Hilton House

Hilton House is a residential care home providing personal care to 36 people at the time of inspection. The service can support up to 55 people. Hilton House accommodates people over two floors, each floor has been environmentally adapted to meet the needs of people.

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

Risks were not always managed safely, sensor alarms which alert staff when a person requires assistance were not always set correctly. The deployment of staff was insufficient to meet people's needs and care plans did not contain enough detail to monitor risks safely.

There were systems to monitor safety of the service people received, however many of these were newly implemented; therefore, the success of these new systems could not be measured.

Infection prevention control was adequate, visitors received COVID-19 checks before being permitted into the service and the home was clean. There was room for improvement regarding following current government guidance in relation to monitoring and recording people’s temperature twice daily.

There were processes in place to protect people from the risk of the spread of infection and measures were in place to mitigate the risks associated with COVID-19.

The service worked in partnership with other health and social care professionals to achieve good outcomes for people.

Medicines were managed, stored and administered in a safe way. Robust quality audits ensured medicines were routinely stock checked.

Safeguarding and whistle-blowing policies were available to staff and they told us where they were located. Staff received training, they knew how to safeguard people and felt confident to report their concerns.

The provider's procedures for staff recruitment helped protect people from the risk of abuse. Staff were recruited safely, and the registered manager ensured all relevant staffing checks were conducted prior to employment.

Relatives felt people were safe living at the home and with the staff who supported them. Regular health and safety checks were carried out on the environment and contingency plans were in place to keep people safe.

The registered manager was new in the post. All staff and people felt the registered manager was approachable and had confidence in their abilities.

Quality audits were in place to monitor risk, many of these were newly implemented. These will be reviewed at the next inspection. There was a culture of improving care, the registered manager had clear plans in place to drive improvements within the home.

Relatives and staff members felt involved in the care provided within the home and there was a culture of transparency and learning from mistakes.

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.

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 requires improvement (published 19 August 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to infection control, staffing and people's care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed, the service remains requires improvement. This is based on the findings at this inspection.

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 assure the service can respond to COVID-19 and other infection outbreaks effectively.

The provider needs to make improvements to ensure safe care is provided at all times. The registered manager has begun to take actions to remedy the shortfalls we identified and put measures in place to further mitigate risk. Please see the Safe and Well-Led relevant key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hilton House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hilton House is a residential care home providing personal care to 44 people at the time of the inspection. The service can support up to 55 people. Hilton House accommodates people over two floors, each which have their own adapted facilities.

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

Medicines were not always managed in a safe way. Risks were managed safely, however, at the time of the inspection some care planning documentation did not contain the most up-to-date information about people’s care needs to ensure staff were able to support people safely.

The management were in the process of updating and improving the quality assurances processes to ensure shortfalls were identified in a timely way and to ensure actions were addressed and lessons learned when things went wrong.

Staff were well trained and knew how to care for people to ensure they were protected from the risk of harm and abuse. There were enough safely-recruited staff to safely meet people’s needs.

There were processes in place to protect people from the risk of the spread of infection and additional measures had been put in place to mitigate the risks associated with COVID-19.

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.

People and their relatives were consulted about the day to day running of the service and staff felt valued and appreciated. Staff were optimistic about the changes implemented across the service.

The regional support manager was in the process of completing their application to become the registered manager of the service.

Rating at last inspection

The last rating for this service was good (published 21 February 2019).

Why we inspected

We received concerns in relation to the management of medicines and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. The regional support manager had begun to take actions to remedy the shortfalls we identified and put measures in place to further mitigate risk.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hilton House on our website at www.cqc.org.uk.

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.

People’s experience of using this service:

People felt safe and risks to their safety were managed. People received safe and effective care from staff who were well trained and supported to meet their needs.

People were supported by staff that were kind and compassionate who understood their preferences. People’ could make choices and were encouraged to be independent and their privacy and dignity was respected.

People were encouraged to take part in activities and were involved in the planning and review of their care.

People were involved in their care and gave their views about the service. Complaints were listened and responded to.

Systems to monitor the quality of care were effective, and picked up on any areas for improvement.

The registered manager encouraged a positive culture and learning was promoted within the service.

The service met the characteristics of Good in all areas;

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 4 January 2018).

Why we inspected: This was a scheduled inspection based on previous rating.

The service was registered to provide accommodation and personal care for up to 55 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 52 people were using the service.

The service had a 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.

At the last inspection in April 2016, the service was rated as ‘good’. At this inspection we found some breach of regulations. You can see what action we told the provider to take at the back of the full version of the report .

The risks to people were not always suitably assessed and managed. Staff knew people well but their risk assessments and care plans did not always contain enough up to date information to ensure they received consistently safe care.

Staff knew how to protect people from harm and abuse but the systems in place to ensure that allegations of abuse and harm were investigated were not always operated effectively. Suitable plans to reduce the risk of repeat incidents were not always put into place.

The principles of the Mental Capacity Act 2005 were not consistently followed to ensure that people’s rights were upheld.

Systems in place to monitor the quality and safety of the service were not always effective to ensure that issues were identified and acted upon to improve the quality and safety of the service.

There were enough staff to meet the needs of people who used the service and this was regularly reviewed by the registered manager and provider.

Medicines were safely managed, stored and administered to ensure that people got their medicines as prescribed. Staff were suitably trained and supported to meet people’s need.

People with provided with enough food and drink to maintain a healthy diet. People had choices about their food and drinks and enjoyed the food and drinks on offer.

People’s health was monitored and access to healthcare professionals was arranged when required.

People were treated with kindness and compassion and they were happy with the care they received. People were encouraged to make choices about their care and their privacy and dignity was respected.

People had support to meet their individual needs and preferences and were offered opportunities to participate in activities that interested them. People were supported to have care plans that reflected their preferences and staff knew people well.

People knew how to complain if they needed to. A complaints procedure was in place and complaints were dealt with in line with the procedure.

People, relatives and staff felt that the registered manager and providers were visible in the home and felt they were approachable. They promoted an open and inclusive culture where people and staff felt involved in the service.

The service was registered to provide accommodation and personal care for up to 55 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 53 people were using the service.

The service had a 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.

At the last inspection on 27 January 2015, we asked the provider to take action to make improvements because they were not ensuring there were sufficient numbers of suitably qualified and experienced staff to meet people’s needs and were not providing care and treatment which met their needs. This action had been completed and improvements had been made.

There were enough staff to people’s needs. We saw that people's needs were responded to promptly and the registered manager regularly reviewed staffing levels to ensure they were suitable. Staff had undergone pre-employment checks to ensure they were suitable to work with the people who used the service.

People’s risks were assessed and managed to help keep them safe and we saw that care was delivered in line with agreed plans.

People felt safe and staff knew how to protect people from avoidable harm and abuse. Medicines were safely managed, stored and administered to ensure that people got their medicines as prescribed.

Staff were suitably trained to meet people’s needs and were supported and supervised in order to effectively deliver care to people. Staff understood how to support people to make decisions and when they were unable to do this, support was provided in line with current legislation and guidance.

People with provided with enough food and drink to maintain a healthy diet. People had choices about their food and drinks and were provided with support when required to ensure their nutritional needs were met. People’s health was monitored and access to healthcare professionals was arranged promptly when required.

People were treated with kindness and compassion and they were happy with the care they received. People were encouraged to make choices about their care and their privacy and dignity was respected.

People received person centred support from staff who knew them well. They were offered opportunities to participate in activities that interested them and could spend their time how they chose. Care plans contained information on life history and preferences so that staff had the information they needed to be able to provide support to meet people’s needs and requirements.

People knew how to complain and staff knew how to respond to complaints. A complaints procedure was in place and we saw that this was followed when complaints were received. People and their relatives were encouraged to give feedback on the care provided. The registered manager and provider responded to feedback and changes were made to improve the quality of the service provided.

The registered manager understood the conditions of registration with us. We saw that systems were in place to monitor quality and that the registered manager analysed information and took actions to make improvements when required. There was a positive atmosphere at the service and people felt the registered manager and providers were approachable and responsive.

On the day of the inspection, people who used the service told us they were happy with the care they received. We observed positive interaction between staff and people, but we saw that people's care was not always delivered in a timely manner and in a way that kept them safe.

One person said, 'I'm not here for long. I came from hospital because I wasn't ready to go home. I've been fine and the staff have been lovely'. Relatives of people who used the service mostly told us that they were happy with the care provided. One relative said, 'It's just fantastic as in everything they do'. Another relative told us, 'They've been very good'.

We found that people had plans in place with guidance about their needs and how they should be met, but care records did not contain up to date information, and people's health needs had not always been monitored to ensure their plans of care were effective.

We found that people were at risk because the provider did not have effective systems in place for obtaining, recording, safe keeping, and disposal of medicines.

We saw the provider had appropriate numbers of staff with the right knowledge to deliver care to people.

We saw that people were at risk of unsafe or inappropriate care and treatment because the provider did not have always have appropriate records in place. We noted that some care records relating to people could not always be located promptly when required.