Hillside

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People’s risk assessments did not always include enough guidance for staff to mitigate risks to them. Staff had not always been recruited safely; the provider had not ensured full employment history was obtained. The registered manager had not always ensured there were medicines administration records and guidance for staff. The service had enough staff and they knew how to recognise and report abuse. The service used effective infection, prevention and control measures to keep people safe from infection.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s relatives felt staff were well trained and understood people’s needs well. When incidents occurred, they felt staff learned from them and improved the support they provided to people. A relative said, “They were good at keeping me informed when there was a bit of an issue with [another person]. They managed it well and kept [them] safe.”

Staff understood the incident reporting process. A staff member told us, “There has been a lot of incidents, we have a [messaging system] group chat for recent messages. That is the first line, then you have a handover meeting. The other thing is the book in the office if there is any important thing to be noted.”

The service had an incident tracker to monitor incidents. This included a lesson learned section. However, we found this was often generic rather than stating the specific learning identified and how it was shared. This meant we were not assured staff were always informed of action taken to help prevent incidents happening again.

People’s relatives said staff worked well with other services to ensure they moved safely between services. A relative told us, “I think they are pretty good with communicating with the day centre.”

People received an assessment before moving into the service. This included determining their compatibility with others living at the service. The registered manager told us, “They look at the support plan, go and meet them and see whether they would fit in with the group. Some have not been chosen as would not fit in.”

Other professionals involved with the service provided mixed feedback. A professional told us, “I did attend several professionals/MDT [virtual] meetings for one of the residents and observed [registered manager] to be prepared with relevant information pertaining to the particular resident.” Another professional gave examples of concerns about service users not identified/shared by the home. However, they added, “In recent months…we have had considerably more contact with the staff team there and in my opinion are working more closely and effectively together for the benefit of the all the individuals living there.”

The provider completed an assessment before people were admitted to the service. For a person who had lived at the service for a few months, we did not see evidence their care had been reviewed and found some information was missing. Following the assessment, the provider shared documentation which showed elements of their care had been reviewed. However, we did not see evidence of how the findings of these reviews had been updated in the support plans and risk assessments. The provider had not always made referrals to other professionals; in 1 person’s record we found they had been reviewed by an occupational therapist who indicated a physiotherapist should also be consulted. We requested evidence from the registered manager of input from physiotherapy, but this was not provided.

People were happy living at the service and their relatives were confident they were safe. A person told us, “I am happy here. I like my keyworker - they do shopping with me and holidays. Yes, I like holidays, the seaside. Really like painting things. I do like it here.” A person’s relative said, “Yes, we do feel they are safe, we've always thought that. It’s a home away from home. [Person] seems happy there. Calls it home and is always happy to go back there when they have been here.”

The registered manager described the process for reporting safeguarding concerns and identifying themes. Staff confirmed they had training and would report any concerns to their manager. They gave examples of concerns they would raise. A staff member said, “If I noticed scars on my client’s body I would have to raise a safeguarding. Or if you notice the resident is a bit scared of particular staff, that may be a sign.”

People appeared at ease with each other, and in the company of staff. We observed warm conversations and a comfortable atmosphere. Staff were relating to people equably and consulting them about what they wanted to do.

The provider had a tracker to monitor safeguarding. We found this had not been completed fully; the update section lacked detail and the lesson learned section was often blank. There were examples of safeguarding concerns which had not been reported to CQC as required. The registered manager had not ensured mental capacity assessments were always completed. A person had been assessed as lacking capacity about the decision to live at the service, there was no evidence of a best interest meeting held related to this.

Most people’s relatives felt involved in discussions about risk. A relative said, “They will always share anything they need to with me.” However, we were also told, “They don't always involve us no. Sometimes feel they could communicate with us a bit more. Don't need them to call every week but sometimes a bit more would be nice.”

Staff were able to describe risks to people and how these were managed. This included how to de-escalate situations where people became distressed or expressed themselves in physical ways. However, they confirmed there was no guidance for how to manage 1 person’s medical condition and mobility support for another person was unclear.

We observed staff supporting people to manage risk when making day to day decisions. People were involved in discussions about what they wanted to do and supported to carry out tasks, such as making each other tea, demonstrating they were supported to take positive risks.

The registered manager had a tracker for monitoring Deprivation of Liberty Safeguard (DOLS) applications with status updates. People’s records did not always include all relevant risk assessments, and some lacked sufficient guidance for staff. For example, a person’s moving and handling support plan was very confusing, and the guidance appeared unsafe. Some information staff would need to know was documented in different sections in the records; we found there was a risk this would be missed. People were not always involved in their risk assessments. With one exception, records only noted the staff involved, not the people.

People’s relatives did not share any concerns about the premises and felt the environment suited peoples’ needs.

Staff confirmed the environment was well maintained and they had enough equipment to support people safely.

People’s care was provided in an environment which was mostly in good decorative condition with some improvements planned.

The registered manager completed audits of the property and health and safety. Actions identified were recorded on the service improvement plan.

People’s relatives said there were enough skilled and experienced staff to meet people’s needs safely. A relative told us, “There always seem to be lots around when I visit.”

The registered manager ensured there were enough staff to meet people’s needs. During our assessment, additional staff were working to meet the needs of people at the time. The rota was managed flexibly to accommodate extra shifts when needed. Staff told us there were enough staff to support people and felt they had received sufficient training. A staff member told us, “Most of the time we have enough staff for everything to run smoothly and efficiently.” Another member of staff said, “l am very happy with training and these trainings are very informative and give me more confidence in delivering care to people l support. We have enough staff to support people.”

People were supported by enough staff to meet people’s needs safely during our visit.

Staff recruitment processes included Disclosure and Barring Service (DBS) checks which provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. However, staff files we reviewed did not include full employment history. Following our assessment, we saw the provider had amended their interview questions to include explanation of any gaps in employment history. The registered manager had a staff training matrix which showed most staff were compliant with their mandatory training. Staff also received annual competency assessments. We found these lacked detail of how competency had been determined; there was no learning identified or feedback for staff in those we reviewed. Following the assessment, criteria for how to assess competency was added to the template and we reviewed an example where additional information had been included for how staff had demonstrated their competency.

People’s relatives did not share any concerns about the cleanliness of the home or infection prevention and control (IPC). A relative said, “Whenever we've been there it is clean and tidy.”

Staff did not raise any concerns related to IPC. They confirmed the personal protective equipment (PPE) they used.

We found the service clean and fresh. However, we found some IPC issues during our visit which had not been identified by the registered manager. For example, the paintwork on some furniture in communal spaces was damaged.

The registered manager had a maintenance list and a service improvement plan where issues relating to IPC concerns were recorded. However, we found these had not been actioned in a timely way. Some remained an issue at the time of our visit, and we found further issues which were not on the list. The most recent IPC audit had not carried forward issues which remained outstanding from the previous one meaning it was not an accurate reflection of the situation at the time of the audit.

People’s relatives did not report any concerns about how staff supported people to take their medicines. A relative told us, “They understand [person’s] medicines really well because they have to administer them.”

The registered manager acknowledged that they had not picked up the issues in relation to medicines management identified at the site visit.

The registered manager had not ensured there were always protocols to guide staff for when to administer PRN medicines. PRN medicines are those administered as and when required. A further concern was there was no Medicine Administration Record (MAR) for a medicine which had been changed from daily to PRN. This meant staff had no guidance for when to administer it and nowhere to record it if they did so. Following the inspection, the provider told us this had been amended.