018 the first day was unannounced.

Hill House Nursing Home is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Accommodation was provided over three floors.

The last inspection was carried out in January 2017 and the overall rating for the service was 'requires improvement.' The provider was in breach of two regulations. These related to 'safe care and treatment' (Regulation 12) and 'good governance' (Regulation 17). We issued requirement notices in relation to these breaches. We asked the provider for an action plan which they provided telling us how they were going to make the necessary improvements.

During this inspection we found improvements had been made.

A registered manager was in place. 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 told us staff treated them properly and they felt safe. One person said, “I feel safe and am happy here.” People were protected as staff had received training about safeguarding and knew how to respond to any concerns. There were systems in place to protect people from abuse. There was an up to date safeguarding policy in place and contact details for the local safeguarding adult’s team were displayed around the home.

Risk assessments were in place to help protect people from the risk of harm. People's risk assessments were reviewed regularly and provided guidance for staff in how to keep people safe and minimise the risks. Where people had been identified as at risk, records directed staff on the actions to take to reduce this risk. For example, some people were assessed as being at high risk of pressure damage to their skin and appropriate pressure relieving equipment was in place to minimise these risks.

People, relatives and health professionals were consistently positive about the caring approach of staff. Staff were kind, compassionate and caring toward the people they supported and spoke about people positively and with affection. The atmosphere in the home was calm and relaxed. People's privacy and dignity was respected by staff and people were encouraged to be as independent as possible, without compromising their safety.

People, relatives and staff told us they thought there was enough staff available to meet people's needs in a timely manner. One person said, “When I ring the call bell I never have to wait long.” People were supported by staff that had been safely recruited. Recruitment checks were in place and demonstrated that the staff employed had satisfactory skills and knowledge needed to care for people.

Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs.

Staff respected people's rights to make their own decisions and choices about their care and treatment. People's permission was sought by staff before they helped them with anything. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well. Where people may need restrictions on their liberty and freedom in order to keep them safe applications had been made to the local authority to make sure people were not unlawfully restricted.

Staff were knowledgeable about people's needs and how to meet those needs. Care records were person centred and written in a respectful, sensitive and personalised way. They were well-organised and included information about each person. However, we found that some improvements could be made to ensure that all care plans included accurate detailed guidance on specific health needs to ensure people received responsive care at all times. We made a recommendation about reviewing the accuracy of care plans.

Medicines were managed safely and in line with current regulations and guidance. Staff had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered and audited appropriately.

Quality assurance systems were in place to assess and monitor the service people received. Families were consulted so that their views could be gained. A survey of people's views was carried out in 2017 and showed people were very happy with the care delivery at the home. People told us they could raise concerns or complaints if they needed to because the registered manager and staff were always available and approachable and people were confident they would be listened to.

This inspection took place on 5, 12 & 13 January 2017, the first and second days of our inspection were unannounced. Two adult social care inspectors carried out this inspection. Hill House was previously inspected in November 2013, when it was found to be compliant with the regulations at that time.

Although Hill House did not have a registered manager at time of our inspection, a new manager had been appointed, and was being supported by the nominated individual. The previous manager had left in October 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People's medicines were not always managed safely. Medicine Administration Records (MARs) were not always completed accurately. This meant staff were unable to tell if people had received their medicines as prescribed. Where people were prescribed medicines to be given “when required” there was no guidance provided for staff as to when this should be used. Where people were prescribed topical medicines or creams, detailed guidance had not been provided and staff were not recording consistently within people’s records these had been applied. People received their prescribed medicines when they needed them and in a safe way. People were given time and encouragement to take their medicines at their own pace and staff always sought people’s consent. Staff had received training in the safe administration of medicines and records confirmed this.

People were not fully protected from the risks posed to them by environmental factors. Whilst some premises checks had been completed in a timely manner there were no recordings of water temperatures being carried out. Although the manager assured us taps were thermostatically controlled, these checks are important as they allow staff to monitor the temperature of the water to protect people from scalding when having a bath or shower. Whilst we did not find any taps where very hot water was being delivered, staff were not carrying out checks to ensure this was always the case.

There was insufficient oversight by the management team and nursing staff to ensure people's needs were being monitored on a day-to-day basis, as some records were either not maintained or were incomplete. Although people’s care plans had been regularly reviewed, we found nursing staff did not consistently review people’s daily notes as part of this process. This meant nursing staff were not reviewing all the information available to them and as such could not be sure that people were being adequately supported or receiving care appropriate to their needs.

We looked at the home’s quality assurance and governance systems and found the provider did not have effective systems to assess and monitor the quality and safety of the services provided at the home. Although some systems were working well others had not identified the concerns we found during this inspection.

We raised our concerns with the manager; who told us they were in the process of undertaking a complete review of the home. The manager had already identified many of the concerns we identified as part of this inspection and they were in the process of developing an action plan with time scales to address these concerns.

People said they felt safe and well cared for at Hill House, their comments included "I do feel safe” and "I love it here.” Relatives told us they did not have any concerns about people's safety. One relative said, "People are safe and well looked after here”. A visiting healthcare professional said people always appeared to be happy and well cared for.

People were protected from abuse and harm. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of how to keep people safe. There was a comprehensive staff-training programme in place. This included safeguarding, first aid, pressure area care, infection control, moving and handling, and food hygiene. Some staff had received additional training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were encouraged to make choices and were involved in the care and support they received. Staff had an awareness of the MCA and DoLS and how to support people within their best interests.

People told us staff treated them with respect and maintained their dignity. Throughout the inspection, there was a relaxed and friendly atmosphere within the home. Staff spoke about people with kindness and compassion. People and relatives told us they were involved in identifying their needs and developing the care provided. People's care plans were informative, detailed, and designed to help ensure people received personalised care.

People spoke positively about activities at the home and told us they had the opportunity to join in if they wanted. The home had a programme of organised activities that included arts and crafts, music sessions, exercise classes, card games, and quizzes.

People, relatives, and staff spoke highly of the management team and told us the home was well managed. Staffs described a culture of openness and transparency where people, relatives and staff, were able to provide feedback, raise concerns, and were confident they would be taken seriously.

The home had notified the Care Quality Commission of all significant events that had occurred in line with their legal responsibilities.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us they were treated with respect and dignity by care workers and we also observed this to be the case. We found that care workers supported people to make choices in their everyday lives. People were encouraged to maintain independence and pursue their interests.One person said, "They are fabulous here, top notch'. Another person said, "They are so kind they help me with everything"

People's care needs were assessed and risk assessments and care plans we looked at showed how people were supported with their care and treatment. Staff we spoke with knew about people's care needs and how to meet them. We observed that staff interacted well with people, and were caring and compassionate. Staff responded to people's care needs and worked at a pace that suited them. There were enough staff on duty to meet people's needs.

The home was clean and comfortable.

The home was well managed with a robust system of monitoring of the quality of care.