This inspection took place on 27 and 28 September 2017 and was unannounced.The service was previously inspected in May 2015. The registered provider was complying with all regulations at that time..
Hill House is a care home providing both accommodation and nursing and personal care for up to 23 adults who have a physical disability. The service is provided by Leonard Cheshire Disability. The home is a modern purpose built facility and includes a bungalow separate to the main building. All bedrooms are single and have en-suite bathrooms fitted with overhead hoists. A passenger lift is installed to access the two floors. On the day of our inspection the service was providing accommodation and nursing care to 20 people.
There was a registered manager in post although they were not present during the 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.’
We identified four breaches of relevant legislation in respect of safeguarding service users from abuse, safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.
Overall the people and relatives we spoke with were positive about the care and support received at Hill House.
People told us that they felt safe from abuse and harassment and trusted the staff. However, we found that not all staff could demonstrate a clear understanding of the procedures they should follow if they witnessed or suspected that abuse had taken place. We were told about concerns by a member of staff and that they had not passed them on. As a result they had not been investigated or reported to the local authority and the Care Quality Commission (CQC) as required. This meant that people were not fully protected. We brought this to the attention of the deputy manager at the time of the inspection and it was then dealt with appropriately.
We saw that risk assessments had been recorded in people’s care records and that weight loss and pressure ulcer risks were regularly monitored. Accidents/incidents were not always recorded and we found that recording was not sufficiently robust.
Medicines were administered safely although we found that in some areas management systems needed to be improved. We saw that regular audits were taking place. There were two recent instances of missing medicines and we found that the process used for checking stocks needed to be reviewed.
At the time of the inspection we found that there were sufficient staff. Some people and staff told us that there were sufficient staff to meet their needs whilst others felt that this was not the case at night and weekend. We saw that staff received an induction and training was provided. Staff told us that they received the training and support they needed to carry out their roles effectively. Staff were also supported through supervisions although we saw that some were behind schedule. We found that safe recruitment systems were in place.
The environment was clean, spacious, fit for purpose and well decorated. Recent improvements had been made with the construction of an orangery extension and a sensory garden. Further works were planned to create an activity and physiotherapy centre within the grounds.
We were provided with two different versions of an emergency plan. We found that these lacked sufficient detail and guidance for staff in the event of a full evacuation. Following the inspection we received additional details which provided this information. A personal evacuation plan detailing each person’s individual needs was also in place.
We checked whether the service was working within the principles of the MCA, and whether any conditions to deprive a person of their liberty were being met. It was evident that the deputy manager had a clear understanding of the MCA and its application.
We saw that people’s nutritional needs were being met. People had choice and the food was of a high quality. People were supported to have sufficient to eat and drink and maintain a balanced diet. Staff were knowledgeable about people’s nutritional needs.
People received care that was personalised, effective and responsive to their needs. Care plans were detailed and contained sufficient information to enable staff to meet people’s needs. People spoken with told us that they were given choices about the way in which their care was delivered.
People looked happy, well cared for and were supported to maintain their independence. Staff were observed interacting in a kind, caring and attentive manner. An advocacy service provided by Leonard Cheshire Disability was available.
The home had two activities co-ordinators and there was a varied programme of activities taking place. Fully adapted transportation was available for outings. The service was supported by a well organised volunteer programme.
There was a complaints procedure available and people told us they knew how to complain should they need to. Regular meetings were held with the people living at Hill House and they were involved in decisions about their home.
We found that the home had systems in place to assess and monitor the quality of service, however actions identified were not always followed up and the systems had not been sufficiently robust to identify some of the issues raised during this inspection.