Hillcroft

Hillcroft is a care home which provides personal and nursing care in one adapted building for up to 10 people with a learning disability including autism. At the time of our inspection, there were nine people living at Hillcroft.

The service is a large home, bigger than most domestic style properties. It is registered for the support of up to 10 people. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people. This was because the building design fitted into the local residential area. Staff were also not wearing anything that suggested they were care staff when coming and going out with people.

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

People were cared for by staff who were attentive and knew them well and staff who demonstrated an empathetic approach towards people. People received the medicines they required and had access to health care professional input when needed. Staff helped to ensure people lived a healthy lifestyle by offering suitable foods and encouraging people to take exercise.

People were cared for by a sufficient number of staff which enabled them to access the activities of their choice when they wished to. Staff showed people respect and dignity and allowed them privacy when they wished it.

People were encouraged to make their own choices in relation to their care, this was both in how they liked to spend their day and what they wished to eat.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to gain new skills and become more independent.

People were cared for by staff who felt supported and who had received appropriate training.

People, their relatives, visitors and staff were given the opportunity to contribute their ideas and feedback into how the service was run. Staff continually looked at ways to improve the service provided and worked in conjunction with external agencies for the benefit of people.

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 we gave the service a rating of requires improvement (published 8 June 2018). We issued recommendations to the registered provider in relation to staffing levels, medicines, records and supporting the registered manager.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found the necessary improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence 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.

There was no registered manager in place at the time of our inspection. 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. The manager was currently going through the application process to register with CQC. The manager assisted us with our inspection.

Medicines management processes were not sufficiently robust to ensure people’s medicines were always handled in a safe way. Staffing levels were such that people did not always receive attention promptly or were supported to access the community when they wished.

Some records in relation to people were not completed. This was partially due to staff’s understanding of why they were filling in the documentation. Although technology had been introduced to the service, the registered provider had not supported the manager to ensure this could be used with people.

Hillcroft was a clean place for people to live and staff knew of their responsibilities in relation to infection control. People were cared for by staff who understood the risks for people and as such took steps to avoid people getting harmed. Where accidents and incidents had occurred lessons had been learnt from them. People were helped to keep safe from abuse as staff had a good understanding of the signs to look for and how to report any concerns.

People lived in an environment that was adapted for their needs and checked for its safety. They were cared for by staff who were trained in their role and understood national and local guidance such as the principals of the Mental Capacity Act.

People were involved in choosing the foods they ate and were supported by staff to live a healthy life as they had access to healthcare professionals as they required them. Pre-admission assessments had been carried out on people to ensure that their care and wellbeing needs were met through a combination of staff and external agencies.

People were care for by kind, caring staff. Staff encouraged independence in people and supported them to do things for themselves. It was evident people could make their own decisions and by providing people were different tools they were able to express themselves to staff. People could return to their rooms as they wished to have some privacy and relationships they had that were important to them were encouraged by staff.

People’s care plans contained sufficient information in them to enable staff to provide responsive care. There was individualised information which was going to include any particular wishes people had around their end of life care.

Although no formal complaints had been received since our last inspection, there was a policy in place for people. We noted several compliments had been received by the service.

Staff told us they felt supported by the manager and they, people, relatives and stakeholders all had the opportunity to feed in suggestions and comments to how the service was run.

During our inspection we made four recommendations to the registered provider. These were in relation to staffing levels, medicines management processes, record keeping and staff knowledge of records and progressing with new technology to assist people in their daily lives.

There was 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 and associated Regulations about how the service is run. The registered manager assisted us during our inspection.

Staff had identified and assessed individual risks for people. Accidents and incidents that occurred were recorded, although we found records in relation to these were not always comprehensive or completed in line with the Trust policy.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Staff said they felt supported and told us they met with their line manager on a one to one basis to discuss training or any aspect of their work. Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had access to a whistleblowing policy should they need to use it. Appropriate checks were carried out to help ensure only suitable staff worked in the home.

People lived in a homely environment and staff treated people with care and respect. We observed good relationships were established between staff and people. People had the opportunity to participate in activities both in and outside of the home. People’s care plans were written in line with people’s own wishes.

People were supported to be independent and encouraged by staff to make their own decisions, from the food they wished to eat to what they wanted to wear or how they spent their time. Staff supported people to keep healthy by providing nutritious foods and everyone was involved in the menu planning. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

There were a sufficient number of staff on duty to enable people to either stay indoors or go out to their individual activities. Staff knew people well, understood people’s individuality and needs and respected people when they wished to have time alone.

Staff received a good range of training which included training specific to the needs of people living at Hillcroft. This allowed them to carry out their role in an effective and competent way. Staff met together regularly as a team to discuss all aspects of the home.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Actions identified from these were acted upon.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place. We read people would be evacuated to another of the Trust’s homes should the need arise.

A complaints procedure was available for any concerns. People and their relatives were encouraged to feedback their views and ideas into the running of the home.

During the inspection we made one recommendation to the provider.

As part of this inspection we spoke with four people who use the service, the registered manager, one care staff and four relatives of people who used the service.

We also reviewed records relating to the management of the home which included, three care plans, daily care records, meals and maintenance records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People told us the staff were nice and they felt safe at the home.

At the last inspection we found the home was too hot. At this inspection people told us the home and their rooms were not to hot anymore. They also told us their rooms were not too cold. Staff told us the building was no longer too hot and the heating had been repaired.

People's relatives told they felt people were safe at the home. One person's relative told us they visit often and have never seen anything to give them concern about how their family member was treated.

We saw that the Trust had an emergency procedures file, which covered such things as fire evacuation, electricity power cuts, gas failure, heating failure, and adverse weather conditions.

We saw that doors and areas that were required to be kept locked to protect people were secure, for example electrical cupboards and the Control of Substances Hazardous to Health (COSHH) Cupboard were locked and medication was secured.

We saw risk assessments in peoples care plans which included eating, mobility, activities and bathing. The risk assessments identified what action should be taken by staff so that risks to people's safety could be minimised. For example, where a risk of choking had been identified the home referred the person to a speech and language therapist to assess how food should be prepared and presented, so the risks of choking could be minimised.

The provider continued to notify CQC of any relevant issues relating to the safety and welfare of people who used the service and took the appropriate action if necessary. This safeguarded to people who used the service and ensured multi agency involvement and communication.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. To ensure people's rights, applications had been submitted to people's local authority's regarding some people not being allowed out alone without support from staff. Relevant staff had been trained to understand when an application should be made, and how to submit one and the proper policies and procedures were in place, to ensure applications were submitted for consideration where needed.

Is the service effective?

People's health care needs were assessed with them and written in a care plan.

We noted that the people who used the service were registered with a local General Practitioner. Records of GP visits, dental care, and visits from the chiropodist, optician and other healthcare professionals were recorded in care plane. This also meant that people's health care needs were being monitored and maintained.

People's relatives told us the food was good and their family members were 'well fed'. One person's relative said 'It was good that they had normal lives and were offered a full English breakfast at weekends'. Another relative said that although the food was good there could be more fruit available.

People who used the service spoke positively about community activities they were involved in, like, shopping and voluntary work. They also told us about activities they enjoyed at the day centre.

People said they liked the food, there was plenty of food on offer and could have snacks and drinks at any time. One person told us they could choose what they wanted to eat.

Is the service caring?

People who used the service told us the staff were nice.

People's relatives also told us the staff were caring and their family member was well cared for. They told us that the home kept them informed about their family member's well-being and their care. One relative told us staff would do thoughtful things like visit their family member when they were in hospital. Another relative told us 'People are treated with respect, you see the love and care, I don't have to come away from visits and worry.'

We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner.

We saw people were supported with meals where needed and staff did not rush people. We saw that staff gave people as much time as they needed and wanted to eat their meal.

Is the service responsive?

One person's relative told us they did have to raise some concerns in the past but they were listened to and the concerns addressed.

We observed staff were appropriately responsive to peoples' needs. For example during a meal one person who used the service was talking to a member of staff at the same time as there were other people in the room who were not able to vocalise as well. We noted that the member of staff acknowledged the person that was talking with them and turn and offer support to another person who had indicated they needed assistance. This also showed us that staff were appropriately vigilant while supporting more than one person.

People's relatives told us that they were invited to regular meetings at the home and they were quite involved in the running and development of the home.

Is the service well led?

People's relatives told us they thought the home was well run by the manager.

There was a good auditing system in place for the monitoring of service provision and to recognise improvement when required. There were regular health and safety audits undertaken to ensure the health and welfare of people who used the service and to promote a safe working environment.

We noted that the manager had developed their own written local contingency plans. This meant that the homes contingency procedures were more relevant to the individual home.

Two people said they were too hot in the home and one person put our hand to their head to show us it was wet with sweat. Another person told us the heating was still on but it can't be turned down.

We saw that people who used the service could be confident that their human rights were taken into account because the provider had systems in place to gain and review consent from people who use services, and act on them.

People were offered food that they like and had plenty of carbohydrates but there was a lack of variety and nutrition, especially vegetables.

We saw there was an appropriate recruitment and selection system in place and appropriate checks were undertaken before staff began work.

Records could be located promptly, were kept confidentially, securely and for an appropriate time.

We found that the home was putting people at risk by wedging fire doors open, leaving electrical or other hazardous cupboards required to be locked open, and also found the heating system in the home to be inadequate because it did not function properly. This had a potential impact on people's health and welfare.

People spoke about community activities they were involved in, like meeting friends, shopping and voluntary work.

People also told us the staff were nice, they felt safe at the home and they liked the home and their rooms.

One person told us that they got on with the people there and didn't get on with one of the staff but the rest were alright.

A person who uses the service showed us their room and how they had individualised it, and showed us pictures of their family.

A relative of a person living at the home told us that the building was suitable, there were enough staff, their relative was looked after well, and they felt their relative was safe there and safe there then anywhere they had been. They had not needed to raise any formal complaints, but if they needed to raise anything, they felt listened to and action would be taken to address the situation.

We found the home to be well maintained hygienic and clean.