Background to this inspection
Updated
25 April 2019
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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was prompted in part by notification of two unexpected deaths. The information shared with CQC about the incident indicated potential concerns about the management of risk of insufficient monitoring of people. This inspection examined this risk. We found the provider had put in place arrangements for people to receive appropriate monitoring and support specifically during the night.
Inspection team:
The inspection was carried out by a single inspector and an Expert by Experience. An Expert by Experience is a person who has had experience of the relevant care setting, in this instance experience of service for people living with a learning disability.
Service and service type:
The service had a manager registered with the Care Quality Commission. 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. However, the registered manager was responsible for three other locations and a home manager was overseeing the service.
Notice of inspection:
This was a comprehensive inspection and was unannounced. We inspected the service on 20 February 2019.
What we did:
Prior to the inspection we examined information we held about the service. This included notifications of incidents that the registered persons had sent us since our last inspection. These are events that happened in the service that the registered persons are required to tell us about.
The provider had completed a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report
During the inspection we spoke with seven people who lived at the service, one relative, two members of care staff, the registered manager and the home manager. We also looked at three care records in detail and records that related to how the service was managed including staffing, training, medicines and quality assurance.
Updated
25 April 2019
About the service: Hill House 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. It provides accommodation for people living with a learning disability. The home can accommodate up to 35 people. At the time of our inspection there were 14 people living in the home. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the location.
The service had been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disability were supported to live as ordinary a life as any citizen.
People’s experience of using this service:
There was a system in place to carry out quality checks. The home manager had started to carry these out on a regular basis, however these checks had not been in place long enough to understand the impact these would have on the service.
Medicines were not consistently managed safely. Arrangements were in place to monitor and manage medicines but these had not identified the issues we found at inspection.
People said they felt safe. There was sufficient staff to support people.
People enjoyed the meals and their dietary needs had been catered for. This information was detailed in people’s care plans.
Staff followed guidance provided to manage people's nutrition and pressure care.
The care plans were in the process of being reviewed. Care plans contained information about people and their care needs.
Staff had received training to support their role.
Staff had started to receive supervision and plans were in place to ensure people received this on a regular basis.
People had good health care support from professionals. When people were unwell, staff had raised the concern and taken action with health professionals to address their health care needs. The provider and staff worked in partnership with health and care professionals.
Staff were aware of people's life history and preferences and they used this information to develop positive relationships and deliver person centred care. People felt well cared for by staff who treated them with respect and dignity.
There was a range of activities on offer. The home manager was looking at how they could develop this area further.
The environment was adapted to support people living with learning disability. A refurbishment plan was in place to address this. The home was clean and arrangements were in place to manage infections.
The provided had displayed the latest rating at the home and on the website. When required notifications had been completed to inform us of events and incidents.
More information is in the detailed findings below.
Rating at last inspection: Requires Improvement (Report Published 11 April 2018). At our previous comprehensive inspection in February 2017 the service was rated overall good. However, a focussed inspection was carried out on 11 April 2018 following concerns raised. We looked at three domains safe, caring and well led. We found a breach of Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010.The service was rated overall Requires Improvement at this inspection.
At this inspection we found the regulation was being met. There were improvements in the quality monitoring systems. However, these improvements had not fully taken effect because they had only recently been introduced. We have taken this into account in determining the rating.
Why we inspected: This inspection was carried out following concerns about two notifications.
Follow up: We will ask the provider for an action plan to indicate when they will have consistently addressed all the issues. Please see the ‘action we have asked the provider to take’ section at the end of this report.